What are different levels of snoring?

December 05, 2016 – https://www.thenews.com.pk/print/169794-What-are-different-levels-of-snoring

What is snoring-IV

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 respiratory effort related arousal (RERA).

When the resistance increases even further, the ventilatory efforts cannot keep up with the degree of resistance to maintain adequate levels of oxygen, and airflow decreases or stops. This often leads to a decrease in the level of oxygen in the blood. As a result, sleep becomes more fragmented and arousals more frequent. The events are referred to as obstructive hypopneas (reduced breathing) or apneas (absent breathing), and the condition is termedobstructive 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 the 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 (sleep apnea, see below) or resulting 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. Multiple studies have shown that simple clinical evaluations cannot determine if a person only snores, or if he or she has a more significant sleep disturbance. Therefore, a sleep study is often needed to determine if obstructive sleep apnea is present prior to initiating any treatments.

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:

1. Home sleep study (portable sleep study)

2. Full sleep study (polysomnography in a laboratory with a technician)

Home sleep study

A home (unattended) sleep study can measure some basic parameters of sleep and breathing. A pre-test evaluation by a sleep medicine specialist to determine if home testing is appropriate is recommended. Often, the home sleep study will include pulse oximetry (a measurement of the level of oxygen in the blood), a record of movement, snoring, and apneic (pause in breathing) events. A home study can prove that there are no sleeping problems or suggest that there may be a problem. Some types of home sleep studies may monitory blood vessel reactions or tone as well as detecting respiratory events. Improved technology has expanded the ability to perform testing in the person’s own sleep environment.

If a home sleep study suggests a problem, treatment is often initiated. If the results are not clear, repeat testing with a full sleep study (polysomnography) may be performed in a clinic. (For a complete description of a full sleep study, 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 to 3 below, patients rank their risk of dozing in the chart below. (This chart can be printed out and taken to the doctor.)

After ranking each category, the total score is calculated. The range is 0-24, with the higher the score the more 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.”)

What are some objective tests to measure sleepiness?

For someone who reports being sleepy during the day, it is sometimes helpful to measure how sleepy he or she is. Also, after treatment of sleep problems, we sometimes want to measure improvement in daytime sleepiness.

Sleepiness can be measured with a Multiple Sleep Latency Test (MSLT). Basically, the MSLT measures how fast someone falls asleep during the day. It must be done after an overnight sleep study (polysomnography) has documented adequate opportunity for sleep the night before and no untreated obstructive sleep apnea. The test is composed of four to five “naps” that last 20 minutes each and are spaced two hours apart. The person is instructed to “try to fall asleep.” The average time to fall asleep is calculated for all four or five tests. A normal time would be greater than ten minutes needed to fall asleep. Excessive sleepiness is defined as falling asleep in less than five minutes.

The Maintenance of Wakefulness Test (MWT) also measures daytime sleepiness. The person taking this test is instructed to “try to stay awake.” This is repeated for four 40-minute sessions, two hours apart. Not falling asleep in all four tests is the strongest objective measure of the absence of daytime sleepiness.

Some businesses use these tests to ensure that their employees are not excessively sleepy while at work. Specifically, airline pilots and truck drivers who experience sleepiness need to have a test to ensure public safety and productivity at work. Unfortunately, there is no test that will guarantee that someone will not fall asleep at his or her job or while driving.

— medicinenet.com

To be concluded