SAWING LOGS SNORING AND HOW TO STOP IT

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TABLE OF CONTENTS

INTRODUCTION

o About this eBook THE SNORING EPIDEMIC

o You aren’t alone

o Debunking stereotypes

o Age matters WHAT IS SNORING, ANYWAY?

o The physiology of snoring

o But we don’t snore in the afternoon WHAT MAKES US SNORE? SLEEP APNEA

o What is sleep apnea?

o Snoring isn’t necessarily sleep apnea

o The dangers of sleep apnea SERIOUS SNORING

o When is snoring really serious?

o How can you tell if and when you’re snoring?

SNORING AND SLEEP DISRUPTION

o Snoring causes sleep loss for everyone

o Snoring puts a strain on relationships

o Sleep deprivation is a real problem THE MEDICAL CONSEQUENCES OF SNORING SILENCING THE SNORE AT THE DRUGSTORE

o Snoring “cures” are nothing new

o Store-bought snoring remedies QUIETING THINGS DOWN WITH LIFESTYLE CHANGES

o Snoring and weight loss

o You are what you eat

o Smoking and snoring

o Avoiding happy hour

o Resting up can turn the volume down MEDICAL CAUSES AND SOLUTIONS

o Medical problems can be at the root of snoring MEDICINAL CAUSES OF SNORING SOLVING SNORING WITH APPLIANCES AND INSTRUMENTS

o Dental devices and similar solutions

o Continuous positive airway pressure (CPAP)

o An appliance you wouldn’t expect

SURGICAL SOLUTIONS FOR SNORING

o An overview of snoring surgeries

o Somnoplasty

o Uvulopalatopharyngoplasty (UPPP)

o Tonsillectomy and adenoidectomy

o Nasal septoplasty

o Nasal polypectomy CONCLUSION APPENDIX ONE: FTC CONSUMER ALERT ON SNORING SOLUTIONS APPENDIX TWO: FDA PERSPECTIVE ON SLEEP APNEA APPENDIX THREE: FDA SLEEP DISORDER INFORMATION SHEET

INTRODUCTION No one remembers if Gary snored when he was little. As an infant, his mother remembered a few instances when he’d “saw twigs,” but that usually happened when he was congested. He might have snored as he grew, but no one would have noticed. Gary’s dad was a world-class snorer. In fact, his ear-busters were part of family lore. If little Gary was snoring the night away, no one could have heard him over the intermittent gasps, snorts and other sound effects emanating from Gary’s dad. A few years after a heart attack took Gary’s dad, however, it was clear that the boy was chip off the proverbial old block. He was only eleven, but you could hear him from the other side of the house with door closed at night. About this eBook This eBook offers an overall look at the issue of snoring. It addresses the extent of the snoring problem, the causes of snoring, the negative impact of the problem, and treatment options. The book is not designed to advocate a particular solution to the snoring problem. Nor was it written as a substitute for sound medical advice from a licensed professional. All information is believed to be accurate, but this guide should not take the place professional guidance and consultation.

THE SNORING EPIDEMIC The snoring was never a big problem for Gary as a kid. His family was conditioned to the noise and no one really gave it a second thought. Like father, like son. When he hit his early teens, he began to understand that his snoring was significant. He went on camping trips with his buddies and they’d insist that he pitched his tent on the opposite side of the fire, as far away as possible. They claimed they’d never get to sleep otherwise. He interpreted as half-truth, half-joke and it didn’t bother him too much when one of the guys would call him “the midnight lumberjack” because he spent all night “sawing logs.” You aren’t alone If you, or someone in your home, is a snorer, you certainly aren’t alone. In fact, medical experts like lung specialist Laurence Smolley claim that nearly forty-five percent of all normal adults have a tendency to snore. Others make even more startling claims. One source argues that snoring affects fifty million households in the United States alone. That’s over one half of the households in the country. Two thirds of adults living with partners report that their partners snore. Nearly sixty percent of all adults profess to snoring themselves, according to the National Sleep Foundation. In other words, snoring is anything but unusual. It’s more common than most people think and those who suffer from bouts of snoring should know that they are not alone in dealing with the problem. Debunking stereotypes Many people think of snoring as a “male thing.” The stereotypical image of a problem snorer is usually a middle aged, overweight man with a tendency toward over-eating or drinking.

It’s true that male physiology encourages snoring to some extent. It’s also true that dietary habits, the intake of alcohol and excessive weight can play a role in snoring. However, dismissing snoring as a uniquely male proposition is incorrect. Anyone can be a snorer. Infants and children are often known to “saw a log” during their slumber and many are diagnosed with sleep disorders including sleep apnea. Women are less likely to be problem snorers than men, but as they age the likelihood of snoring increases considerably.

Dismissing snoring as a

uniquely male proposition is incorrect...

Anyone can be a snorer.

Age matters Physiological changes explain why women tend to snore more as they age. Post-menopausal hormone shifts and changes in body fat distribution leave nearly forty percent of women over age sixty with a snoring habit. The age factor, however, isn’t unique to the fairer sex. A 1997 British Medical Journal study reports that that the percentage of snorers increases by approximately ten percent between the ages of thirty and forty. As we age, we are simply more likely to snore. WHAT IS SNORING, ANYWAY? The first time the snoring really bothered him was in college. He was assigned a roommate in the dorms, but that didn’t last long. They guy claimed he couldn’t get a good night’s sleep and demanded a transfer to another room. After a resident assistant did a little spying at the door one night, the roommate was gone the next day. Gary asked if they were going to assign someone else to share his room. The resident assistant mumbled something about finding a hearing impaired student and shook his head. Gary had the room to himself. He usually slept well, except when the guys next door decided to whack the thick dorm walls with a broom handle in the middle of the night when they could hear him. The physiology of snoring Snoring may be common, but it isn’t normal. It is symptomatic of a problem and should be taken seriously. Snoring can be defined as the noise produced when an individual breathes during his or her sleep. This breathing (particularly the process of inhalation) creates a vibration in the soft palate and uvula.

Those vibrations create a sound as the tissues contact one another in the back of the throat and in the nose. The uvula (the hanging entity in the back of your throat) and the soft palate (the soft spot on the roof of your mouth) aren’t the only body parts involved in snoring, though. Your adenoids and tonsils may also be involved in the noisemaking activity. That’s one reason why many non-snorers are known to create a racket when they are sick or congested. But we don’t snore in the afternoon So, why do we snore while sleeping but don’t saw logs during the day? It’s because of relaxation. When you sleep, your body relaxes deeply. Even your internal body parts take a break. Your throat muscles relax and when that happens, your airway closes partially. That might sound eerie, but it’s perfectly normal. However, if you add an obstruction of some sort to that natural closing of the airway, snoring can result. WHAT MAKES US SNORE? Gary graduated after five years of college. It should have taken him four years, but he had a nasty habit of dropping classes and that forced him to hang around one more year to earn the required number of credit hours. It wasn’t that he was a bad student. He just lacked the energy for education. Evening studying was difficult and every attempt to make it to early morning classes seemed to fall flat. Missing that Genetics final exam didn’t help him either. Gary had a tough time making it to eight o’clock tests.

