Airway Problems, Snoring and Sleep Apnea: Part 2

By Carol Waldman January 27, 2014

Last week I discussed with you some of the types of airway problems that are occurring in the general population.

This week, I would like to focus on the most common of airway problems: Snoring and Sleep Apnea

The reason that these two problems are put together is that they are commonly (but not always) occurring together and are part and parcel of the same condition: Restricted airway occurring during sleep.

As I discussed previously, when asleep, our bodies and our muscles relax. In our mouths, nose and chest, the muscles that help to keep the breathing passageways open, also relax. This includes the tongue. The tongue often repositions itself during sleep into a more retruded (backwards) position and this repositioning can help block our airways. In addition to the tongue, our palate and uvulae (what my kids call the ?hangy ball thing?) at the backs of our throats also droops and contributes to restricted airflow. And to make matters even more constricted, our tonsils and adenoids if enlarged further restrict air flow. Adding even further is weight gain. Patients who tend to put their weight on around their necks (larger collar size) also are at increased risk of reduced airflow into the lungs.

So what exactly is ?snoring? and ?sleep apnea?’

Well as discussed last week, snoring the audible sounds made by the person while sleeping. This noise is mostly caused by a couple of things. The first is the turbulence of the air that the patient is trying to force through the restricted airway that can make a whistling sound ?or even sound like a locomotive for those whose airways are particularly restricted. Other causes of noise are the vibrations of the tissues in the throat as the turbulent air is moving past it. (Sounding like a storm).

Sleep apnea occurs then the airway becomes so obstructed that no air movement occurs. When this happens, the brain becomes saturated with carbon dioxide instead of oxygen and this increase of carbon dioxide will cause the brain to send a wake up signal to the patient who will suddenly wake up and take a big gasp of air. Sometimes these people might even feel like they are dying (which they are in fact perilously close to doing if the brain fail-safe systems didn?t work as well as they do). Other times, they just wake up, take a gasp of air and then fall back to sleep again.

For the most part, sleep apnea is the severe form of snoring. But that doesn?t mean that a person can be gauged for sleep apnea based on the level of snoring or how loudly they snore. Rather, patients can be screened for sleep apnea with a simple written test called the Epworth Scale of Sleepiness.

I will post this for you below so that you can test yourself and see if you have reason to be concerned.

More on Airways and Breathing coming up in the next few blocks: Stay tuned

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired’ This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation.

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing


Chance of Dozing

Sitting and reading

Watching TV

Sitting, inactive, in a public place (e.g., a theater or a meeting)

As a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking with someone

Sitting quietly after a lunch without alcohol

In a car, while stopped for a few minutes in traffic


The Epworth Sleepiness Scale Key:

1 ? 6: Congratulations, you are getting enough sleep!
7 ? 8: Your score is average
9 and up: Seek the advice of a sleep specialist without delay