My grandmother always said when my grandfather started snoring each night, it sounded like someone "had cranked up a chainsaw". As a result of the noise, they started sleeping in separate rooms. Otherwise, she said "he keeps me up all night long and when he stops breathing he jerks up in the bed and it scares me". Her description is only one of dozens I've heard about snoring and its tendency to "keep everyone else in the house awake". For years, doctors thought snoring was a hereditary thing. If your father snored then you would snore. We now know that's not true and snoring and the associated "stop breathing event" (apnea) can be treated in about 75% of the population.

Regardless of the cause of sleep apnea, the disorder can make you feel like you didn't sleep and result in moderate to severe fatigue during the next day. Some persons are so "sleep deprived" from "almost waking themselves up" during loud snoring episodes, they will fall asleep during daylight hours without warning. On occasion, this sudden onset of sleepiness may occur while driving or operating machinery. I've heard comments such as "he falls asleep every time he sits down" and "I can't see why she wants to sleep all the time, since she sleeps all night long". Lack of adequate sleep can cause irritability, mood swings, depression, problems with your family and difficulties concentrating at work and school. Over a period of years, sleep apnea can even cause high blood pressure and heart problems. Let's take a look at the different flavors of sleep apnea and why it causes snoring.

There are three basic types of sleep apnea; obstructive, central and mixed.

Obstructive sleep apnea (OSA) occurs when anything blocks the flow of air in and out of your nose or mouth. OSA can occur as a result of severe allergies with overgrowth and thickening of linings of your nose, throat, sinuses, trachea and upper airways. In fact any condition that causes an increase in the size of throat, nose and neck structures can cause OSA. This tends to explain why overweight individuals can dramatically improve OSA by losing a lot of weight.

Central sleep apnea (CPA) occurs when there is a decrease in your brain's respiratory drive center ability to respond to lower blood oxygen levels and maintain normal rates and depths of breathing. Exactly what causes CPA is unclear, but apparently brain chemicals or structures have been altered in a way that keeps the respiratory drive center from "firing" at the rate and level needed for "normal respiration" while you're asleep.

Mixed sleep apnea (MSA) results from having some or all of the problems of both central sleep apnea and obstructive sleep apnea. This may actually be the most common type of sleep apnea and is the hardest to treat. In all three cases, when apnea occurs, blood oxygen levels drop, brain activity increases and normal sleep is interrupted.

The part of normal sleep that gives us the most restful feeling is the dream state or rapid eye movement stage (REM). REM sleep is often interrupted as sleep apnea onsets. Since dreaming is cut short or totally eliminated, you can see why being sleep deprived can make you so tired and irritable.

Now let's discuss some of the treatment options in sleep apnea.

As you read above, losing weight can result in shrinkage of nose, throat, sinus and neck tissues causing improvement in OSA. Once these tissues are smaller or thinner, air can move easier through your upper airways. Similar results can occur when ENT doctors repair a deviated nasal septum, remove excess mucous producing structures from the nose and throat such as tonsils, adenoids and other overgrown tissues, and treat chronic sinusitis or allergies.

ENT doctors can also use laser to remove the uvula (little hanging down thing) and part of the soft tissue in the back of your throat to improve airway. In extreme cases, a tracheotomy or permanent surgical opening in the lower front of the neck may be needed for adequate treatment.

The most common treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy. This involves using a machine that pumps air into an attached tube and facemask to provide constant pressure in your nose, mouth and air passages. The pressure setting is determined by procedure called a sleep study in which the number of times you stop breathing per minute is calculated while your oxygen and brain activities are monitored. For further information, please see our articles on "Diagnosing Sleep Apnea", "Sleep apnea and poor attention in kids", and "Using CPAP to treat sleep apnea" at drhuggiebear.com.

Medications have not been shown very effective in the treatment of sleep apnea. Adhesive strips designed to flare the nostrils out while applied to the outside of the nose may often a little improvement when only nasal obstruction is responsible for sleep apnea. Overall, if you feel you may have sleep apnea, it is best to see a physician and request testing to make an accurate diagnosis.