The physiology of snoring isn’t that complicated, but understanding that your hanging uvula and soft palate are vibrating on top of a partially constricted airway doesn’t really explain why you might be snoring in the first place. There are a variety of potential snoring causes. Consider a few of them: You may have a naturally narrow throat. When you relax the natural

closing of the airway may encourage snoring. This genetic cause of snoring probably isn’t the most common explanation for a loud evening, but it may be part of the story.

Carrying extra weight or fat in the neck can also cause a more

restricted airway. That will, obviously, encourage snoring. Age naturally creates a narrowing of air passages, which makes

snoring more likely. This is why many women who have slept silently for decades suddenly find themselves snoring after menopause.

Smoking is a potential cause of snoring. When you smoke, muscles

relax. We’ve discussed the role that can play in the process. Additionally, inhalation of smoke creates lung and nasal congestion, which will also spur snoring. Many studies indicate that second-hand smoke exposure can also turn otherwise silent sleepers into snorers.

Irregularities with the nasal passageways may cause labored breathing and snoring. This may be a genetic situation or it may be caused by a facial trauma of some sort.

Enlarged tonsils or adenoids may create airway obstructions that lead

to more vibrations and, thus, more snoring. This can happen in cases of infection (such as tonsillitis) or when a person simply has adenoids or tonsils that are larger than average.

Those with long soft palates or extended uvulas are far more likely to

suffer from snoring than are others. Consumption of alcohol can cause snoring, as can some types of

medication. Again, the culprit is over-relaxation which leads to additional airway closure.

Sleep position can also play a role in snoring. When you sleep on your back, your throat’s flesh may relax and block your airway more than when on your stomach or side. Propping your head up on pillows may also create an angle that will contribute to blocking your airways, encouraging snoring.

Snoring may be

common, but it isn’t normal. It is

symptomatic of a problem and should be taken seriously.

SLEEP APNEA Monica was always proud of her traditional values, but sometimes she really wished she’d been a little more liberal about things before choosing a husband. She fell in love with Gary the first time the two of them met and their relationship grew comfortably and naturally from there. Fresh out of college, the two of them decided to tie the knot.

The honeymoon was the first time they spent the night together. It was also the first time Monica ever saw someone from hotel staff summoned to a sleeping guest’s room to quiet him down. She didn’t sleep a wink. She figured that, in time, she’d adjust. What is sleep apnea? Sleep apnea refers to breathing obstructions that force the sufferer to wake up in order to re-start their breathing. The word “apnea” refers to the absence of breathing, and as frightening as that idea is, it is exactly what happens to many problem snorers. Here’s what happens. The snorer suffers from a significant airway obstruction that prevents him or her from taking in necessary levels of oxygen. In essence, they stop breathing. Luckily, the body recognizes this danger even during slumber. It automatically triggers the body to “wake up” and to start breathing again when faced with a bout of apnea. The apnea sufferer wakes up, begins breathing again, and then goes back to sleep. Interestingly, these automatic “breathing bouts” may happen many times in any given night and yet the sufferer may not remember any of them. Although the body “wakes up” to the apnea threat, the conscious mind of the snorer usually doesn’t. Amazingly, someone with sleep apnea may believe they slept restfully through the whole night when, in reality, his or her body was engaged in a frequent and repetitive fight for oxygen. In many cases, the partner of the sleep apnea sufferer is more likely to wake up and have sleep disruptions than is the sufferer.

Snoring isn’t necessarily sleep apnea Although most every sleep apnea sufferer is a snorer, not all snorers have sleep apnea. Snoring is a symptom of sleep apnea, but snoring is not proof of a serious breathing obstruction warranting the apnea diagnosis. In other words, if you snore you might have sleep apnea. However, a tendency to saw logs isn’t proof positive that you have the disorder.

According to the National Sleep

Foundation, sleep apnea may affect

between twenty and forty percent of the

adult snoring population.

Sleep apnea is common It may seem unthinkable that millions of people are struggling to breathe every night and that many of them actually stop breathing, spared only by the body’s instinctive search for oxygen. That is, however, exactly what is happening in countless beds around the world every night. According to the National Sleep Foundation, sleep apnea may affect between twenty and forty percent of the adult snoring population. A BBC news story reported that nearly ten percent of all men between thirty and sixty suffer from sleep apnea.

That same report noted that as many as four percent of all women in the same age bracket have the disorder and, proving again that snoring-related problems are not an all-man phenomena, the journal Pediatrics has published research showing sleep apnea in up to ten percent of children! The dangers of sleep apnea When you think about what sleep apnea really is, it is easy to believe that this common problem carries with it some very real dangers. Although many people wrongly consider their snoring little more than a nuisance that occasionally forces someone to retreat to the living room sofa in order to get a night’s sleep, sleep apnea should be taken very seriously. The body is unable to breathe in cases of sleep apnea, and the disorder poses a very serious medical risk. Consider some of the potential health problems associated with sleep apnea: Sleep apnea causes accidents. People with sleep apnea are more

than six times more likely to be engaged in automobile accidents than those who don’t have the disease. That’s because all of those nightly efforts to regain one’s breath prevent the sufferer from getting adequate rest while sleeping. Drowsiness and an increased tendency toward accident result.

Sleep apnea is linked to strokes. According to the National Sleep

Foundation, people suffering from sleep apnea are four times as likely to experience a stroke. A 2002 study in the respected medical journal, Lancet, found that treating apnea reduced the risk of stroke by approximately twenty percent.

Sleep apnea is linked to heart disease. The same study found that

sleep apnea victims were three times more likely than the general population to suffer from heart disease.

Sleep apnea and hypertension are linked. American Family Physician reports that approximately one half of those people diagnosed with essential hypertension also suffer from sleep apnea. That isn’t a coincidence, as the same researchers found that half of those diagnosed with apnea suffer from elevated blood pressure. The link is clear.

Obviously, we have to take snoring seriously. Snoring can be a sign of sleep apnea and the stakes of having that disorder are too high to overlook. Snoring may be a cartoon punch line featuring a series of ZZZZZzzzz’s, but in real life it can be a life or death matter. Those with serious snoring problems must be aware of sleep apnea and its risks. At the same time, we should keep in mind that not all episodes of snoring are indicative of sleep apnea or any other potentially life-threatening malady. It does make sense to distinguish between serious and mild cases of snoring.

Snoring may be

a cartoon punch line featuring a series of

ZZZZZzzzz’s, but in real life it can be a life or death matter.

SERIOUS SNORING It’s hard to say whether Gary or Monica ever really explained why it wasn’t working. No one can remember either of them blaming the snoring, although Gary used to joke with co-workers that he was the only man in America forced to sleep on the couch even though he didn’t do anything wrong. Relationships are complicated and it would be too simplistic to lay the blame on those sleepless nights and all of that noise. Then again, all of that frustration and distance had to have some impact, right? In any case, Monica never made the adjustment. The marriage didn’t last. When is snoring really serious? You should consult with a physician if you have any reason to believe your snoring may be indicative of a potential health problem. That being said, there is a difference between mild snoring and the more serious forms of snoring that bring substantial health risks. The rule of thumb is quite simple. If your snoring stops when you shift your body position during sleep, it probably isn’t serious. If, however, the snoring continues regardless of your sleeping position, the problem may be more serious. You should also consider snoring a problem if you ever find yourself not breathing and needing to wake up in order to find your breath. If you are losing sleep from your own snoring, or interfering with the sleep of your partner, you should consider your snoring problematic. If you feel you are exhibiting signs of problem snoring, meet with a medical professional.

