So, what causes this airway narrowing or closure in obstructive sleep apnea and snoring?
Abstract: The cause is simply partial or complete closure, or obstruction of the airway at one or more levels, it may be pressure from the outside (anatomy, fat, etc.) or the inside (anatomy, muscle wall, etc.)
It used to be considered that women were considered somewhat immune unless they were post-menopausal and had lost their hormonal protection – that’s not what’s always seen however.
It used to be considered that just older and middle-aged men were affected – that’s not what we see.
Fit, young people never had it! – well they do.
Children grew out of it and it didn’t affect them in later life – absolutely wrong. If you didn’t snore you didn’t have it – wrong!
Once treated you were fine – wrong!
Heavy snoring
Heavy snoring. This is especially important when it has been going on for more than a few years or if it’s loud and disruptive. Having gasping or stopping breathing with snoring is even more significant. In many parts of the world heavy snoring is considered to be normal, or worse still, a joke.
Physicians have frequently not seen it’s relevance yet snoring alone is associated with an increase in stroke and heart attack incidence yet this is rarely mentioned.
Fluid dynamics
An area of interest which has been of scientific scrutiny since the 80’s is positional therapy for OSA. All day long intercellular fluid (which is drained back to the veins) tends to overload the system and accumulate in the lower extremities – hence the swollen ankles many get during the day.
“Putting your feet up” is a good solution as it helps reverse this – but you’re still sitting upright. When you go to bed, this fluid can redistribute to the upper body and neck. In so doing it increases the volume of the neck and increases the chances of, or severity of, OSA and/or snoring.
Having the foot of the bed slightly higher than the head can help just as can the use of an extra pillow – however ifs not that simple as the relationship between the neck and head is also important and changes can affected its apparent effectiveness.
Witnessed breath holding
Witnessed Breath holding or gasping at night . This is probably one of the most significant signs but unfortunately the partner’s often asleep apart when there is (in either or both parties) disruptive snoring.
Consequently, it is more difficult to tell – although apps are now available for those on their own.
It is always important to have a sleep test performed as while you may snore and not have OSA, you may need management of this too.
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Dr. Stephen Bray 2019