Snoring, sleep apnoea

Snoring - social snoring, and sleep apnoea

Snoring is something that, directly or indirectly, affects the majority of us - and it is a common condition. Perhaps you don’t snore yourself, but your partner does - which disturbs a good night’s sleep for both of you. Some couples have separate bedrooms as a result of a snoring problem: something that most people don’t want to talk about. This is what is meant by social snoring.

Moreover, the number of people that suffer from suspension of breathing, apnoea, is larger than was earlier thought. A person suffering from apnoea syndrome; may have hundreds of pauses in their breathing each night - each followed by a ’mini wake-up’ and a reduction of the oxygen levels in the blood: something that leads to serious health risks. [1] Few people are aware of their night-time breathing interruptions until first alerted to it when they have shared a bedroom with someone else.

In this section we will look at the most common symptoms, and risks, of snoring and apnoea. We will also explain what happens physically during snoring and apnoea syndrome, as well as describe the effect that the new neuromuscular treatment, IQoro®, can have on this problem. IQoro® is a new and unique neuromuscular treatment method that requires just 30 seconds’ exercise, three times per day.

 

Social snoring - more men than women are directly affected [1]

Most of us know someone who snores or is disturbed at night time by a partner who snores, this is called social snoring.

It is twice as common that men snore compared with women. Several studies at the Academic Hospital in Uppsala and Sunderby Hospital in Luleå, both in Sweden, show that approximately 18% of men and 8% of women snore regularly. These figures vary, depending on which age groups are studied: the proportion with loud and disturbing snoring increases with age. The highest prevalence of snoring occurs in the age range 50 to 60 years old, where 25% of men, and 15% of women, snore every night.

It is the female hormone oestrogen that accounts for the difference – probably having a protective effect, and the fact that overweight tends to affect the sexes differently: men with a more central excess fat distribution around the middle and neck.
 

Many snore when pregnant

Snoring during pregnancy is common, especially in the final phases when over 20% of all pregnant women snore. Researchers in Umeå in Sweden have shown that pregnant women that snore run twice the risk of high blood pressure and pre-eclampsia.

 

Sleep apnoea – nocturnal breathing suspension [1]

Swedish research leads the world in obstructive apnoea, repeated breathing suspension during sleep. Research results show that apnoea has a correlation with several serious conditions including: raised blood pressure, heart and artery problems, diabetes and depression. [3, 1] There is also a correlation between apnoea and traffic accidents.

To be classified as apnoea the breathing suspension must have a duration of at least 10 seconds. In a person with severe apnoea this can occur up to 600 times in one night.

To have sleep apnoea without daytime symptoms is nearly three times as common amongst men (24 %) as women (9 %). A new Swedish study even claims that apnoea is far more common than was previously believed: as many as 50% of all women between 20 and 70 years old suffer from apnoea. The condition is more prevalent in people who are overweight or with high blood pressure, and also becomes more common with age. [4]

With sleep apnoea syndrome the apnoea causes daytime tiredness. Despite the fact that it appears in both men and women, it is more common amongst men. At least 4% of men and 2% of women suffer from sleep apnoea syndrome.
 

Sleep apnoea in children

Air pathway obstruction can also occur in children. It is not normal that children snore and therefore an examination of the nose and pharynx should always be carried out. The most common reason for apnoea in children is enlarged tonsils or adenoids which can block the upper air pathways.
 

Two types of sleep apnoea

  1.  Central sleep apnoea

People with central apnoea do not snore. The condition is typified by total- or partial reduction of the nerve impulses to the breathing muscles. During the interruptions to breathing, which last at least 10 seconds, the breathing movements first increase and then successively reduce to a central apnoea completely without chest movements. During an apnoea the body makes no attempt to inhale air.

The underlying reasons for central apnoea are fairly unknown, as are its consequences and how it can be treated.

