SOONER OR LATER, EVERYBODY SLEEPS. Cats, at best a vaguely sentient life form, are synonymous with snoozing. Hippos doze for hours, wallowing like huge bloated minivans in steamy jungle rivers. But what forever sets us humans apart from our beastly brethren are those giant sucking sounds we make while sleeping. More precisely, it’s the sharp, pointy elbows of our beloved spouses digging into our rib cages that define our differences.
Only humans would mercilessly capitalize on nocturnal noise, grinding out bidet-shaped pillows, pajamas with built-in tennis balls, tiny strap-on electronic cattle prods, vile herbal nighttime con codions, and worthless sleeping pills; all dubious commercial remedies designed to relieve us of cash in return for the promise of a decent night’s sleep. A new field of medicine has even sprung up to treat this common, incredibly annoying, and even potentially dangerous malady known as sleep apnea. Once again, it seems that as evolution’s (arguably) crowning achievement, people have somehow managed to screw up yet another of life’s most basic functions.
Just ask my wife. On a rock ’n’ roll scale of snoring, I come in at “Aerosmith.”
“Almost everyone’s heard that snoring and sleep apnea are related, so everyone who snores thinks they’ve got apnea, but that’s just not true,” says Andrew Jamieson, M.D., clinical co-director of the Sleep Medicine Institute at Presbyterian Hospital of Dallas. He and his staff of 12 see 1,500 patients a year for various sleep disorders. About 4 percent of males and 2 percent of females suffer from genuine apnea.
“The true indicator of sleep apnea is excessive tiredness,” he says. “Granted, we’re running up a huge sleep deficit in this country,” he adds. “Everybody’s tired, and it’s taking its toll. But it’s really extreme exhaustion that indicates sleep apnea; snoring is just an alarm, nothing more and nothing less. “
“Most men, of course, don’t snore,” Jamieson says, his face splitting into a Martin Mull-ish grin. “They just happen to sleep with women who hear things.”
Now this is my kind of guy. I tell him my wife complains about my snoring all the time, but when I stayed up all night recently, I never heard a thing. Ignoring me, he says the key to figuring out who’s on first begins with a little quiz called the Epworth Sleepiness Scale. By determining daytime somnolence, the Epworth helps establish a baseline that separates the chronically pooped from those with real problems. Then, a little device called an oximeter can determine whether a sleeper is getting enough oxygen in the bloodstream. A deficit indicates a problem.
Demonstrating the difference between run-of-the-sawmill snoring and true sleep apnea, Jamieson draws an undulating line on a marker board. “This is regular snoring,” he says, imitating that distinctive, raspy, guttural sound perfectly. “This is an apnea,” he says, flatlining the marker silently across the board, then spiking up with an explosive “SNORK. “
“What’s happening,” he explains, “is that the throat’s airway is blocked during sleep, which creates the snoring sound and inhibits the effective exchange of oxygen and carbon dioxide; so the patient doesn’t get the benefits that a normal night’s sleep should provide. It’s called Obstructive Sleep Apnea, or OSA.”
Jamieson says that some apneas during sleep, say five an hour or so, are normal. If you suffer more than that, you’ll likely find yourself waking up completely exhausted from a full night’s sleep, dragging yourself through the day, then going back to bed, only to wake up the next morning totally drained again. “And while apneas may or may not be a warning sign,” he says, “this intense daytime somnolence is highly indicative of OSA, and, once we formulate a diagnosis, treatment may require special procedures, such as surgery or CPAP,”
CPAP, or Continuous Positive Airway Pressure, requires a combination gas mask/jockstrap gizmo that fits over your face and hooks up to a machine that forces air down your throat. Sounds awful, but for those poor zombies who sleepwalk through life, it’s an absolute godsend.
I take the Epworth quiz, which thankfully indicates I’m just a lazy, nap-lovin’ guy. The oximeter, a chip-clip that fits over a finger as I sleep (and snort), confirms that my oxygen levels are fine, so apnea isn’t a concern.
