Only specialized doctors can find out the causes of sleep disorders.
One of the most important examinations here is polygraphy as a screening examination and the sleep laboratory. Patients spend the nights here “wired up” to measure essential bodily functions.
When sleep becomes a nightmare:
Leaden tiredness, lack of concentration, extreme irritability. Many heavy snorers are unaware that their bodies are fighting for survival at night. The interplay between snoring and apnoea can lead to secondary symptoms that have an extremely negative impact on life and whose actual cause is often not recognized.
More than half of the population in Germany snores more or less frequently and to a greater or lesser extent. Men snore more than women, over 40s more than younger people. And they snore at different volumes: from a light 17 db to an unbearable 90 db, the volume of a truck on the highway.
Many factors contribute to snoring:
During sleep, the muscles in the throat and pharynx relax. This is the same for everyone and has no negative effects for most people. In some people, however, the loss of tension in the muscles is so great that breathing is significantly impaired. The airway narrows, which means that air has to be inhaled with increased negative pressure. This accelerates the airflow, which leads to repeated fluttering back and forth of the soft tissues in the throat, such as the uvula or soft palate. The typical snoring sound is produced.
There are also factors that further narrow the airways and thus increase snoring. Some of these are congenital, such as a deviated nasal septum or a recessed lower jaw. Other factors are acquired: When you have a cold, you snore more often because the mucous membranes are swollen.
Enlarged palatine or pharyngeal tonsils also narrow the airways. And finally, there are factors that are your own fault. Being overweight, for example, also contributes to snoring. Not only do the fat pads narrow the airways, the abdominal fat presses on the respiratory organs and makes it difficult to breathe.
Alcohol and sleeping pills before going to bed also cause the muscles to relax even more. Coffee and smoking irritate the mucous membranes and further constrict the airways.
When sleep becomes dangerous:
Although snoring is particularly annoying for the person next to you in bed, it is initially harmless to your health.
Only when the increasing relaxation of the throat muscles leads to complete closure of the upper airways does heavy snoring with breathing interruptions occur, known as apnoeic snoring, also known as sleep apnoea (apnoea, Greek for “windlessness”), which is when the body’s fight for survival begins. In these cases, snoring is interrupted by pauses in breathing of varying lengths. In more than 90 percent of cases, this is due to the muscles in the throat becoming slack.
These interruptions are usually first noticed by your bed partner and lead to the usual attempts to wake you up. However, the body itself also has a built-in, automatic alarm clock for this case. The respiratory arrest causes the oxygen content in the blood to drop, as do the blood pressure and heart rate. In order not to suffocate, the lack of oxygen triggers an arousal reaction in the brain. As a result, heavy snorers may consciously or unconsciously wake up several hundred times during sleep. Although this is a vital reaction, it costs the snorer the urgently needed regenerative sleep. The wake-up reaction interrupts the deep sleep phase, and blood pressure and heart rate increase significantly. The lack of deep sleep causes the throat muscles to tense up again and the breathing obstruction is lifted. The typical intensification of breathing now occurs and the snorer takes in a lot of air to compensate for the previous deficit.
Sleep apnea means more than 10 interruptions per hour:
Breathing pauses are considered serious if a sleeping person experiences more than 10 breathing pauses lasting more than 10 seconds per hour. This is considered sleep apnea. In addition to total cessation of breathing (apnoea), phases of reduced breathing intensity (hypopnoea) can also occur. In this case, the mechanical breathing movement, i.e. the up and down movement of the chest, is reduced by at least 50 percent. The respiratory flow is also reduced. If a drop in oxygen saturation of at least four percent is clinically detected, this is referred to as hypopnoea.
Sleep apnoea is rarely recognized as the cause of secondary symptoms.