  1. Obstructive sleep apnoea

A person who has obstructive apnoea snores, and has a narrowed upper air pathway: this causes daytime tiredness. The breathing movements are vigorous during the breathing suspension, but the person gets no air because the upper air pathway is blocked, often because the tongue has fallen backwards, or because of enlarged tonsils or enlarged adenoids. Being overweight is also common reason, even if a large proportion of apnoea sufferers are not overweight. Fat deposits around the neck can increase the risk for blocking the air pathways because the area from the nose to the vocal cords consists only of soft tissue, muscles and fatty tissue which cannot hold the pathway open.

 

Symptoms of snoring with apnoea syndrome [1, 2]

It is not always the case that a person is aware of his snoring or his apnoea, often because many live alone. It is common that a person can live many years with the condition without being aware of it, perhaps only uncovered during a trip with a friend, or a visit to the doctor for some other reason.

Common symptoms of apnoea syndrome are:

  • Snoring.
  • Abnormal daytime tiredness.
  • Dryness of the mouth.
  • Pain in the pharynx in the mornings.
  • Disturbed sleep.
  • Urinating several times per night.
  • Mood swings.
  • Reduced sexual drive.
  • Waking during the night with the sensation of suffocation.
  • A feeling of never being rested.
  • Prone to fall asleep in various every day situations.
  • Become easily tired when driving, or as a passenger in a car.
  • High blood pressure.
  • Headache in the morning.
  • Acidic indigestion.
  • Coughing at night.
  • Giddiness.

     

Underlying reasons for snoring, with or without sleep apnoea [1, 2]

Breathing is a natural process, and not something that one would normally think about: but it is a complex procedure. Breathing in and out is controlled by signals from the breathing centre in the lower part of the brain stem: partly by various reflexes, but it can also be controlled voluntarily.

When awake and inhaling, the muscles in the walls of the pharynx react and widen reflexively. When we sleep, the muscles relax whereupon the walls of the pharynx become more or less slack and more sensitive to changes in pressure. In some individuals the muscle activity is so slight that they cannot manage to hold the airway open during inhalation. The low pressure formed when breathing in, can cause the walls of the pharynx to be pressed inwards until they collapse together completely. This, in combination with reduced muscle tension in the soft palate – a muscle situated behind the hard palate and next to the pharynx – and the tongue which can then fall backwards, fatty deposits in the upper airways, and enlarged tonsils and adenoids in the nose can all result in a constricted upper air pathways, and thus snoring.

The noise made when snoring, comes from the vibrations that occur when the air pathway in the pharynx is too narrow and the soft palate begins to vibrate. In extreme cases a snorer can reach 80 dB. In some cases the upper pathway is blocked completely during inhalation, which results in an suspension of breathing: a sleeping apnoea.

 

There are several reasons why we snore, or have sleeping apnoea:

  • Due to poor health, or being overweight.
  • Unhealthy eating- or alcohol habits.
  • Muscle relaxant drugs, for example: sleeping tablets or morphine-based preparations.
  • Inherited, or medically-induced factors that cause narrowed nostrils, or enlarged tonsils or adenoids.
  • Slack musculature in the pharynx and air pathways.
  • Various sicknesses or conditions including: lack of thyroid hormone (hypothyreos), diabetes, rheumatism, stroke, overweight, increased blood pressure and blood and artery sicknesses.
  • Smoking, or passive smoking.

 

Diagnosing sleeping apnoea syndrome [1]

Many feel unsure how to go about discovering if one is suffering from sleep apnoea. Especially those that live alone and do not have someone to notice possible nocturnal breathing suspension.

If you have a problem, or suspect you have a problem, with snoring or sleep apnoea the usual process is that you visit your local clinic or practitioner, who then refers you to a specialist clinic for sleep investigation. These clinics are usually situated in the hospital’s Ear, Nose and Throat (ENT) department, or lung department. You can also discuss snoring and suspected sleep apnoea syndrome with your dentist who can also refer you for a sleep investigation.

