Snoring (cont.)
What are different levels of snoring?
Mild resistance to airflow for any of the above reasons in the upper airways
may result in some snoring that is not associated with any sleep disturbance.
If resistance to airflow increases, the efforts to maintain adequate
ventilation and breathing may cause transient arousal from sleep that is
typically not severe enough to cause the level of oxygen in the blood to
decrease (hypoxia). This is called the upper airway resistance syndrome (UARS).
When the resistance increases even further, the ventilatory efforts cannot
keep up with the degree of resistance to maintain adequate levels of oxygen.
This causes a decrease in the level of oxygen in the blood. As a result,
arousals are more frequent, and sleep becomes more fragmented. This is termed
obstructive sleep apnea-hypopnea syndrome.
How should someone with snoring be evaluated?
To thoroughly evaluate someone with a snoring problem, it is important to
also talk to that person's bed partner or family members. A complete history and
physical examination is often performed.
In addition, more detail about their snoring and sleep problems needs to be
obtained. The patients may be asked about their sleep pattern and sleep hygiene,
daytime symptoms of sleepiness, daytime napping, and frequency of awakening at
night.
A thorough physical examination may also be performed including assessing the
patient's body weight and body mass index (BMI), assessment of the neck
circumference (area around the neck), and visualization of the throat, nasal, and
oral cavities to determine how narrow the oral and nasal passages are.
How is it determined if snoring is a medical problem?
People who sleep (or lie awake not sleeping) near a snorer often report signs
that may indicate a more serious problem. Witnessed apnea (stopping breathing)
or gasping can suggest a breathing problem like sleep apnea (see below) or heart
problems. Leg kicking or other jerking movements can indicate a problem such as
periodic limb movement disorder or restless leg syndrome. Referral to a sleep specialist
may be recommended if obstructive sleep apnea, restless leg syndrome, and
periodic limb movement disorder are suspected.
If someone's sleep is disrupted because of snoring, the person may also
notice other symptoms. Frequently, people complain of difficulty waking up in
the morning or a feeling of insufficient sleep. They may take daytime naps or
fall asleep during meetings. If sleep disruption is severe, people have fallen
asleep while driving or performing their daily work.
Daytime sleepiness can be estimated with a sleepiness inventory, and a sleep
study can be performed if a sleeping problem is suspected. There are two general
types of sleep studies:
- Home (unattended sleep study
- Full sleep study (polysomnography)
Home sleep study
A home (unattended) sleep study can measure some basic
parameters of sleep and breathing. Often, it will include pulse oximetry (a
measurement of the level of oxygen in the blood), a record of movement, snoring,
and apneic (stop in breathing) events. A home study can prove that there are no
sleeping problems or suggest that there may be a problem.
If a home sleep study suggests a problem, a full sleep study
(polysomnography) often is performed in a clinic. (For a complete description of
sleep studies, see below).
If the sleepiness inventory and sleep study suggest there are no sleeping or
breathing disorders, a person is diagnosed with primary snoring. Treatment
options then can be discussed.
Epworth Sleepiness Scale
The Epworth Sleepiness Scale is a "test" based on a patient's own report that
establishes the severity of sleepiness. A person rates the likelihood of falling
asleep during specific activities. Using the scale from 0-3 below, patients rank
their risk of dozing in the chart below. (This chart can be printed out and
taken to the doctor.)
| 0 = Unlikely to fall asleep |
| 1 = Slight risk of falling asleep |
| 2 = Moderate risk of falling asleep |
| 3 = High likelihood of falling asleep |
| Situation |
Risk of Dozing |
| Sitting and reading |
|
| Watching television |
|
| Sitting inactive in a public place |
|
| As a passenger in a car riding for an hour, no breaks |
|
| Lying down to rest in the afternoon |
|
| Sitting and talking with someone |
|
| Sitting quietly after lunch, without alcohol |
|
| In a car, while stopped for a few minutes in traffic |
|
After ranking each category, the total score is calculated. The range is
0-24, with the higher the score the more sleepiness.
Scoring:
- 0-9 = Average daytime sleepiness
- 10-15 = Excessive daytime sleepiness
- 16-24 = Moderate to severe daytime sleepiness
Breaking it down further, excessive daytime sleepiness is greater than 10.
Primary snorers usually have a score less than 10, and individuals with moderate
to severe sleep apnea usually have a score greater than 16. (One woman filled
out the sleepiness scale and had a low score. Sitting in the physician's office,
however, she was falling asleep while waiting. The physician asked her why her
score was so low. She replied, "I don't ever read books, watch TV, or ride in a
car, so the likelihood that I would fall asleep doing those things is very low."
)
Next: What are some objective tests to measure sleepiness? »
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