The risks associated with severe sleep disturbances like sleep apnea and problem snoring are serious and deserve equally serious attention.

You should consult with a physician if you have any

reason to believe your snoring may be indicative of a potential health problem.

How can you tell if and when you’re snoring? If you sleep alone, you may be snoring without even knowing it. In most cases, others tell snorers about their tendencies. A houseguest, a neighbor or a sleep partner is usually the one to break the bad news. If you don’t have a third party available to assess your snoring, you can find out about your noisemaking habits in one of two ways. Some people set an audio recording device and then check the tape in the morning. If you’re looking for a less technologically-oriented approach, you may just want to pay close attention to how you feel when you wake up in the morning.

After a full night’s sleep, you should feel refreshed. If you wake up and still fill drowsy or tired, that might be a sign that you spent your evening battling sleep apnea or severe snoring. If you aren’t feeling rested after sleeping, you may want to determine if you have a serious snoring problem. SNORING AND SLEEP DISRUPTION Gary settled into a rhythm. He switched to second shift at work. For whatever reason, that three-to-eleven shift seemed to be more productive for him than trying to work early in the day or very late at night. Things seemed to be going well. Until the car wreck. Gary didn’t see the guy coming. One moment everything was clear. The next moment he woke up in St. Regis Hospital with a nasty headache and plenty of plaster around his left leg and arm. On the bright side, he met Janice at the physical therapist’s office. She was coming off a work injury. They hit it off and things seemed to be going well until she told him in no uncertain terms that she’d never spend the night with him until he figured out a way to stop snoring. Snoring causes sleep loss for everyone Snoring causes sleep loss for both the snorer and anyone unlucky enough to share a bed with him or her. The snorer may wake up several times during the course of a night. The noise of the snoring may actually stir the snorer! In other cases, the snorer suffers through repeated punches, kicks, tugs, pulls and shoves from a partner who can’t sleep due to the noise and who hopes “manually repositioning” the snorer’s body will solve the problem. Those who suffer from sleep apnea or severe snoring may wake up repeatedly in order to breathe.

Of course, the snorer’s sleep partner also suffers. In many cases, the “innocent bystander” is the more adversely impacted of the two parties. He or she must suffer through sleepless nights, unable to slumber due to the noise produced by the snorer. It can be very difficult to sleep through snoring. In fact, snoring scores higher on the decibel scale for loudness than a normal adult conversation and may actually exceed the noise associated with a busy city street. The loudest snorers among us can occasionally reach seventy to ninety decibels in volume. When you compare that to the sixty decibels or a bustling city or the one hundred and ten decibels of a jet plane in flight, you get a good idea of why so many partners of snorers never seem to get a good night’s rest. Snoring puts a strain on relationships Those sleepless nights of noise can take a serious toll on even the strongest relationship. A Canadian study of married couples discovered that more than a third of respondents would prefer to live with a good sleeper than a talented lover! Snoring is obviously more than a mere inconvenience. A heavy snorer may wake his or her partner over twenty times within a single hour. That is right, loud snorers can prevent a partner from getting more than three solid minutes of sleep at a time. Those disruptions may not always be consciously recognized, but they do prevent one from experiencing the real rest necessary for proper health and energy. We’ll discuss the way that can affect one on a medical level later, but it is important to note here that the exhaustion associated with sleeping alongside a snorer often leads to relationship problems. In an effort to secure quality sleep, a snorer’s partner may seek asylum in another room of the house in order to find some restful quiet. Obviously, that can have a real impact on the dynamics of a relationship.

The impact on both conversational and physical intimacy can lead to feelings of isolation and frustration that can be destructive in any relationship. A recent British case shows just how extreme these problems can become. In 2006, an English woman was jailed after becoming so frustrated with her husband that she attempted to pour bleach down his throat to put an end to the snoring. She grew so angry with his high-volume snoring that she stabbed him, as well. Obviously, that is an egregious example of how snoring can hurt a relationship. Even most very loud snorers don’t need to worry about physical attacks due to their volume. However, problem snorers due often experience relationship problems as a result of the problem. The combination of exhaustion, frustration and concern about health creates a potent source of argument and friction.

In an effort to secure quality

sleep, a snorer’s partner may seek asylum in another room of the house

in order to find some restful quiet. That can have an

impact on a relationship.

Sleep deprivation is a real problem The sleep deprivation encouraged by snoring isn’t a mild inconvenience, either. Most people think of scoring’s dangers in more obvious medical terms. They worry about sleep apnea, heart problems or strokes. They may (usually unnecessarily) develop an anxiety regarding their ability to breathe when asleep, as well. Those are all serious symptoms of snoring, but the risks associated with the sleep deprivation snoring so often causes are also worth considering. Look at just a few of the horrible potential consequences of losing sleep to problem snoring: Sleep deprivation at night causes drowsiness during the day. In turn,

that encourages accidents and can decrease productivity. It also damages the overall quality of the snorer’s life.

Sleep deprivation is bad for the body itself, too. We sleep for a reason.

Restful slumber is necessary for the body to heal itself and to build up its immune system. Those who don’t sleep well risk a severely compromised immune system and attendant health problems.

Failure to get adequate rest and sleep also has a serious psychological

and mental toll. Constant drowsiness can lead to frustration, anger and a feeling of depression.

Physical skills are damaged by sleep deprivation, too. Both gross and

fine motor functions are impaired when one has too little deep sleep. Reaction times slow and one may be unable to adequately perform a variety of otherwise simple tasks.

Sleep deprivation can result in a lack of clarity of thought. Decision

making is eventually impaired by sleep deprivation. Serious snoring can have serious consequences on the level of sleep deprivation.

Even if other medical risks didn’t exist (and they certainly do), the challenges posed by the sleep deprivation associated with snoring would be reason enough to take action. The consequences of sleep deprivation are particularly worrisome because they don’t just affect the snorer. The snorer’s sleep partner can experience all of these dangers simply by virtue of trying to spend a night in bed with the snorer. MEDICAL CONSEQUENCES OF SNORING Gary didn’t see the doctor. He tried a few of those drugstore nasal strips and made an effort to make sure Janice fell asleep every night before he did. That allowed everyone to get to sleep, but that was about it. A ritual developed. “Honey, you’re snoring.” “Uhh huh…” “Roll over.” Like a dog, he did. Later there’d be a shake. After that maybe a shove. Occasionally, a little punch. Anything to “shake him out of it.” Usually, he was too tired to know what was happening, or at least he was in too much a stupor to do anything about it. Sometimes, though, he’d answer back by complaining or stumbling out of the bedroom to the sofa, mumbling angrily the whole way. Janice would never admit it, but she loved it when he got mad enough to leave for the couch. She’d stretch out, close her eyes…And sleep for a change. We’ve discussed the risks of sleep apnea, a pernicious form of snoring. We’ve also isolated some of the many risks of snoring stemming from sleep deprivation. Snoring also brings with it other negative medial repercussions.