 

Current treatments of sleep apnoea syndrome [1]

There are different methods of treating snoring and sleep apnoea. When choosing the correct treatment, several factors play a role: the severity of the apnoea, the age of the patient and other condition present including heart and circulation problems.

The most common treatment for sleep apnoea syndrome is CPAP Continuous Positive Airway Pressure – a mask that creates high-pressure - or an oral appliance for sleep apnoea: both compensate for the reduced breathing ability. The patient is, however, tied to using his CPAP or oral appliance every night.
 

CPAP – high pressure breathing mask

CPAP is the most effective treatment for the symptoms of medium- and severe cases of sleep apnoea. Simply stated, you wear a facemask at night which forces air in, and makes your breathing pathways open. Some people find the CPAP mask noisy and difficult to sleep with, others can be disturbed by the pipes, or a mask that doesn’t fit properly. Therefore it is important to have an individually tested and fitted mask. [1]
 

Oral appliance for sleep apnoea

In cases of slight- to medium sleep apnoea, an oral appliance against snoring or apnoea is a common treatment alternative, as it is also for severe sleeping apnoea in those cases where other treatment methods cannot be tolerated. Such an oral appliance can be tested at a dentist who has special competence in this area. It pushes the lower jaw forward and in this way eases breathing when you sleep. [1]

People with such an oral device should be aware that it is fundamentally a tooth regulation apparatus that is being put in the mouth, and that it will move teeth to some extent. Because the lower jaw is pushed forward during the night time the treatment can, in time, promote an underbite. For those that had a normal bite from the beginning, this is of course undesirable. Such changes, however, occur slowly and can be followed up by a responsible dentist. This can sometimes lead to the oral appliance treatment having to be terminated. [1]
 

Surgical intervention

Surgery is nowadays an unusual treatment, good clinical studies of the effectiveness of the treatment are few, and side-effects are common after an operation on the soft palate. Surgery can, however, be appropriate on children if their sleep apnoea is caused by enlarged tonsils or adenoids in the nose. Enlarged tonsils in adults with sleep apnoea are also often recommended for surgical intervention. [1]

 

IQoro® – a new neuromuscular treatment method

IQoro® is a new and unique neuromuscular treatment method that takes just 30 seconds’ exercise, three times per day. It has been shown through many scientific studies that it can effectively train the musculature that is involved when we eat, swallow and breathe. Today, after more than 20 years’ clinical experience we know that IQoro® promotes noticeable improvements amongst patients that have been referred to CPAP treatment, or who have had an unsuccessful surgical operation against snoring.

The research also shows that the musculature in the upper airways and soft palate is significantly strengthened after training with IQoro®. People with total paralysis of the pharynx regained their function after 13 weeks’ training. [5] Objective tests with high-resolution manometry and pressure measurement have shown that the neuromuscular treatment method with IQoro® reaches all the musculature in the whole chain from the oral cavity to the diaphragm. [6, 7] IQoro® activates the brain’s control system for the swallowing process, which is also closely linked with the breathing function.

Read more about this in the section: ”The swallowing process – when it works as it should”, and ” treatment methods -  why IQoro® works”.

A pilot study has been carried out in Sweden where people with sleep apnoea syndrome prescribed CPAP treatment, have also exercised in parallel with IQoro® for three months. Sleep registration before treatment, and after the three months, have shown clear improvement with the suspension of breathing reduced from severe-, to mild apnoea.

Against this background: articles published and reviewed internationally, long clinical experience of positive treatment results, the pilot study, and the fact that there are no negative side-effects, IQoro® can be recommended as a complement to CPAP or snoring screens for those with sleep apnoea, and also for those that suffer from social snoring.

If the treatment effect with IQoro® is so positive that you wish to end your ongoing treatment with CPAP or oral appliance prescribed by a doctor, you should always decide in consultation with him or her before these treatment methods are be terminated and replaced just by continued training with IQoro®.

Larger studies of snoring and sleep apnoea are in the planning. It is hoped that this can in time arouse interest from other medical professionals to use IQoro® in similar studies to be able to further scientifically validate the effect of IQoro® in these areas.

