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Is snoring causing you problems? LVHN doctor talks about sleep apnea and how to manage it

If you snore, it doesn’t necessarily mean that you have sleep apnea. But if you have some of the other risk factors - obesity, daily fatigue, and a bed partner that says you stop breathing in your sleep - then yes, you may very well have sleep apnea.

Dr. Joseph Schellenberg, a pulmonologist in Sleep Medicine with Lehigh Valley Health Network, said there are many levels of snoring. Some people only snore on their back, while some only snore after drinking alcohol or taking a muscle relaxant. Only about 10% to 15% of the people who snore have sleep apnea. Weight is the most common risk factor for it.

“As we gain weight, (snoring) tends to get worse, and as we lose weight, it gets better,” Schellenberg said.

Getting tested

Getting tested for sleep apnea used to be somewhat off putting. A person had to go to a sleep study center and get hooked up to monitors, then sleep the night at the center.

In the last six to seven years, it has become very easy, Schellenberg said. It’s just a matter of stopping by the sleep study office, picking up the equipment, sleeping with it on, and returning the equipment the next day.

“Most people who are going to be tested will use home testing. This is much more readily available,” he said. “Most insurances require home testing, unless there’s a reason to move to lab testing. There’s a significant cost differential between the two.”

Unlike the sleep center tests, home testing only measures airflow in breathing patterns, Schellenberg said. It doesn’t measure electroencephalogram patterns or track the amount of light sleep, deep sleep and rapid eye movement sleep a person experiences.

Apnea specifics

Schellenberg said the most common form of sleep apnea is called obstructive sleep apnea. It occurs when the muscles of the upper airway (everything above the vocal cords) relaxes during sleep. The muscles stay constricted when a person is awake, but they collapses to the point where airflow becomes blocked partially or completely while asleep. Basically, the back of the throat closes up.

“As the airway blocks, air is not entering their lungs, so essentially people are choking while they’re sleeping,” Schellenberg said. “They’re not aware it, because they are in a state of depressed awareness - sleep.”

With the airway collapsed, oxygen levels drop, and the body will jerk slightly to wake up the person enough to breath.

“Airflow is restored. Oxygen level is recovered, but then people fall immediately back to sleep and the pattern continues. This can happen continuously through the course of the night,” Schellenberg said.


The mild result is the person constantly feels fatigued during the day, has trouble remembering things, concentrating on things, and focusing on topics.

Schellenberg said his patients often ask him if they are going to die from sleep apnea. He tells them the episodes of not breathing will not kill them, but “if you drive your car into a tree because you fell asleep at the wheel, then maybe.”

Sleep restores the body, heals muscles and brain, Schellenberg said. When this is disrupted, the body is put under stress.

“When stress levels are high, our stress hormones are high,” he said. “One of our stress hormones is cortisol, and cortisol is a hormone involved in our metabolism in particular promotes insulin resistance. This can be an added problem for people with diabetes.”

Over time, the stress on the body can cause high blood pressure, atrial fibrillation, stroke or cardiovascular issues such as an enlarged heart.

Treatment options

Sleep apnea is usually treated by using a continuous positive airway pressure (CPAP) machine. The newer ones are called automatic positive airway pressure (APAP) machines.

Schellenberg said the APAP machines automatically adjusts the air pressure throughout the night to meet the person’s changing needs as he or she sleeps.

The machines generate an air pressure that moves through the tubing to a mask that a person wears while sleeping, he said. That air pressure moves into the back of the throat, which holds open the airway so it won’t collapse.

“It is by far the most effective treatment that we have,” Schellenberg said. “The biggest obstacle is compliance. People have to use it as prescribed.”

Patients can also try a dental appliance made from a mold of the teeth, either from an over-the-counter kit or at a dental office.

“It latches on the upper and lower jaw and pulls the tongue and jaw forward to move then away from the airway. Those are better for milder forms of sleep apnea where weight is not a major risk factor, and their oxygen levels are not changing very much,” Schellenberg said.

Some people have also tried a surgical option where the uvula, a portion of the soft palate, and sometimes the tonsils and adenoids are removed.

“It is very painful,” he said.

Often, it doesn’t completely correct the problem and it has the potential risk associated with any surgery, Schellenberg said.

The newest treatment is called the Inspire device. It has been around for about 4 to 5 years.

“It is essentially a pace maker for the tongue,” he said.

Schellenberg explained that an electrical device is implanted in the chest wall. One electrical lead measures the breathing pattern, and the other one is implanted in the nerve that makes the tongue contract. At bedtime, the user turns on the device, which then sends electrical signals to the tongue to contract the tongue in phase with the breathing. The contracted tongue keeps more space open, which allows in more air.

“Initial data on it says the efficacy has been pretty good,” he said.

Developers are still working on sizing it appropriately. People with a body mass index of 30 or more in the obesity category 30 have not done as well as other people with the device.

Dr. Joseph Schellenberg
Snoring and sleep apnea are very real problems that can cause you to not get proper rest. METROGRAPHICS