If you still are not convinced that snoring is a serious problem that must be addressed, consider some of the medical problems produced by “sawing logs:” Links to strokes and heart attacks from snoring do exist. Researchers

have found that problem snorers (even those who do not carry an official diagnosis of sleep apnea) are more likely to suffer from these life-threatening maladies.

Snoring reduces oxygen flow. That means the body and the brain may

not get the oxygen it needs. This can result in premature death. Snorers, on average, don’t live as long as non-snorers and oxygen deprivation is often cited as a potential reason for this observable tendency.

Snoring and Type II diabetes are linked, as well. Those who snore are

more likely to develop the disease than are those who sleep quietly. Snoring isn’t merely a matter of making a little noise when the sun goes down. It can be an incredibly serious proposition and warrants real attention.

Sleep deprivation at night causes drowsiness

during the day. In turn, that encourages

accidents and can decrease productivity. It also damages

the overall quality of the snorer’s life.

SILENCING THE SNORE AT THE DRUGSTORE Those rabbit punches to the ribs and nights on the couch allowed Janice to survive Gary’s snoring, but they weren’t doing any favors for him. Always a slow riser in the mornings, Gary’s fatigue became even more pronounced. He tried to counteract his exhaustion by going from a morning cup of coffee to a full pot and trying to conserve his energy, which led to an overall reduction in activity. It may seem obvious to us, but Gary and Janice really hadn’t put two and two together yet. They knew Gary seemed fatigued. They felt a certain strain on their relationship. They knew he snored and that the bedtime ritual could get a little frustrating, but they didn’t see those gasps and snorts as a root problem. Most snorers never do. It just seems like a part of life. Something natural. No big deal. They snore and they survive. Snoring “cures” are nothing new Snoring isn’t a new problem and people have been looking ways to silence loud sleep partners for centuries. For many years, the preferred systems involved preventing snorers from sleeping on their backs. As noted earlier, those who sleep on their backs often experienced additional airway closure and, in many cases, changing sleep position can remedy non-serious snoring. That’s why sewing empty spools of thread to the back of pajamas was a common strategy early in the twentieth century. Many of today’s more technologically-advanced methods have their roots in this same way of thinking.

Folk remedies also have a place in snoring history. Many cultures and societies have advocated the use of particular herbal remedies and other tactics to reduce snoring. One could credibly argue that this age-old approach underlies many of today’s over-the-counter snoring solutions that rely upon proprietary herbal blends. If one searches through the patent office paperwork, they’ll discover literally hundreds of mechanized snoring solutions ranging from Rube Goldberg-style devices that seem downright unbelievable to today’s often-prescribed CPAP machines. Searching for a snoring cure is nothing new. Store-bought snoring remedies Although problem snorers should immediately seek medical treatment and professional consultations, many people first try to put an end to the problem themselves using readily-available over-the counter solutions. The proverbial jury is still out on many of these products. Some of them make strong claims about their ability to fight snoring, but may not deliver on those promises. A 2006 study by the Australian Consumers Association, for instance, found that there is only week evidence to support that most anti-snoring products can consistently alleviate snoring. That does not, however, mean that the products are useless. Many of them will reduce snoring for some individuals. The fact that there is no “sure cure” doesn’t mean that one can’t find relief with one of the products. It merely underlines the previously-established fact that there are many potential causes for snoring. It’s not surprising that no one has found a single “magic bullet” to remedy all snoring problems. Any experts suggest that snorers experiment with a variety of potential solutions in hopes of finding a simple remedy that will lead to a restful and quiet night’s sleep.

The range of available snoring solutions is amazing. Consider some of the options available to those who want to take on snoring themselves: Nasal strips are a popular means of combating snoring. These Band-

Aid like device are placed across the nose. They use the nose as a fulcrum, lifting the face outward and increasing the airflow through nasal passages. This, theoretically, should improve the user’s ability to breath without undue restriction, preventing snoring. Many snorers find relief with nasal strips, but the long-term costs associated with their purchase and the inconvenience of placing them on the face every night can be frustrating for some people.

Pills, often consisting of proprietary herbal blends are also available.

These products generally claim to prevent snoring by decreasing nasal congestion or somehow fighting airway restriction via some other technique. Although some people may find relief with these pills, there is little hard evidence to suggest that they have a high degree of efficacy. Users are also cautioned to remember that these herbal products do not undergo high levels of government scrutiny and that some people may experience adverse reactions to the pills.

Specialty pillows attempt to fight snoring by positioning the head and

neck in a way that discourages restriction of air flow. In some cases, a specially-molded “snorer’s pillow” can encourage nighttime slumber. One weakness of this strategy, however, is that movement during sleep may result in a person moving off of the pillow or incorrectly positioning his or her head on it, destroying its ability to stop snoring.

Throat sprays are also available to fight snoring. The idea is that a

lubricating spray of some sort can reduce friction and vibration between the soft palette and uvula. This, manufacturers argue, will decrease the level and volume of snoring. There is some logic to this approach and some users have reported silent nights after treating themselves with these sprays. Some are “enhanced” with herbal blends, as well. Even when they work for a user, however, these sprays simply may not last long enough to get someone through the night.

Other devices are available to discourage snoring. These often work based on the assumption that a change in sleep position and avoiding resting on one’s back will stop snoring. There are wristbands that will vibrate when one snores, encouraging the user to change position to avoid the annoyance, for instance. The manufacturers of these devices argue that one can be “trained” to maintain a correct sleep position. However, that kind of Pavlovian approach seems to have only minor effectiveness for most sleeping people.

Over-the-counter cures certainly have a strong appeal for many snorers. The idea of a simple, affordable intervention that will solve snoring without any medical bills or the hassles of a doctor’s visit attracts many snorers to the products. When one decides to combat snoring with these systems, they should keep in mind that snoring can be a serious medical issue. Although one may find relief by finding a product that’s a “perfect fit,” problem snorers are always advised to seek professional medical opinions. QUIETING THINGS WITH LIFESTYLE CHANGES Gary kept snoring. Janice kept pushing, punching and cajoling. Things certainly weren’t getting any better, but they persevered. When Timothy was born, the snoring became even more frustrating. Between late-night feedings and Gary’s volcanic snoring, no one was getting any sleep. Exhaustion was taking its toll on the family. The couple couldn’t wait for their little bundle of joy to fall into a pattern of sleeping through the night. Eventually, it happened. Janice woke up at four in the morning, shocked and a little bit frightened that she hadn’t heard a single cry all night over the baby monitor. The snoring was driving her nuts and she reached out to give Gary a little shove in hopes of silencing him. He wasn’t there. She vaguely remembered him leaving for the couch hours earlier. That familiar labored sound wasn’t coming from her husband. It was being piped into the room on the baby monitor. Timothy, like Gary, was a snorer.