 

Roger Sundström

IQoro® really helps

Roger Sundström had tried most things to help his snoring before he began training with IQoro®. Thanks to this new treatment method, effective against both swallowing problems and snoring, Roger at last solved the problem of his nightly noise.

Social snoring, that is to say when a person is disturbed by somebody else’s snoring, is considerably more common than people think; and can result in a couple not being able to share the same bedroom. And so it is in Roger’s home.

 Read patients' own stories here

 

 

 

 

Åke Sonerud

Åke’s snoring is gone

Åke Sonerud, Sweden had snored for many years before he at last cured the problem. After a lecture at his Rotary Club about the neuromuscular training device IQoro’s® positive effects on several conditions, including snoring, Åke Sonerud went and bought one. Nothing that he regrets today!

Åke Sonerud and his wife Annette have been together for several decades. There have been three children, or perhaps we should say four. The fourth is Åke Sonerud ’s innovation, a mechanical invention that lies behind the success of his company Oil Quick in Hudiksvall.  Nowadays he has eased off a bit and handed over a great deal of the responsibility to his children Henrik and Linnea, in order to enjoy life as a pensioner together with his wife Annette.

 Read patients' own stories here


Text by: Dr. Mary Hägg, Doctor of Medicine, Post-doctoral researcher at Uppsala University specialising in orofacial medicine, Head of Department at the Speech and Swallowing Faculty: Ear, Nose and Throat Clinic at Hudiksvall Hospital, Sweden. Registered Dentist. In cooperation with MYoroface.

October 2016. (Translation from the original Swedish text by T.W.Morris, MYoroface.)


Sources:  

  1. Hjärt och lungfonden (2016), Sömnapné – En skrift om andningsuppehåll under sömn. vetenskapligt ansvarig: Karl Franklin, universitetslektor och överläkare, Enheten för kirurgi, Umeå universitet, Umeå, Experter: Richard Harlid, överläkare vid Aleris FysiologLab i Stockholm; Jan Hedner, professor i sömnrelaterade sjukdomar, Sömnlaboratoriet, Sahlgrenska universitetssjukhuset i Göteborg; Michael Lysdahl, Aleris FysiologLab i Stockholm; Eva Lindberg, docent och överläkare, verksamhetschef för lung och allergikliniken vid Akademiska sjukhuset i Uppsala; Marie Marklund, tandläkare och universitetslektor vid institutionen för odontologi, Umeå universitet. https://www.hjart-lungfonden.se/Documents/Skrifter/S%C3%B6mnapn%C3%A9_2016_webb.pdf
    (English translation, ”Sleep apnoea – A paper on breathing suspension whilst sleeping”)  
     
  2. Sömnapné.se, http://www.somnapne.se (English translation,”Sleep apnoea”).
     
  3. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005: 353: 2034-2041.
     
  4. K. A. Franklin, C. Sahlin, H. Stenlund, E. Lindberg, Sleep apnoea is a common occurrence in females, European Respiratory Journal Mar 2013,
    41 (3) 610-615; DOI: 10.1183/09031936.00212711 
     
  5. Hägg M., Tibbling L. Effect of IQoro® training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke. Acta Otolaryngol 2016; 136 (7):742-748. DOI:10.3109/00016489.2016.1145797
    http://dx.doi.org/10.3109/00016489.2016.1145797.
     
  6. Hägg M, Tibbling L, Franzén T. Effect of IQoro® training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms. Acta Otolaryngol. 2015 Jul;135(7):635-9.
     
  7. Hägg M, Tibbling L, Franzén T. Esophageal dysphagia and reflux symptoms before and after oral IQoro® training. World J Gastroenterol 2015; 21(24): 7558-7562
    Open access: http://www.wjgnet.com/1007-9327/full/v21/i24/7558.htm

 

Products
      

    Produced by:  Wikinggruppen