By Angela Butera Dickson, RN
My uncle Charlie could snore the shingles off the roof of every house in his neighborhood and then some. He was the nicest man on the planet but his loud, uneven, vibratory breathing was a nighttime nuisance for everyone within earshot and a source of amusement for my brother and me growing up. In our young minds the cartoonish vision of the shingles above flapping up and down with each inhalation and exhalation would dissolve us to fits of childish giggles every time we visited his home.
But the sad and serious truth is that Obstructive Sleep Apnea (OSA) is no laughing matter and probably contributed to his cardiac issues, diabetes and history of strokes. In short, OSA most likely shortened his life span.
OSA affects all age groups but it is a more common, and certainly an unwelcome guest in the elderly. According to Dr. Steven Park, Clinical Assistant Professor of Otolaryngology, Head & Neck Surgery, New York Medical College and author of Sleep Interrupted, a book that revels the number one reason why so many of us are sick and tired, "It's estimated that in 30- to 35-year-olds, 20 percent of men and 5 percent of women snore. But by age 60, 60 percent of men and 40 percent of women snore. Knowing that about 35 percent of habitual snorers are found to have obstructive sleep apnea, if you are over 60 and you snore, you'll have a 1 in 5 chance that you may have obstructive sleep apnea."
Sleep apnea isn't simply a noise problem. Snoring is a symptom of a bigger issue. Besides contributing to the overall fatigue of sufferers, there are several serious health complications that are linked to OSA, like hypertension, diabetes, depression, anxiety, heart disease, heart attack, and stroke.
Fatigue can also lower a person's pain threshold, an important issue for those recovering from surgery, dealing with chronic health issues, or battling cancer. Dr. Park says, "Another thing that one needs to consider is that fatigue, poor focus and irritability can sometimes be attributed to dementia and that treating any sleep-breathing problem may improve some or all of those symptoms too."
Unfortunately, OSA may not land near the top of the priority list for your loved one's doctor. This is especially true if there are other major medical problems that require evaluation and treatment, as these may overshadow OSA ssues.
What Makes People Snore?
As people age, the muscles and other tissues at the back of the throat may become slack especially while sleeping. This decreases the open space that allows air to move freely in and out of the nose and throat and into the lungs. As a result, suction builds up when the person tries to breath in, further collapsing the air pathways and exacerbating the problem. A partial collapse means snoring; a complete blockage and the person actually has periods of not breathing.
This lack of air, and with it a lack of oxygen, causes the person affected to wake repeatedly throughout the night to be able to breathe more deeply or more regularly. Some people with OSA can awaken hundreds of times during a typical overnight sleep cycle.
What You Can Do to Reduce Snoring
It isn't necessary for caregivers to wait for their loved one's doctor to diagnose a possible sleep-breathing issue problem before taking action. If your loved one snores or has pauses in breathing while sleeping there are a few things you can do to improve their air flow now. "In the elderly, especially if they are immobile or bedridden, they'll most likely be lying or sleeping on their backs. We know that in people with OSA, this is the worst position to be in, since structures in the throat are most susceptible to collapse due to gravity," Dr. Park says. "In general, people snore more and sleep less effectively on their backs. Most people find it uncomfortable to sleep in this position so they naturally prefer to sleep on their side or stomach, so they can breathe better."
If it's possible to lower the head of your loved one's bed and help them to find a comfortable side, or even stomach lying position, that change alone could improve their snoring and their sleep. Of course it's important to always ask them what sleep position they prefer if that's possible.
"It is a good idea to promote better nasal breathing too," Dr. Park adds. "Although not a major cause of sleep apnea, nasal congestion can sometimes aggravate the vacuum effect downstream, worsening soft palate or tongue collapse. Allergy prevention methods, including using a HEPA filter or using nasal saline or prescription allergy medications are all conservative options."
Getting the Right Diagnosis for Snoring and Sleep Apnea
The best way to get a definitive diagnosis is by undergoing an overnight sleep study, but that can be a difficult prospect for the bedridden, elderly or person affected with a disease like Alzheimer's. If this is the case, Dr Park advises, "One simple way of screening for sleep apnea is to use a continuous oxygen monitor on the person at night while he or she is sleeping. A simple finger probe device that measures blood oxygen levels is worn on one digit while sleeping. If the person's oxygen level keeps dropping repeatedly at night along with breathing pauses, then a more formal sleep study may be warranted."
Many doctors never consider the possibility of OSA in patients who are neither overweight nor heavy snorers, but the fact is some people who suffer from the problem are neither. And because sleep apnea can certainly aggravate underlying health conditions, it is important to have your love one evaluated if you suspect a problem. Dr Park believes that, "If you suspect that your loved one has obstructive sleep apnea, even if your doctor dismisses it, be persistent, or ask for a second opinion. Treatment is available. The best current treatment may include using a CPAP, or continuous positive airway pressure machine. This small machine is used to deliver a small amount of positive pressure to keep the airways open while the person is sleeping. For certain people a mandibular advancement device may be another option, and surgery is always possible as a last resort."
Snoring is no laughing matter if you stop to consider how a lack of restful sleep can contribute to other more serious health issues as well as daytime fatigue, reduced pain tolerance and in some cases dementia-like symptoms. As a caregiver you are the best person to advocate for your loved one and to ensure that they receive the medical attention and treatment needed if they suffer from OSA or other sleep-breathing problems.
Angela Butera Dickson is a Registered Nurse and freelance medical writer living in Rhode Island. She has been published over 800 times and has 25 years of practical nursing experience in hospice, acute & long term care, psyche nursing, and home care.