Snoring and weight loss As we’ve noted, overweight people have a greater likelihood of snoring. In fact, many experts will tell you that being overweight is the number one cause of snoring over the entire snoring population. Additionally, people tend to snore more violently as they grow larger. Weight gain invariably produces even more snoring and more episodes of obstructed breathing. It should come as no surprise that losing excess weight or replacing fatty weight with muscle can reduce, if not eliminate, snoring. Fat loss stems snoring by decreasing the amount of fatty tissue in your airways. That’s right, losing fat doesn’t just mean looking better on the outside. It also means internal fat reduction and that can have a monumental impact on snoring. A 2006 study conducted in the United States involved one hundred overweight children who were places on exercise plans. After ninety days of after-school activity, the percentage of children who tested positive for serious snoring and sleep-disordered breathing was chopped in half! The children who were involved in the most rigorous of the exercise programs experienced an eighty percent decrease in problematic nighttime breathing and snoring. Dietary changes and a commitment to physical fitness have been described as the “easy cure” for snoring. Of course, that doesn’t mean dropping pounds and changing your lifestyle is an easy proposition. It can, of course, be very challenging. However, it is the most effective route to eliminate snoring for most people. It also has an obvious serious of attendant health benefits. Those who are more fit generally live healthier and happier lives in addition to avoiding the nightmares of sleep apnea and serious snoring.

You are what you eat Dietary changes do have an impact on snoring beyond weight loss and fitness. Many snoring sufferers have found they can minimize their problem by avoiding certain foods. A common example of this phenomenon relates to dairy products. Non-skim dairy products have a thickness that can result in improper draining of mucus. Retention of mucus in the throat, in turn, can increase the risk of snoring. A simple dietary adjustment may alleviate snoring for some people. Smoking and snoring Another effective means of fighting snoring with lifestyle change is smoking cessation. Cigarette smoking causes a swelling of mucus membranes, a swelling of throat tissue, muscle relaxation and a blockage of lung vessels. All of these represent the kind of breathing barriers that encourage snoring. There are a million and one good reasons to quit smoking. It’s an insanely unhealthy habit. One compelling reason to kick the habit is as a means of fighting snoring. Avoiding happy hour Alcohol consumption can cause snoring. Alcohol over-relaxes the body and encourages a collapse of the airways that represent the immediate cause of sleep apnea. If you’re snoring and you have a tendency to enjoy a few cocktails in the evening, you may want to rethink your habits. Many people find that cutting alcohol out of their lifestyle results in an immediate decrease in snoring.

Resting up can turn the volume down We’ve discussed the ways snoring can decrease the amount of restful sleep you get. Interestingly, that very lack of rest may be one reason why one is snoring in the first place. Here’s how it works: There are to parts of the sleep cycle in which unstable breathing is very likely. The first stage of sleep, right as you drift off is one of them. REM sleep (this is the part of sleep in which most people dream) is the other. If you aren’t sleeping well, you may never pass through Stage 1 into restful sleep. Instead, you will bob in an out of Stage 1 – which is the very period at which you are most vulnerable to snoring in the first place. It can be a vicious circle. Snoring causes lousy sleep and that lousy sleep keeps you locked into the very sleep stage that is most vulnerable to episodes of snoring! The solution? Do everything you can to get enough sleep. Don’t allow yourself to build a sleep deficit. Strive to get at least seven hours of sleep per night. You might discover that the additional sleep will help stave off that annoying snoring! MEDICAL CAUSES AND SOLUTIONS Hearing the baby snore finally did it. It finally got Gary’s and Janice’s full attention. Before you could say “midnight lumberjack,” Gary was in the doctor’s office and was scheduled for some sleep testing. He was nervous about the situation. After years of ignoring his snoring problem, he was suddenly confronted with some frightening facts about snoring and its serious potential consequences.

Gary was never a fan of spending time with physicians, but he finally understood that his snoring was much, much more than a minor inconvenience. As he waited in the lobby to see the doctor, he began to make connections between his nighttime tendencies and many of the problems he’d experienced over the years. He was still on edge, but he was hopeful, too. If he could find a way to avoid snoring, the quality of his life and his relationships could improve drastically. Medical problems can be at the root of snoring Lifestyle, food choices, genetics and a slew of environmental factors encourage snoring, but in some cases the root cause of the problem can be traced back to a medical condition. Your snoring could be a symptom of another condition. Consider a few of the potential medical causes that often underlie nighttime breathing and snoring problems: Asthma can cause snoring. A wealth of evidence clearly shows that

those suffering from asthma are far more likely to be snorers than other population groups. Asthma could be at the root of your snoring problem, and medical intervention to treat the ailment might produce quieter nights.

Allergies are another regular cause of snoring. People with allergies to

airborne particles often develop nasal blockages that produce snores. Animal dander, pollen, and other allergens are often responsible for snoring. When the allergy is treated in these cases, the snoring often disappears. Stopping snoring might require nothing more than avoiding cats or closing the windows at night.

Throat blockages are an easy way to make otherwise quiet sleepers

into rumbling monsters. Swollen glands and tonsils can produce snoring.

Serious medical conditions including diabetes and hypothyroidism are also capable of making someone snore. Those nights spent sawing logs could be evidence of a serious underlying medical condition warranting professional treatment.

When people tell you snoring can be a serious issue, they mean it. The snoring itself poses its own collection of serious health risks. In addition to those concerns, it is entirely possible that snoring is a sign that something else is wrong, too. Some of the medical causes of snoring are far less than life-threatening. An allergy to the lilac bush outside your bedroom window for instance may make you snore while not rising to the level of a medical emergency. Some medical causes, however, are incredibly serious. Your snoring could be a clue that you are suffering from a far more dangerous medical condition. In these cases, seeking treatment for the underlying condition can eliminate the snoring problem. This is yet another reason why problem snorers should seek professional medical assistance. MEDICINAL CAUSES OF SNORING Luckily, Gary wasn’t suffering from a life-threatening illness. He was, however, putting himself at risk of a serious medical situation if his snoring continued unabated, his doctor explained. The doctor explained that Gary’s snoring was probably the byproduct of several different factors. Genetics played a definite role in the situation. Gary’s airway was naturally smaller than usual and he had a healthy, but slightly oversized uvula. That wasn’t the sole issue, however. The doctor ran through a long list of factors that were probably contributing to the snoring.

Gary wasn’t a drinker, but he did enjoy an evening cigar. The doctor recommended immediate cessation. Gary was also overweight and the sleep expert recommended an exercise program. Gary asked about over-the-counter products. His doctor shrugged. “You might find something to help,” she said, “but your best bet is to lose the weight and to stop the smoking. Let’s work with that and see what happens, okay?” Gary nodded. He couldn’t believe he was going to walk away from this appointment with a cure based on giving up his cigars and big dinners. It seemed too easy. It was. “Gary,” the doctor said, “I want to talk with you about something called a CPAP machine. Are you familiar with what that is?” You’ve undoubtedly realized that anything that can affect breathing or airway access can have an impact on snoring. We’ve discussed the ways by which some medical conditions can cause a snoring problem, but sometimes the cure for a particular malady can actually instigate heavy snoring, too. There are many different medicines that can cause or encourage snoring. Consider just a few examples: Antihistamines can create a nighttime racket. Antihistamines relax the

throat muscles. That, as we’ve noted elsewhere, can cause an excessive collapse of airways, which results in snoring.

