Sleep Disorders: Snoring and Sleep Apnea
Guest: Dr. M. Boyd Gillespie – Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatrist
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. M. Boyd Gillespie, who is an otolaryngologist; a specialist in Ear, Nose, and Throat. He’s Director of the MUSC Snoring Clinic. Welcome, Dr. Gillespie.
Dr. M. Boyd Gillespie: Thank you.
Dr. Linda Austin: Snoring seems like a really common problem. Just how common is it?
Dr. M. Boyd Gillespie: Snoring is extremely common, and it tends to get worse as we age. In the United States, about 40 percent of men are chronic snorers at nighttime; and about 20 percent of women. So, this is roughly 50 to 60 million people in the United States.
Dr. Linda Austin: Are any groups of people especially prone to snoring?
Dr. M. Boyd Gillespie: There are characteristics that do influence snoring. Certainly, weight is a major contributor to snoring, so there’s a tendency to have worse snoring with increased body weight. However, there are some people that are thin who snore loudly as well. We think that some of this may also be genetic. So, if someone has a parent who snores loudly, often they will snore loudly as well.
Dr. Linda Austin: Now, you run the Snoring Clinic, so obviously snoring can become a true clinical problem for some people. When should a person become concerned about his or her snoring?
Dr. M. Boyd Gillespie: Snoring may just be what it is; snoring, which is a turbulent airflow while breathing at night that causes a loud sound. This can affect people’s quality of life, and the quality of life of their bed partner. If that’s the case, it should be evaluated. However, snoring may also be the sign of a more serious medical condition, such as sleep disorder breathing or sleep apnea. What may lead someone to get an evaluation is the feeling that when they wake up in the morning they don’t feel refreshed, or they tired, or they’re excessively sleepy or tired throughout the day. Also, if their spouse, or bed partner, notices pauses in their breathing, they would certainly benefit from having an evaluation of their snoring.
Dr. Linda Austin: Now, you used the term sleep apnea, just what is that?
Dr. M. Boyd Gillespie: Sleep disorder breathing is really a spectrum of disorders. On the one hand, you have snoring, at one end of the spectrum, which is mainly a disruptive sound during breathing that affects sleep quality. At the other end of the spectrum, you have sleep apnea, which is an actual medical condition where there are stoppages in breathing. It’s not a partial collapse of the airways during sleep, but it’s a complete collapse that leads to problems with respiration and getting the body the oxygen it needs during sleep.
Dr. Linda Austin: And then what happens? You know, you’ll hear people snore, go silent, gasp, wake up a little bit, and then go back to sleep. Are there long-term consequences of having that happen?
Dr. M. Boyd Gillespie: There are. Patients who have periods of apnea, or stoppages in their breathing during sleep; you’re correct, they have to wake up to take a breath. Patients with this will have multiple episodes during the course of sleep of waking up to take a breath. That doesn’t allow them to get to the deeper restorative sleep. So, these patients are excessively sleepy because they never really get to deep sleep during the course of the night.
That can be quite dangerous and lead to increased risk of motor vehicle accidents, or other accidents with heavy machinery, and also reduce quality of life. Also, every time someone wakes up to take a breath, their blood pressure rises. If this is repeated night after night, year after year, this remodels the blood vasculature, and can increase resting blood pressure and put stress on the heart, increasing the risk of heart disease and stroke.
Dr. Linda Austin: Now, clearly, you can be a snorer and have sleep apnea, but can you have sleep apnea and not be a snorer?
Dr. M. Boyd Gillespie: Rarely. Snoring is typically the major sign of sleep apnea. The folks for whom snoring is not a problem, and they have sleep apnea, are typically people who sleep alone. There’s a percentage of our population that does sleep alone, and they don’t know if they snore or not; they haven’t been told. However, if they’re waking up with a headache or a feeling that they didn’t get a good night’s sleep, or if they’re waking up multiple times during the night, they may have sleep apnea, and they would benefit from an evaluation.
Dr. Linda Austin: Let’s imagine I’ve come to you because I’m a snorer and I’m not feeling very well rested, and my husband is complaining about it, how would you go about evaluating me?
Dr. M. Body Gillespie: The first part of the evaluation would be to determine the quality of your sleep. That includes a basic history of when you go to bed, when you wake up. The first thing we want to make sure of is that you’re actually getting enough sleep at night. Secondly, we have some forms that you fill out, some questionnaires that allow us to gauge how sleepy you are. We know from testing people who don’t snore or have sleep apnea, compared to people who do snore and have sleep apnea, where the normal range is. We can actually determine how sleepy you are and find out if you’re in the abnormal range.
Dr. Linda Austin: Tell us more about that. Exactly, how do you determine that?
Dr. M. Boyd Gillespie: There’s what we call a validated, or tested, questionnaire called the Epworth Sleepiness Scale. It’s a simple eight-question questionnaire that’s been shown to be highly predictive of sleep apnea. If patients score above a certain level on that questionnaire, it leads us to be concerned that they may have sleep apnea, and encourage us to do further testing.
Dr. Linda Austin: What are some of the questions on that?
Dr. M. Boyd Gillespie: Some of the questions ask about your level of daytime alertness, for instance: Do you ever get sleepy while driving? If you’re sitting still after lunch, do you tend to nod off? Do you fall asleep while doing activities such as sitting and watching TV, or reading? So, it’s a series of questions based on common everyday activities and your level of sleepiness during those activities.
Dr. Linda Austin: So, let’s imagine that you determine that I have a problem, that I have excessive daytime sleepiness, what’s the next step in your evaluation?
Dr. M. Boyd Gillespie: At that point, we would encourage you to undergo an overnight sleep study. The overnight sleep study is a special study where you actually go into a sleep lab in the evening ours; usually checking in around 9:00, 10:00 at night. You sit until you’re ready to go to sleep. And when you’re ready to go to sleep, an attendant at the sleep lab will hook you up to some monitors that will monitor your breathing, your heart rate, and your oxygen during sleep, and then you’ll just go to sleep as you normally would. Then, a special computer there will record your sleep and give us some idea of how you’re breathing during sleep.
Dr. Linda Austin: So, let’s imagine that I do, in fact, have sleep apnea, what would you do then?
Dr. M. Boyd Gillespie: The recommendations for how to treat sleep apnea depend on the individual situation. The sleep apnea can be mild. It can be moderate in degree, or it can be severe in degree. Our recommendations for treatment often depend on where you fall along that spectrum.
Dr. Linda Austin: Dr. Gillespie, let’s talk about the treatment in another podcast, but I want to thank you so much for talking with us today.
Dr. M. Boyd Gillespie: Certainly.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.