Obstructive sleep apnoea (obstructive = obstructing the airways) is the most common, organically caused, sleep-related breathing disorder in Germany. It is currently estimated that around two million patients in Germany require treatment. And it is not uncommon for those affected to be unaware of their illness. Normally, the heart rate and blood pressure drop during sleep, the body temperature drops, as do the respiratory rate and depth of breathing. The body can recover. In the case of obstructive sleep apnoea, breathing disorders during sleep can affect the health of those affected in two ways. Firstly, sleep is disturbed to such an extent that the REM and deep sleep phases, which are important for performance, are constantly interrupted. As the snorer is usually unaware of the breathing interruptions during sleep and subsequently of their frequent awakenings, the consequences are “inexplicable” daytime tiredness, the feeling of never being properly rested, poor performance, concentration problems, irritability and depressive moods. Drunk driving is particularly fatal: HUK studies have shown that falling asleep at the wheel, known as microsleep, is the most common cause of fatal accidents on freeways. Around a quarter of all highway accidents are said to be caused by sleep apnea. A lack of deep sleep phases also reduces the brain’s ability to store things in long-term memory. An American study even shows that breathing interruptions lead to the death of nerve cells that are particularly important for learning. On the other hand, those affected are exposed to extreme stress during sleep. Due to the lack of oxygen, the body is constantly on alert and releases increased amounts of stress hormones such as cortisol and adrenaline. This leads to a rapid rise in blood pressure and heart rate. The higher the number of apneas, the more frequently this occurs. As a result, the blood pressure of sleep apnoeics remains too high for the entire duration of their sleep. Such patients still have high blood pressure when they wake up in the morning. Sleep apnoea is also considered a risk factor for vascular calcification, heart attacks and strokes. This is because during the pauses in breathing caused by obstructive sleep apnoea syndrome, significant pressure fluctuations in the chest also lead to reduced blood flow in the heart vessels.
Today, it is assumed that the metabolism of the most important vascular cells is significantly altered in sleep apnoea, increasing the risk of vascular disease as well as the risk of increased blood pressure. If there is also a lack of oxygen, the risk of a heart attack or stroke increases dramatically.
Other symptoms and consequences of sleep apnoea requiring treatment can include headaches, dizziness and ringing in the ears (tinitus), sexual dysfunction and night sweats. Pressure fluctuations in the chest are also the main cause of the typical nocturnal urge to urinate. They are transmitted to the heart. Differing blood filling of the heart chambers simulates overhydration of the body. The result is increased urination at night. Experts have now discovered that sleep-related breathing disorders can be detected in up to 50 percent of cases following a heart attack and in cases of relevant cardiac insufficiency. The number of patients with high blood pressure who have been diagnosed with sleep apnea syndrome is up to 30 percent.
And almost 60 percent of stroke patients also had a sleep-related breathing disorder.
See a doctor quickly if you have symptoms!
Of course, all of the symptoms mentioned can also be a manifestation of other illnesses.
However, if one or even several of the symptoms described above are present, this should give rise to a diagnostic clarification.
The initial diagnosis is relatively simple to carry out. Relevant data is recorded at home at night using a small recorder and evaluated in the doctor’s surgery. If the recordings confirm the suspicion of obstructive sleep apnoea, a detailed diagnosis can be carried out in a sleep laboratory. There are many therapies. If the findings are mild, it may be enough to lose a few kilograms of body weight or give up alcohol and nicotine. In the case of more severe findings, the doctor will recommend the appropriate treatment method, which can range from splints and nasal mask ventilation to surgical and minimally invasive procedures.
Fast, gentle and painless: the RFITT method as a sustainable therapy
More and more doctors in Germany are using bipolar radiofrequency current. The doctor uses a fine probe to treat the tissue inside the soft palate and possibly also the base of the tongue if this narrows the breathing space considerably. The tissue in the treated areas is tightened. This counteracts the vibration and thus the snoring noises. In this way, the most common cause of snoring can be successfully treated in many patients.
Due to its minimally invasive nature, bipolar radiofrequency-induced thermotherapy – also known as “RFITT” or the Celon method – is a gentle alternative or supplement to traditional surgery and laser therapy. And, unlike other widely available therapies involving tablets, ointments, vibrating cushions, wristbands or throat sprays, it has a lasting effect. The procedure can usually be performed on an outpatient basis and causes very little pain for the patient both during and after treatment. If only the soft palate or soft palate needs to be treated, the patient can leave the hospital or outpatient practice shortly after the procedure, which takes around 15 minutes. They are hardly restricted in their everyday life. When taking a medical history at the doctor’s surgery, it is important that the symptoms are not taken lightly and associated with obstructive sleep apnoea. Only five percent of all cases are diagnosed today. If detected correctly, treated early and correctly, the risks can be significantly reduced.
For those affected, this means a peaceful night with pleasant dreams for the first time again after often years of physical and psychological suffering.
Alarm signs for sleep apnea disorder
- Interrupted breathing during sleep.
- Heavy snoring.
- Frequent waking from sleep.
- Daytime tiredness, “never feeling properly rested”.
- Attacks of falling asleep, “microsleep”.
Author:
Institute for Sleep Disorders Wiesbaden; Prof. Dr. med. L. Klimek