Muscle relaxants are another source of snoring. The over-relaxation

they produce encourages the airway constriction that underlies snoring.

Prescription pain medications can also produce snoring due to the

over-relaxation factor.

Other prescription drugs may have side effects that encourage circumstances conducive to snoring. If you are developing a problem with snoring and regularly take a prescription medication, discuss the possibility of a relationship with your physician and pharmacist.

If your medications are causing you to snore, you may want to discuss alternatives with your doctor. In some cases, snoring may be a temporary and unavoidable consequence of necessary medication. In other situations, however, it is possible that a medicine designed to reduce the symptoms of one problem may create an even more serious situation by encouraging excessive snoring. SOLVING SNORING WITH APPLIANCES AND INSTRUMENTS Gary was familiar with CPAP. He had never actually seen one of the machines, but in the recent push to get his snoring under control, he had read a little bit about them. “They’re like oxygen masks or something, right?” “Well,” his doctor replied, “somewhat. But not exactly.” She pulled a small machine with slender hose attached to it out from one of the cabinets. “Let me show you. Gary, your snoring is serious and although I think an aggressive approach to fitness might eventually get things under control, I’m going to recommend you use one of these devices in the meantime.” Gary recoiled at the idea of sleeping while connected to a machine. This was not what he wanted. But he knew he didn’t really have a choice. “This is a CPAP device,” she began.

Dental devices and similar solutions Some snorers find relief by using dental devices designed to keep airways upon and unobstructed. These devices work to bring the tongue forward and/or to lower one’s jaw while sleeping. This can have a dramatic effect on airflow and can often prevent snoring. Devices like these are distributed by medical professionals. They are usually made of acrylic or something similar. They fit inside the mouth of a snorer and may be reminiscent of a childhood orthodontic device or a sports mouthpiece. Other appliances actually fit outside one’s head, relaying up straps or some similar apparatus to reposition the lower jaw. These devices can work effectively for some people, but others find them very difficult to use. It can be difficult for people to fall asleep while wearing the equipment. Continuous positive airway pressure (CPAP) A CPAP machine may look like a small oxygen mask and pump. Although it does share some similarities with that kind of breathing assistance device, it really is a very distinct entity from using oxygen. CPAP machines are designed to keep one’s airways open during sleep. A small device pumps pressurized air through a tube and into a small mask worn by the sleeper. Depending on one’s snoring situation, the mask may be placed over the nose, the mouth or the lower half of the face. The pressurized air prevents the airway collapses that often result in snoring. CPAP is often a very successful snoring treatment. It is frequently prescribed in serious snoring cases and for those who suffer from sleep apnea. Not surprisingly, many snorers dislike the idea of being attached to a machine through the night.

They may feel constrained or uncomfortable wearing a mask and having a tube trail from their face to a bedside device. The whole process can feel quite unnatural. However, most individuals who use CPAP soon develop such an appreciation for its efficacy that they overlook the drawbacks associated with its use. In many cases, a physician will prescribe CPAP for a problem snorer while simultaneously pursuing other treatment methods. In time, the patient may be able to sleep quietly without use of the device. An appliance you wouldn’t expect Dental devices and CPAP represent medial innovations designed specifically to prevent snoring. If you go to Australia, you can find another interesting “device” with a very different history. The Australian aboriginal population has long used the didgeridoo as part of its musical tradition. The elongated wooden wind instrument produces a unique, deep sound. It may also fight snoring. The breathing manipulations required to play the didgeridoo seem to strengthen the upper airways. Training to play the instrument may relieve snoring in some people. A 2005 report in the British Medical Journal found that those who regularly played the instrument snored less and experienced a reduction in the amount of disturbances to sleep partners. If you have a taste for exotic music and are looking for a unique way to combat snoring, you might want to pick up this decidedly non-medical instrument! SURGICAL SOLUTIONS FOR SNORING Gary didn’t like the idea of the CPAP machine and he found it difficult to adjust to the device at first. In time, however, he managed to fall asleep more easily.

Janice noticed the difference almost immediately. After a few weeks of use, Gary started to notice a change, too. Not only was there less snoring, he was waking up feeling far more energized than he had in years. He was less sluggish, more attentive and happier than he could remember. He was also thankful that his condition could be treated without a surgical intervention. He continued to take his daily walk on the treadmill. He ate healthier foods. He even managed to break the cigar habit. Things were getting better. An overview of snoring surgeries No one likes to “go under the knife,” but in some cases the best way to remedy problem snoring is by surgery. A variety of different procedures exist to eliminate snoring. The exact method chosen by a surgeon will depend upon the exact cause of a patients’ snoring, his or her physical features and musculature and a host of other factors. Almost all snoring procedures work based on the basic idea of increasing airflow by removing excess tissue from the airways. The tissue in question may vary with the patient, but that core concept is usually at the heart of the procedure. Somnoplasty Somnoplasty is a relatively new procedure that is gaining in popularity. Somnoplasty involves heating the tissues of the patient’s soft palette with radio frequency energy. The procedure takes about a half hour and can be performed under a local or general anesthesia.

Somnoplasty works because the heated tissue cells die and are then naturally removed by the patient’s immune system. The procedure basically encourages elimination of excess soft tissue located under the soft palette as a means by which to eliminate snoring.

No one likes to “go under the knife,” but in some cases the best way to remedy problem

snoring is by surgery.

Uvulopalatopharyngoplasty (UPPP) With a name like “uvulopalatopharyngoplasty,” it’s no wonder people refer to this procedure by the acronym UPPP. UPPP involves surgically removing excess tissue at the back of one’s throat as a means of eliminating the airway obstructions that cause snoring. The uvula itself is also removed. The resulting widened airway facilitates better air flow and can eliminate snoring altogether for many patients. Although a surgeon may use a scalpel to perform the UPPP procedure, laser-assisted variations of the procedure are growing increasingly common.

Tonsillectomy and adenoidectomy As noted, enlarged adenoids and/or tonsils can be a cause of snoring. In these cases, the logical surgical solution is removal of these non-critical elements. When one’s tonsils or adenoids are blocking airways and causing snoring, this relatively simple procedure can solve the problem. Nasal septoplasty Sometimes, snoring is the result of blocked nasal passages. In most cases, those blockages are the result of a nasal deformity present since birth or that occurred as the result of a significant facial trauma. Nasal septoplasty rectifies the situation by straightening the bone, septum and other surround tissues that may be interfering with proper breathing. Nasal polypectomy In some cases, breathing is obstructed due the growth of polyps that find their way into nasal passages. Nasal polypectomy is a procedure to remove those round tissue growths to restore appropriate airflow. Most snorers would prefer to avoid a surgical procedure, but in some cases these interventions are the best possible way to eliminate problem snoring. Surgical innovations are always underway and the proven techniques used to combat problem snoring may seem extreme, but can be necessary and effective in the right circumstances.

