Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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."
)
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
The common cold (viral upper respiratory tract infection) is a contagious illness that may be caused by various viruses. Symptoms include a stuffy nose, headache, cough, sore throat, and maybe a fever. Antibiotics have no effect upon the common cold, and there is no evidence that zinc and vitamin C are effective treatments.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
It is thought that the tonsils and adenoids assist the body in fighting incoming bacteria and viruses by helping the body form antibodies. This is thought to be important only during the first year of life. Acute tonsillitis, strep throat, mononucleosis (mono), chronic tonsillitis, peritonsillar abscess, and hypertrophic tonsils and adenoids are all common problems involving the tonsils and adenoids. Treatment of tonsillitis and adenoids include antibiotics and other medications depending on the cause. In some cases, a tonsillectomy or adenoidectomy (the removal of the tonsils or adenoids) may be necessary.
Marfan syndrome is hereditary condition affecting connective tissue. A person with Marfan syndrome may exhibit the following symptoms and characteristics: dislocation of one or both lenses of the eye; a protruding or indented breastbone; scoliosis; flat feet; aortic dilatation; dural ectasia; stretch marks; hernia; and lung collapse. Though there is no cure for Marfan syndrome, there are treatments that can minimize and sometimes prevent some complications.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
A deviate septum is a condition in which the bone and cartilage that divide the nasal cavity of the nose in half (nasal septum) is significantly off center or crooked. The causes of a deviated septum can be congenital, or develop after a trauma or injury to the nose. Symptoms of a deviated septum include nasal congestion, recurrent sinus infections, nosebleeds, headache, facial pain, postnasal drip, snoring, and loud breathing. A deviated septum can be relieved with medications, and if necessary surgery, called a septoplasty.
Periodic limb movement disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. They tend to cluster in episodes that last anywhere from a few minutes to several hours. These movements are very different from the normal spasms, called hypnic myoclonia, that we often experience initially while trying to fall asleep.
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