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It's not an uncommon scenario. A wife kicks her husband out of the marital bed because his snoring is loud enough to shatter windows. Yet science has made it clear that loud snoring could indicate a much bigger problem than annoying a spouse. The trend in medicine is moving more toward recognizing the role sleep plays in health and how sleep disorders can be precursors for underlying health concerns.

The most common sleep disorder is obstructive sleep apnea (OSA), a condition affecting the upper airway in which breathing stops or gets very shallow during sleep. These pauses in breathing are repetitive throughout the night and can occur 20 to 30 times per hour or more. During sleep, there is not enough airflow getting into the lungs through the mouth or nose. This can be caused by several factors, the most common of which is the anatomy of the throat and neck. When breathing stops, the amount of oxygen in the blood may drop and the brain responds with a quick punch of adrenaline, raising blood pressure and heart rate. With a loud snort or choking sound, normal breath resumes. This fragmented breathing process deteriorates the quality of sleep and wreaks havoc during the day, causing lethargy and moodiness.

"If you stop breathing at night, it puts stress on your heart, your brain and you can develop a whole host of comorbid problems [such as] high blood pressure, heart attack, stroke, difficult to control diabetes if you already have it, you name it, as well as car accidents," explained Dr. Marc E. Hofmann, a pulmonologist and critical care physician with Memphis Lung Physicians, PC. Hofmann is also the director of centers for Opus Medical Management, a new holding company that develops sleep disorder clinics. Opus develops and manages the sleep labs, provides sleep technicians and fills basic administration needs. Currently, Opus has developed sleep labs in Marion, Ark., and Southaven, Miss., with two centers under construction in Memphis and another pair under construction in Charlotte, N.C.

"There are many different things that occur when you develop sleep apnea," continued Hofmann, "and if you don't treat it, it's not going to hurt you when you're 30; you may feel tired and cranky. But when you hit 50 and 60 years old and you have your first event, especially if you smoke or have a family history of it, it puts a double or triple whammy on you."

In normal breathing, negative pressure is created by sucking in air. That tissue should normally relax during sleep, but in people with sleep apnea, the pharynx and neck collapse down, creating a vacuum within the neck area that closes off the airway. Sometimes people consciously awaken or the brain comes out of sleep mode to force the body to breathe.

"Severe apnecs have no clue half the time," noted Hofmann. "They just feel tired and they are falling asleep at work or while they're driving. When we get them in the sleep lab, [apnea] is recognized."

A person with sleep apnea stays in the earlier stages of sleep, stage one and two, and does not make it to the deeper stages three, four and REM restorative sleep that are vital for restoring the body to normal functions.

It is estimated by the National Heart Lung and Blood Institute that 12 million Americans have obstructive sleep apnea. More than half of those are overweight. Sleep apnea is more common in men and in people 50 years old and older. Adults with a family history of sleep apnea, who snore loudly, who are overweight, have high blood pressure or have anatomic obstructions are most likely to develop this disorder.

Treatment for OSA includes both noninvasive devices and invasive surgery. One type of treatment uses an oral device that pulls the jaw forward and moves the tongue out of the way. This can be provided by an oral surgeon or dentist, but the device works best on those with mild apnea and it can cause discomfort. Another option is an invasive head and neck surgery called a uvula palatal pharyngoplasty to remove the uvula and tissue in the back of the throat. It only takes care of the problem 50-60 percent of the time.

The most successful noninvasive treatment for OSA is a device known as the CPAP (continuous positive airway pressure). It consists of either a nasal mask or a face mask covering the mouth and nose. A hose connects the mask to a small machine that blows filtered air through the nose or mouth to open the airway, essentially acting as a pneumatic stent, explained Hofmann. That effectively eliminates snoring and frees up the breathing passageways.

"Once you initiate [CPAP] therapy, more often than not you hear from patients that they had the best night sleep they've ever had," Hofmann added.

Hofmann, who spends 80 percent of his time treating obstructive sleep apnea and sleep disordered breathing problems, said it's important for patients and their primary care physicians to take sleep issues seriously. Instead of going directly to sleeping pills, Hofmann advises physicians to refer patients to a sleep disorder clinic where they can receive a thorough sleep study. Sleep studies reveal massive amounts of data about airflow, heart rate, brain activity and muscle activity during sleep, all which can indicate or rule out a sleep disorder. If sleep disorders are undiagnosed, people could spend years trying to get treatment for a secondary health condition that is either caused or exacerbated by the sleep disorder. Medications people take can actually fragment sleep and some types of sedatives affect respiration.

"I've seen patients go from four blood pressure medications down to one," said Hofmann. "I've seen patients on a CPAP from 250 pounds to 500."

Sleep labs consist of four to five beds with comprehensive computer equipment to monitor patients. Most patients come in for an overnight sleep study, arriving a few hours before normal bed time. Patients have electrodes on their head, eyes, mouth, nose, chest and legs. At least six hours of uninterrupted sleep is needed to make a full diagnosis. Those diagnosed with sleep apnea will receive a CPAP right away to begin treatment and will be followed up in six to eight weeks.

Other sleep disorders treated at a sleep clinic include narcolepsy (difficulty staying awake or sleep attacks), parasomnias (walking, talking, acting out dreams in sleep), circadian rhythm disorders, restless legs syndrome and periodic limb movement, among other less common disorders. While not all of these conditions are curable, they are treatable. Because of the nature of observing brain, heart, respiratory and muscle activity during sleep, other health concerns can be identified in the process, such as sinus problems and even seizure activity.

Ultimately sleep physicians have to retain a continuum of care with cardiologists, neurologists, ENT doctors and primary physicians. Sleep is connected to every aspect of health and it's important for physicians in other specialties to be aware of the complications sleep disorders can cause.


Dr. Marc Hofmann and polysomnic tech Sharon Burt evaluate a patient's vital functions during a sleep study.

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