CONCLUSION Gary’s son, Timothy, never really snored again. That one night – the event that finally motivated him to take action – was a fluke. The child was probably congested and the snoring a mere anomaly. Meanwhile, Gary continued on the doctor-recommended fitness program and swore off his cigars. Motivated by his newfound energy and the restful nights with CPAP, he worked toward becoming a “permanent” non-snorer. Janice felt better, too. She worried about him less, slept better, and discovered energy she didn’t know she had. Eventually, Gary approached his target weight and, with his doctor’s approval, slept without the CPAP device. Janice and Gary turned out the lights at 10:30 p.m. Timothy woke them up the next morning. Snoring is serious. It isn’t a mere inconvenience or an interesting eccentricity. It is, in and of itself, a medical risk. It may also be a symptom of a serious medical problem. It can crush relationships, shorten life-spans and wreck the quality of one’s life. If you are a problem snorer, take action now. If a loved one is sawing logs every night, encourage them to take proactive measures to combat the problem. Although snoring can be a tremendous hardship and an unacceptable medical risk, it is treatable. Some people will find relief through a few simple lifestyle changes. Others may discover a cheap, readily available over-the-counter solution. One may have to look at medical treatments or even surgery.

Regardless of how one beats snoring, the important thing is that they see the fight through to the end and find a way to sleep through the night without creating an unnecessary risk for themselves and an abysmal situation for their sleep partner.

If you are a problem snorer, take action now. If a loved one is

sawing logs every night, encourage them to take proactive measures to combat the problem.

APPENDIX ONE: FTC CONSUMER ALERT ON SNORING SOLUTIONS The Federal Trade Commission of the United States government has issued the following consumer alert about various advertisements and products that claim to cure or treat the symptoms associated with sleep apnea:

Can Anti-Snoring Claims Be Cause for Alarm? Remember the adage, "Laugh and the world laughs with you. Snore and you sleep alone"? For chronic snorers and anyone who has to listen to them, anti-snoring products can sound like a dream come true. But before you start catching zzzz's, consider this: Ads for some of these products are making unsubstantiated claims that the products can cure or treat the symptoms of sleep apnea, a serious, potentially life-threatening disorder. The Federal Trade Commission is concerned that these misleading claims may keep some snorers from getting the medical treatment they need. Sleep apnea affects at least 12 million Americans of all ages, according to the American Sleep Apnea Association. It causes brief interruptions of breathing during sleep when a blockage in the upper airway restricts air flow. Sleep experts advise chronic snorers or people who think they may have sleep apnea to see their physician or a sleep specialist. The FTC warns consumers to be suspicious of anti-snoring product claims that: refer to snoring as a medical condition; infer that the product can treat or cure symptoms of sleep apnea, like

daytime tiredness, headaches, lack of concentration, interruptions in breathing, and partial awakenings; and

refer to the mechanics of sleep apnea; for example, how a restricted airway causes a person to awaken to take a breath.

The FTC works for the consumer to prevent fraudulent, deceptive and unfair business practices in the marketplace and to provide information to help consumers spot, stop, and avoid them. To file a complaint or to get free information on consumer issues, visit www.ftc.gov or call toll-free, 1-877-FTC-HELP (1-877-382-4357); TTY: 1-866-653-4261. The FTC enters Internet, telemarketing, identity theft, and other fraud-related complaints into Consumer Sentinel, a secure, online database available to hundreds of civil and criminal law enforcement agencies in the U.S. and abroad.

APPENDIX TWO: FDA PERSPECTIVE ON SLEEP APNEA The following article was produced by the U.S. federal government’s Food and Drug Administration as a public service to advise citizens on the nature of sleep disturbances and sleep apnea:

Tossing and Turning No More: How to Get a Good Night's Sleep by Tamar Nordenberg

Come, blessed barrier between day and day, Dear mother of fresh thoughts and joyous health! – William Wordsworth in "To Sleep" (1806)

For years, there were no refreshing lulls between days for Lauren Ero. Rather than waking up feeling clearheaded and healthy, the 37-year-old mother of two spent four years perpetually listless and moody. "Those years are like a fog to me. I just remember how hard it was and how hopeless I felt," she says. "I would be more tired in the morning than when I went to bed the night before. I was too exhausted to do even day-to-day activities like taking care of my kids and things around the house." Ero was suffering not from depression, as one doctor surmised based on her look-alike symptoms of despondent mood and irritability, but from insomnia. The definition of insomnia, according to the American Sleep Disorders Association (ASDA), is difficulty falling asleep or staying asleep. If it occurs every night or most nights for an extended time, like Ero's, it's called chronic insomnia. According to ASDA estimates, more than 35 million Americans suffer from this long-lasting type of insomnia, with 20 to 30 million others suffering shorter-term sleeplessness. Men and women of all ages experience insomnia, but it is more common in the elderly and in women, especially

after menopause. The consequences of a "Sleepless Society" can be serious. Overcoming Roadblocks to Sleep Like a headache or fever, insomnia may be a symptom of another problem. It can result from something as simple as anticipating a stressful event, like a test or meeting, or from a longer-lasting stressful circumstance, such as a sick child or troubled marriage. Even worrying about having a tough time falling asleep may itself prevent a person from drifting off. Other common causes of nighttime wakefulness include environmental disturbances, such as noise from traffic or television, an uncomfortable temperature, or light from the sun or other source; use of alcohol or stimulants, such as caffeine or nicotine; and erratic hours, like those of shift workers and people whose air travel takes them across time zones. Sometimes short-term insomnia may go away on its own or with simple changes in daytime or sleep-time habits. (See "Wooing Sleep.") If these lifestyle changes don't work, the careful use of sleeping pills approved by the Food and Drug Administration may help provide temporary relief from insomnia. A doctor can help choose an appropriate medicine. One factor to consider is the drug's half-life, or the time it takes to be cleared from the body. Drugs with shorter half-lives are less likely to have carry-over sedation that affects daytime functioning. A second factor is the drug's toxicity. Because of their lower risk of overdose, the newer benzodiazepines and benzodiazepine-like drugs are used more often to treat insomnia than barbiturates and other older drugs. Among the most commonly prescribed benzodiazepine sleep-aids are flurazepam (Dalmane), estazolam (ProSom), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion). The prescription sleep-aid zolpidem (Ambien) is in the imidazopyridine class of drugs. As a rule, these sleeping pills should be used only for short periods because of the risk of developing dependency and withdrawal symptoms when the drugs are stopped. So, while they may help with short-term insomnia induced by jet lag, shift work schedule changes, or short-term stress, they should generally not be used for chronic insomnia because of

