Inexplicable tiredness, drowsiness during the day, fogginess… you might assume this is due to fatigue and stress and so forth, but actually it can be the result of apnea – temporary respiratory standstills while sleeping – which can develop into a syndrome and ruin your health. Only a professional can figure out whether a person’s snoring is dangerous, whether there is an apnea and what kind of treatment is needed. This interview with Christophe Pytlik M.D. covers this subject.
– Dr. Pytlik, is snoring a disease? If you start snoring while sleeping, does it mean that you should see a doctor?
– Firstly, I want to say that snoring is not a disease or a health disorder. Rather, it is the functional state of the upper respiratory airway. It is individual
for everyone, and it’s familiar to all of us – about one in five people snores. Moreover, we do not know ourselves whether we snore or not, but our partners and children – those we sleep in the same bed or in the same room with – suffer from our snoring. But if your snoring makes you wake up in the middle of the night, then it’s definitely time to see the otolaryngologist. Snoring can be harmless, but at the same time it might signal some serious health problems and some which could be life-threatening.
– I did not realise it was so serious. But many of those who snore assume they wake up at night for some other reasons and in the morning they donot feel pain in the larynx, so they are sure everything is all right. How, for example, can a wife convince her snoring husband to see a doctor? Are there any symptoms that can be noticed during the day?
– Yes , what you’re saying is common. Many people do not even associate their health problems with the way they breathe while sleeping. I should repeat: snoring is not always the cause of more serious problems such as apnea – but if a person has this syndrome, he definitely snores. If a person who snores feels broken in the morning (he can’t wake up without two cups of coffee), if he feels sleepy during the day (he falls asleep while driving and in some other situations
when he needs to concentrate), if he frequently goes to the toilet at night or suffers from high blood pressure – this can be a sign that the person has sleep apnea.
– You name it “sleep apnea”. Does this mean that it can happen when a person is awake?
That’s its correct designation. “Apnea” in Greek means “calmness”. Strictly speaking, apnea is any respiratory standstill. Both you and I experience short touches of apnea when we dive into icy water or take a contrast shower – we catch our breath – and freedivers, descending to the depths without equipment, understand by apnea a long held breath, which the diver consciously does in order to dive.
Apnea while sleeping – or, more precisely, a syndrome of obstructive sleep apnea – is dangerous. I can explain how this happens. During the day, the muscles of our larynx are in a tonus, and there is enough space for air to pass silently. When we fall asleep, the muscles relax, the lumen of the respiratory organs decreases, and this results in snoring. When a person has sleep apnea, the lumen narrows too much or closes completely – that’s when the breathing stops. It can last more than 10 seconds, and in severe cases it can happen up to 60 times per hour!
– And what is the main danger? Can you suffocate?
– Not rea l ly. Our bra in keeps controlling the body while we are sleeping – when the lack of breathing becomes critical, the brain issues the command to take a sharp breath, the person snores and then continues to breathe. That is snoring. If a person has frequent and prolonged attacks, his sleep is disturbed. Normally, we can stop breathing when we sleep, but no more t ha n f ive t i mes a n hour. Imagine this happening 60 (or more) times an hour – a person does not sleep at all.
There are many dangers here. Apnea can cause general hypoxemia – a lack of oxygen in the blood. Waking up in the morning, a person does not understand why he feels broken – and the reason is the lack of oxygen in his blood and hypoxia (that is, a chronic lack of ox ygen) of the organs and tissue. Our brain and the
cardiovascular system are the most sensitive parts of us. As a result, a person suffers from decreased memory and concentration, drowsiness, high blood pressure … The potential of a working person decreases and it is more difficult for him to cope with things. Many people are puzzled as to why they feel so tired – in fact, it’s impossible to be at full strength if you have been suffocating all night long.
– Presumably, there are not only daily but also long-term consequences of this syndrome?
– These ailments eventually lead to a decrease in sexual activity and impaired potency in men, not to mention the fact that sleep apnea is the main reason that
spouses sleep in separate rooms – many people know from their own experience what a thunderous snore people with obstructive sleep apnea have. In general,
one’s quality of life definitely becomes poorer. Apnea leads to a predisposition to obesity, which only strengthens snoring – and then these two ailments can lead to puffiness, where a person’s appearance changes, and not for the better…
– Doctor, this picture is completely bleak. But snoring and apnea are treatable, aren’t they?
