A question: What is snoring? Why do you snore when you sleep?
The upper airway is the part of the airway above the voice box, including the nasopharyngeal cavity, oropharynx and larynx, of which the nasal and nasopharyngeal cavities and larynx are supported by hard structures like bone and cartilage, so they do not deform when inhaling. deformation and collapse.
In general, airflow through the airway does not produce sound, but anatomical or functional narrowing of any of the three parts of the upper airway will cause friction, eddy current and muscle tremor when air passes through these parts without bony structure support, which means snoring, and the narrower the airway, the higher the snoring tone.
In the waking state, the muscles in the throat have a certain tension due to the regulation of the vegetative nerves, so that the airway is kept open and the airway is not narrowed, while in the sleeping state, the sympathetic nerve is inhibited, the vagus nerve is excited, the muscles of the whole body, including the soft tissues of the throat, are relaxed, the tongue is retracted, the airflow is restricted and vortex is generated, the muscles and tissues of the throat vibrate and snore, and in the lying position, the snoring is increased due to the drooping of the uvula by gravity and reduced in the side lying position. The snoring is aggravated when lying down due to gravity and reduced when lying on the side. After exertion or drinking alcohol, muscle tension is reduced and upper airway muscles are relaxed, causing obstruction, which will also lead to increased snoring.
Second question: Is snoring a sign of good sleep?
Snoring is a sign of good sleep, which sounds reasonable, but is actually fallacious. The principle of snoring has been mentioned above, which is caused by the restriction of airflow through the airway when the airway is narrowed or obstructed, and in serious cases, the upper airway resistance syndrome or obstructive sleep apnea syndrome is produced. The main harm of these syndromes to human body is the effect on sleep quality. Due to the instability of breathing, there is intermittent lack of oxygen in the brain, which disrupts the normal sleep structure, that is, the sleep is broken, the deep sleep is reduced, the light sleep is increased, and frequent micro awakenings are found in the EEG, and the severe cases will be suffocated. Sleep is supposed to be the process of resting and restoring the body’s functions, and this kind of sleep does not restore physical and mental strength, although sleep is fast, sleep time is long, but the quality of sleep is very poor, some people are still drowsy during the day, seriously affecting the quality of life and work efficiency. What else can be said about sleeping well.
Three questions: Is snoring a disease?
Not necessarily, it depends on what snoring is caused by.
If the snoring rhythm is regular, there is no apnea and obvious lack of oxygen, and the minimum arterial oxygen saturation is >90% during sleep, it belongs to “simple snoring”, which mostly happens when drinking alcohol, fatigue, taking sedative drugs or cold, etc. It is temporary snoring, which will not affect the human body, and also reminds us to pay attention to develop a healthy living habits.
If snoring alone is serious, if it persists or worsens, it may suffer from “upper airway resistance syndrome”, which is a sleep respiratory disease proposed in recent years, and some studies suggest that it belongs to the early stage of pathological changes of obstructive sleep apnea hypoventilation syndrome. The snoring is pathological when the upper airway resistance is significantly increased during sleep, inducing frequent micro-awakenings and reduced sleep quality.
If snoring is accompanied by intermittent “choking” (apnea), it is likely to be obstructive sleep apnea hypoventilation syndrome, and this snoring is a disease manifestation. This disease needs to be further diagnosed with appropriate tests (polysomnography).
Q4: What is obstructive sleep apnea hypoventilation syndrome?
Obstructive sleep apnea hypoventilation syndrome is a disease with symptoms such as upper airway obstruction, snoring during sleep, apnea with hypoxia, daytime drowsiness and dry mouth in the morning due to anatomical or functional factors. In China, the prevalence of adults is about 2-4%, and modern medicine confirms that it is one of the members of metabolic syndrome (obesity, hyperlipidemia, hypertension, coronary heart disease, insulin resistance) and is the source disease of each other member of metabolic syndrome.
5Q: What are the daytime manifestations of sleep apnea?
The following symptoms are observed during the daytime.