their potential addictiveness and because they can mask underlying medical problems. Some other sleep-aids are available without a prescription, including diphenhydramine (in Nytol, Sleep-Eze, and Sominex) and doxylamine (in Unisom Nighttime). These products contain a sedating antihistamine and, like prescription drugs, must be used with care. Even if taken at night, they can cause daytime drowsiness, which can make driving and other tasks risky. Sleep Apnea: More Than Simple Snoring Unlike short-term sleeplessness, chronic insomnia is often a symptom of a serious underlying medical disorder. Depression and other psychiatric disorders account for many cases of insomnia, as do wholly physical illnesses, such as asthma, arthritis, Parkinson's disease, kidney or heart disease, and hyperthyroidism. Sleep apnea is among the most common and most dangerous types of sleep disorder. An estimated 18 million Americans have the condition, which is marked by repeated episodes of cessation of breathing during sleep that over time can lead to high blood pressure, cardiac disease, and disordered thinking. Sleep apnea was the culprit in Lauren Ero's case. After two years of trying various antidepressants that offered her no relief, Ero sought a second medical opinion and was sent for a sleep analysis. "Then it was really obvious what it was," says Ero, who recently began working for the American Sleep Apnea Association. "It was a classic case." The tests revealed what Ero didn't know and what her husband hadn't found alarming: Ero was snoring. But her "snoring" problem was distinct from the merely annoying type because she was also gasping for air throughout the night--possibly tens of times each hour--which repeatedly roused her out of her refreshing, deep sleep. The results were the telltale signs of sleep apnea: excessive daytime sleepiness and difficulty functioning. Obstructive sleep apnea is by far the most common type. Breathing is interrupted when air can't flow into or out of the nose or mouth. The

reason for the blockage could be an over-relaxation of the throat muscles and tongue, which partially blocks the airway or, in obese people, an excess amount of tissue in the airway. Those with receding chin lines are also at higher risk for developing obstructive sleep apnea. In the less common form, central sleep apnea, breathing is stopped not because the airway is closed but because the diaphragm and chest muscles stop working. Mild cases of obstructive sleep apnea can sometimes be treated by making simple behavioral changes, such as avoiding alcohol, tobacco, and sleeping pills; losing weight; and sleeping on one's side. Also, oral devices to prevent obstruction of the airway by holding the tongue or jaw forward may help with mild cases. The most common effective treatment for obstructive sleep apnea is nasal continuous positive airway pressure, or CPAP. The patient wears a soft plastic mask over his or her nose while sleeping. A device supplies pressurized room air through a flexible tube attached to the mask. The pressurized air acts as a splint to prevent the airway from collapsing. "You have to get used to wearing a mask while you sleep," says Ero, who has been using the CPAP device nightly since 1996. "But you feel so much better, it's worth the hassle. Within two weeks after starting to use it, I felt like a different person. I have so much energy now." Surgery to increase the size of the airway is another possible option for sleep apnea treatment. The removal of adenoids and tonsils, especially in children, or other growths or tissue in the airway is sometimes effective, as are other, relatively more risky surgical procedures, including uvulopalatopharyngoplasty (shaving of the excess soft tissues in the mouth and throat) and tracheotomy (creating an opening in the neck through the windpipe) for the most severe cases. The newest device for this condition is Somnoplasty, used to treat mild cases of sleep apnea. It is a radio frequency surgical device that shrinks the soft palate in a half-hour outpatient procedure. FDA approved the Somnoplasty device in July 1997.

When to Worry Just as snoring isn't always a sign of dangerous apnea, neither is a sleepless night or two necessarily a medical emergency. Sometimes sleep patterns differ based on simple factors like age and lifestyle. Bob Rappaport, M.D., a sleep medicine specialist, neurologist, and FDA drug reviewer, encourages people to consider getting help if their sleeplessness persists and appears to be unrelated to life circumstances.

APPENDIX THREE: FDA SLEEP DISORDER INFORMATION SHEET The Food and Drug Administration created the following overview of sleep disorders, their risks and their treatment:

Sleep Disorders

Most adults need at least eight hours of sleep every night to be well rested. Not everyone gets the sleep they need. About 40 million people in the United States suffer from sleep problems every year. Not getting enough sleep for a long time can cause health problems. For example, it can make problems like diabetes and high blood pressure worse. Many things can disturb your sleep: working long hours stress a sick child light or noise from traffic or TV feeling too hot or cold wine, beer, or liquor

Common types of sleep disorders:

insomnia feeling sleepy during the day snoring sleep apnea

Insomnia includes: trouble falling asleep difficulty falling back to sleep waking up too early

Insomnia is more common in females, people with depression, and in people older than 60. Most people will have trouble falling asleep from time to time. It is usually nothing to worry about. Stress, like the loss of a job or a death in the

family could cause problems falling asleep. Certain medicines can make it hard to fall asleep. Drinking alcohol or eating too close to bedtime can keep you awake, too. Insomnia is called chronic (long-term) when it lasts most nights for a few weeks or more. You should see your doctor if this happens. Treatment Taking medicine together with some changes to your routine can help most people with insomnia (about 85 percent). Certain drugs work in the brain to help promote sleep. Feeling Sleepy During the Day Feeling tired every now and then is normal. It is not normal for sleepiness to interfere with your daily life. Watch for signs like: slowed thinking trouble paying attention heavy eyelids feeling cranky

Tips for Better Sleep Go to bed and get up at the same times each day. Avoid caffeine, nicotine, beer, wine and liquor in the four to six hours

before bedtime. Don’t exercise within two hours of bedtime. Don’t eat large meals within two hours of bedtime. Don’t nap later than 3 p.m. Sleep in a dark, quiet room that isn’t too hot or cold for you. If you can’t fall asleep within 20 minutes, get up and do something

quiet. Wind down in the 30 minutes before bedtime by doing something

relaxing. Several sleep disorders can make you sleepy during the day. One of these is narcolepsy. People with narcolepsy feel very sleepy even after a full night’s sleep. It is normal to take between 10 and 20 minutes to fall asleep. People who fall asleep in less than five minutes may have a serious sleep disorder.

Snoring Snoring is noisy breathing during sleep. It is caused by vibrating in the throat. Some people can make changes that will stop snoring. These include: losing weight cutting down on smoking and alcohol sleeping on your side instead of on your back

Treatment You can buy over-the-counter nasal strips to help prevent snoring. You place one over your nose before going to bed to make breathing easier. Sleep Apnea Snoring loud and often, together with too much daytime sleepiness, may be signs of sleep apnea. Sleep apnea is a very common sleep disorder. It is also very dangerous. The most common type of sleep apnea happens when your breathing stops during sleep. It can stop for about 10 seconds to as long as a minute. You wake up trying to breathe. This stop-and-start cycle of waking to breathe can repeat hundreds of times a night. The danger is that some time you may not wake up to breathe. If this happens, you can die. You are likely to feel sleepy during the day if you have this problem. People with sleep apnea tend to be overweight. It is more common among men than women. Treatment The most common treatment is a device that pushes air through the

airway. This device is called a CPAP. Avoid beer, wine, liquor, tobacco, and sleeping pills. Your doctor may also suggest you lose weight. In some cases, you may need surgery to make the airway bigger.

To Learn More: National Center on Sleep Disorders Research Two Rockledge Centre, Suite 10038 Washington, DC http://www.nhlbi.nih.gov/about/ncsdr/index.htm U.S. National Heart, Lung, and Blood Institute 6701 Rockledge Drive, MSC 7920 Bethesda, MD 20892-7920 301-435-0199 www.nhlbi.nih.gov/about/ncsdr U.S. Food and Drug Administration (FDA) 5600 Fishers Lane Rockville MD 20857-0001 1-888-INFO-FDA www.fda.gov DISCLAIMER AND/OR LEGAL NOTICES:

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