– Yes, there are many ways to get rid of snoring and apnea. Not all of them are effective in the long run, and not all are convenient. A large number of patients use a CPAP device – a device that pumps air into the lungs, leaving the lumen of the respiratory organs always open. You put on a mask for the night – it resembles a gas mask to some extent – and there is no snoring. But the main disadvantage is that the device does not heal, it just eliminates the symptoms. Take it off and you will snore as before.
Moreover, it is difficult to fall asleep with a mask on your face; you need to get used to the fact that your airways are ventilated. And you can forget about romantic moments with your partner for some time – you look like a character in a horror film.
– But there must be a reason that the muscles of the larynx are not sufficiently open to allow air to pass through, mustn’t there?
– Incorrect jaw structure is one possible reason. A nd t his is my competence as a maxillofacial surgeon, and not just as a otolaryngologist.
– Is a pathology of jaw growth the only reason for apnea?
– Of course not. That’s why, when a patient with obstructive sleep apnea visits us, we first conduct a complete physical examination in our clinic –we even take blood for general analysis to figure out what other factors could be affecting his condition. Then we place the patient into the somnological laboratory where he has to spend the night, all the while the specialists monitoring the course of his sleep and determining how severe the apnea is; after that we can offer treatment, including surgery.
– There are sleep laboratories in many countries. Do you accept results from external examinations?
Yes , th equipmentin these laboratories is more or less standard, so you can come to us with the results of surveys conducted by your own somnologist. But regardless, you will go through our own complete physical examination with doctors who will continue to observe you. Usually we suggest guests stay for 3–4 days to go through all the procedures.
– Is t his prepa ration for t he operation? Is it complicated?
– Yes. This is a very complicated operation which must be performed very carefully, otherwise you can accidentally change the appearance of the person. However, it is nothing new. Such operat ions a recalled orthognathic – operations to correct the facial skeleton. They have been successfully conducted around the world for more than 25 years.
In such operations, we push forward both jaws – or, in easier cases, only the lower one – quite a bit, so that the lumen of the upper respiratory airways increases. A little while after this operation, all the muscles in the larynx and mouth change their position: the tongue, soft palate and palatal arches – everything moves
– How much time is needed for recovery after the operation?
– This period is one of the most painful. Immediately after the operation, we install elastic reinforcements on the inner surface of the jaw. It is necessary for proper occlusion – the formation of the bite – because you have to get used to it again. You also should be prepared for the fact that swelling of the nose and nasal stuffiness will persist. For the first week you can take only liquid food and it will be difficult to talk, but then it becomes easier. The first stage of recovery takes about three weeks – food in this period should be soft and pulped. But I warn you that numbness of the tissues and a feeling of discomfort can last up to 5 months.
– Anyway, you have convinced me that getting rid of apnea merits such a price.
– You’re right. Before the operation some patients do not even suspect what a profound effect apnea has had on their life and their general condition. It’s simple – when the blood is saturated with oxygen, when there is no hypoxemia, a person lives a full life. Their work capacity is restored, their business problems disappear, their families become happier… But one should not think that everything is so simple as going under the knife and thus getting rid of obstructive
sleep apnea. We perform the operation only if there are single-valued surgical indications. Many cases of sleep apnea can be healed by the patients themselves. It is important to undergo a survey whereby specialists can make a medical decision on the necessary measures for treatment.
Dr. Dr. med., maxillofacial surgery, plastic surgery and implantology expert. has studied medicine in еhe University of Münster and the Justus Liebig University Giessen. From 1991 to 1996 Christoph Pytlik has worked as a maxillofacial surgeon in the the Hannover Medical School and conducted private consultations in his field of expertise. Since 2003 Christoph Pytlik has started private practice. In 2011 Christoph Pytlik founded the Department of Maxillofacial Surgery in the Hospital of Canton Uri, Switzerland.