1, drowsiness: the most common symptom, the lighter for the quiet or learning situation when sleepy, serious people doze off regardless of the time and occasion, meetings and listening to lectures, etc. will also involuntarily enter dreamland, snoring loudly, and worse, dozing off while driving traffic accidents.
The author encountered a number of traffic accidents due to dozing off while driving in the clinic.
2, dry mouth and chronic pharyngitis in the morning: snoring and sleep apnea patients often dry mouth in the morning, because these patients sleep at night due to nasopharyngeal obstruction, mostly snoring and open-mouth breathing, oropharynx water evaporation, air dust and harmful substances can not be filtered through the nasal cavity, wetting, heating, removal, etc., directly through the oral cavity and pharynx into the lungs, or directly deposited in the mouth The pharynx, resulting in chronic pharyngitis, which is a common symptom in clinical practice.
3, headache, dizziness, fatigue and weakness: is due to intermittent hypoxia at night, brain hypoxia resulting in the impairment of brain function.
4, mental behavior abnormalities: inattention, memory loss, inability to complete some fine work, dementia in the elderly, etc., also related to the brain hypoxia brain function decline.
5, personality changes: easy to appear impatient, sensitive and irritable, hostile, behavior and language misconduct, jealousy, suspicion, depression, anxiety and other negative emotions, and even mental symptoms such as mental confusion, hallucinations and hallucinations, which seriously affects normal learning, life, family happiness and social interaction.
6, metabolic disorders: weight gain, blood pressure, blood lipid and blood sugar changes, also known as metabolic syndrome, sleep apnea is the source of these manifestations of the disease.
7, disorders of sexual function: manifested as low libido, short sexual life, diminished orgasm and reduced frequency.
Five questions: What is the performance of sleep apnea syndrome at night?
Nocturnal manifestations.
1.Snoring: It is the main manifestation during sleep, with irregular snoring and varying pitch, which is caused by fluttering of the surrounding soft tissues due to airflow through the narrow upper airway.
2.Apnea: If the respiratory arrest lasts for more than 10 seconds during night sleep, it is considered that an apnea occurs, accompanied by a decrease in blood oxygen saturation, i.e. hypoxia. OSAHS can be diagnosed if apnea occurs frequently more than 5 times per hour or an average of more than 30 times per hour during 7 hours of sleep.
3, suffocating awakening: Severe apnea and hypoxemia can lead to suffocating awakening, often accompanied by rolling over, even suddenly sitting up, feeling chest tightness, panic, discomfort in the precordial area, etc. Others have profuse sweating, near death feeling, involuntary movement of limbs or even twitching, patting bedmates, etc. Some may also induce epilepsy.
4, excessive sweating and drooling: sweating more, obvious in the neck and upper chest, related to hypercapnia caused by respiratory effort and apnea after airway obstruction.
5. Increased nocturia: Some patients have an increased number of nocturnal starts and individual enuresis, which is associated with reduced renal concentrating function.
6Q: What are the characteristics of the common hazards of OSAHS?
In addition to affecting the sleep of family members and even the relationship between husband and wife, the most important thing is to affect one’s own health, and its harm mainly has the following characteristics.
1, hidden: snoring occurs during sleep, mainly at night, when people are asleep and do not know or pay attention to many things that happen quietly at night, so snoring, the “mysterious killer of the night”, is naturally ignored.
2.Long-term: From the initial mild snoring to the later moderate to severe snoring and even sleep apnea and hypoventilation, it is a process of gradual development, a process of quantitative to qualitative change. During this long process, various organs of human body suffer from damage and lesions, and the lesions are gradually aggravated, people are unaware of this, and it is too late when symptoms appear. “Soft knife kill without blood”, this is more terrible!
3, multi-systemic: apnea damage to the body is multi-systemic, multi-organ, the most important organs are blood vessels, heart, brain and kidneys, the following content will be described in detail.
Seven questions: what is the main damage to the health of the body in what areas?
1, cardiovascular system: cause hypertension, coronary heart disease, heart failure, arrhythmia, cerebral hemorrhage and cerebral infarction, etc.