So, how come I snore like a diesel freight train?
” As men get older, they gain weight around their guts and necks, which tends to narrow the airway and cause snoring,” Jamieson says. He suggests that a dental appliance may help open my airway by forcing my bottom jaw a mite forward, but I tell him: been there, done that, marginal results-and besides, I looked like Hannibal Letter in Silence of the Lambs. “Well, you can either get your uvula trimmed,” he says, all too cheerfully, “or consider losing some weight.”
Because I’m only a tad above my high school weight (a tad being 30 pounds or so), I decide the problem must be with my uvula, which, if you didn’t know you had one, is that fleshy little thing that dangles down from the roof of your mouth. Ear, nose, and throat (ENT) doctors handle uvula problems, and depending on the individual diagnosis, have two alternatives: the first is Laser Assisted Uvulopalatoplasty or LAUP (pronounced LAY-up, like in basketball), which is recommended strictly and works quite successfully for snoring.
The other is Uvulopalatopharyngoplasty, or UPPP (pronounced YOU-pee-pee-pee), and is reserved for more serious cases like OSA, but LAUP has been very well received for mild to moderate OSA, too. (This field is also crowded with acronyms.) Slightly different body parts are ripped and zipped in each procedure, but the big difference is pret-ty simple; LAUP is done with laser, UPPP by conventional surgical techniques.
Dwight Lee, M,D., performs both operations routinely as part of his ENT practice. “Surgery is the cure of last resort,” he says, “and if we’ve tried more conservative therapies like weight loss without success, we’ll look at LAUP or UPPP.”
“The controversial part about both these procedures,” he says, sighing like a man who has explained it many times before, “is that, since they both stop patients from snoring, critics contend both procedures could then mask apnea. Unfortunately, these critics are losing sight of the real apnea indicators, obtained by asking the correct questions, like whether or not the patient has morning headaches, falls asleep at work or in the car, or otherwise demonstrates excessive daytime somnolence. Snoring isn’t a reliable apnea indicator, and just a small fraction of those who snore have true apnea.”
“Please tell your readers,” he adds, “that UPPP is only 50 to 80 percent effective, and while it reduces OSA, it never completely stops; the patient may still breathe quite heavily while asleep. Other modifications, such as tongue advancements and reductions, may be required; each case is individual.”
Tongue advancements and reductions? This is getting grim.
A Dallas cop who had the UPPP procedure described it as “incredibly painful.” A Dallas magazine editor who had the LAUP procedure also, imaginatively enough, described its aftermath as “incredibly painful.” After professing token sympathy, their respective and well-rested spouses declare overall success.
“I’m so tired, I haven’t slept a wink, I’m so tired, my mind is on the blink, I wonder should ! get up, and fix myself a drink, No, no, no.”
-“I’M SO TIRED”
JOHN LENNON AND PAUL MCCARTNEY
POOR SLEEPERS WILL SOMETIMES SELFf-medicate with a highball or two, but Lennon was right; booze doesn’t help. Falling asleep isn’t the problem, says Jamieson, adding that ” the body’s detoxification process interrupts the normal circadian sleep pattern, so poor quality sleep is the ultimate result.” As a final insult, booze tends to make noisy snorers even noisier.
lust ask my wife.
So, what’s the short answer? Ask your spouse or other sleeping partner to check out your snoring objectively before thumping you on the head with a pillow. If your co-sleeper says you sound like a buzz saw with a short circuit, snoring in fits and starts instead of a steady rhythm, ask yourself if you’re plagued by excessive exhaustion and daytime sleepiness on a regular basis. (Wanting to go coma at an afternoon sales meeting doesn’t count; nodding off face-down into the cafeteria chili during lunch does.)
If you’re diving into lunch and not coming up, then you might be on the verge of apnea. Get a solid diagnosis from a credible center like the Sleep Medicine Associates. If you’re truly one of the very small percentage of those suffering from sleep apnea, treatment via CPAP and/or surgery could profoundly change your life.