2, respiratory system: induce and aggravate nighttime asthma attacks, easy to combine respiratory failure, pulmonary heart disease, etc.
3, the impact of brain function: mainly in: inattention, memory loss, executive ability, alertness and complex problem solving ability decreased.
4, the impact of digestive system: long-term snoring patients’ lack of oxygen will lead to gastroesophageal reflux syndrome, reflux esophagitis, gastric ulcer, etc.
5, endocrine and urinary system: impaired kidney concentration function, causing increased nocturia, proteinuria or nephrotic syndrome, leading to damage of kidney function; endocrine system, reduced secretion of growth hormone, delayed growth of children, decreased intelligence, etc.
Q8: What tests can be used to diagnose sleep apnea hypoventilation syndrome?
The diagnosis of sleep apnea syndrome relies on the history and clinical manifestations (daytime manifestations and nocturnal manifestations), specific signs (abnormal pharyngeal and maxillofacial morphology) and multichannel sleep apnea monitoring (PSG) as described above to confirm the diagnosis. Clinically, there is typical nocturnal sleep snoring and irregular breathing, daytime sleepiness, and sleep apnea coupled with hypoventilation episodes of more than 30 or >5 episodes/hour during 7 hours of sleep at night on sleep breathing monitoring, accompanied by a decrease in arterial oxygen saturation (SPO2) of >4%.
Q9: What are the prevention and treatment measures for sleep apnea syndrome?
General treatment.
Weight loss: Many patients with mild to severe OSAHS have a significant reduction in sleep apnea after successful weight loss, even without other treatments. In contrast, for patients with severe OSAHS, weight control is necessary to improve the body condition and reduce the severity of sleep apnea, although the treatment cannot be fully achieved after weight control, and other treatments are also needed.
Sleeping in the lateral position: Position has a greater impact on sleep apnea, which is especially evident in patients with mild to moderate OSAHS, aggravated in the supine position and reduced in the lateral position.
Smoking and alcohol cessation: Excessive alcohol consumption causes relaxation of the upper airway muscles, and it can depress the respiratory center and decrease the response to low oxygen and carbon dioxide. Therefore, excessive drinking before bedtime is prohibited for sleep apnea patients to avoid danger. Smoking can aggravate the inflammation and edema of the upper airway, impair the endothelial function of the upper airway, and aggravate sleep apnea.
Strengthen physical exercise: physical exercise can enhance physical fitness, improve body coordination, strengthen upper airway muscle strength, reduce airway narrowing and improve airway compliance.
Continuous positive airway pressure ventilation (CPAP): Continuous positive airway pressure ventilation, is a nasal mask to send a continuous positive airflow into the airway. Continuous positive airway pressure respiratory therapy apparatus, referred to as CPAP ventilator, is connected to an air pump with a flexible ventilation tube, and the air pump generates a high-speed airflow through the hose into the upper airway, creating a positive pressure in the upper airway, overcoming the negative pressure in the upper airway during sleep, preventing the upper airway from collapsing, collapsing the The narrowed part of the pharynx is expanded to allow smooth passage of respiratory airflow and correct apnea.
Oral orthodontic appliance treatment: Oral orthodontic appliance is a dental retainer made of different materials such as polypropylene plastic, resin, silicone, etc., which is hard on the outside and soft on the inside and is placed on the upper and lower dental arches like a boxing brace. Oral orthodontic appliances can make the lower jaw move forward, widen the upper airway during sleep, reduce the upper airway resistance and negative pressure, and prevent the upper airway from collapsing during sleep, thus achieving the effect of improving OSAHS, which has certain effect on mild to moderate OSAHS.
Surgical treatment.
Correcting anatomical abnormalities of the upper airway by surgical means is one of the important treatments for patients with OSAHS. The key is to strictly grasp the indications for surgery clinically, and to choose the appropriate surgical method according to the cause and site of upper airway obstruction, the severity of the disease and the degree of obesity, and the postoperative period must be strictly followed up and observed.
Q10: Can sleep apnea be treated medically?
There are no specific medications for sleep apnea syndrome.