WHAT’S a bit of snoring, right? You may think it’s just irritating to your family members and quite harmless. You would be wrong.
Snoring or obstructive sleep apnoea (OSA) in senior citizens can lead to diabetes, high blood pressure, heart disease and stroke.
Dr Raymond Tan Suan-Kuo, ear, nose and throat consultant and snoring and sleep specialist, explains that sleep apnoea is closely associated with high blood pressure.
“In my experience, it’s very hard to find a patient who has sleep apnoea who doesn’t have high blood pressure or borderline high blood pressure. We also know that sleep apnoea is a new risk factor for predicting future diabetes.
“Studies have shown that the risk of a patient with sleep apnoea developing diabetes is even as high as 60%. The risk of having a stroke is tripled. There is 27 times increased risk of having a heart attack. There is a seven times increased risk of being involved in a road accident,” says Dr Tan.
Causes of snoring
OSA is caused by structural abnormalities like an undersized or receding lower jaw, jutting lower jaw, narrow upper jaw, enlarged tongue or enlarged tonsils.
It is also caused by obesity, and in senior citizens, it is also caused by a collapsing palate because as we age, the tissues become more lax and soft.
Dr Tan says that obesity is one of the main causes of OSA.
According to The Lancet medical journal, Malaysia is currently the most obese country in Asia with 45.3% of the population found to be obese (49% of women and 44% of men).
It doesn’t help that having OSA causes insufficient sleep which in turn causes bingeing and eating more, making you put on weight, which adds to the OSA problem.
“In sleep apnoea patients, they don’t get refreshing sleep as their sleep is always fragmented. So, even though they sleep eight hours, they wake up feeling very tired. When they don’t get proper sleep, their leptin and ghrelin hormones are altered and they end up eating more food and drinking more sweet drinks to get that glucose rush, so that they feel more awake,” says Dr Tan.
Leptin is also known as the lean hormone because it increases the level of satiety, making you feel full, while ghrelin causes people to gorge on food because it decreases the level of satiety and increases hunger.
When you have bad sleep, the levels of the leptin hormone decreases and the levels of ghrelin hormone increases.
Dr Tan explains that this adds to their weight and causes the throat to choke more because of the fat and adds to their sleep apnoea problem.
About 25% of senior citizens suffer from sleep apnoea and this includes even those who are not obese.
The more narrow the opening of the mouth, the higher the risk of sleep apnoea.
Besides obesity, the narrowing of the mouth is also caused by age. The older the patient, the lower the palate becomes as the tissues become softer.
“As we grow older, the tissues in our mouth become very lax and soft, then the palate collapses more. Sleep apnoea is caused by the heavy collapse in the mouth, nose and throat. It could also be that their tonsils are enlarged,” says Dr Tan.
Signs and treatment
Some of the signs that you have OSA are:
- Snoring loudly – snoring every night. This does not include those who snore once every six months when they’re tired.
- More lethargic, sleepy in the daytime.
- Observed to have stopped breathing during sleep.
- Treated for high blood pressure.
If you think you have OSA, you should see an ENT specialist to assess your airway for areas of collapse. The doctor would typically also check your history – snoring, choking episodes and tiredness. Then a sleep study would be done at home or in the hospital.
- Lose weight.
- Sleep on the side – when you sleep on your back, the tongue collapses and chokes you even more.
- Do not take alcohol or sleeping pills – this puts you into a deeper sleep and the muscles relax more and the airways close more, too.
- Surgery – One way to rectify a collapsed palate is via the palatal lift operation where the palate is lifted up and a higher and new palate is created.
- CPAP (Continuous positive airway pressure) machine – you might try sleeping using a face mask attached to this machine. This permanent measure sends high pressure air into the back of your nose and throat, acting as an air splint. The only problem with it is the compliance rate. Studies have shown that only one in five will use it for the long term because not everyone can take the high pressure air in their face as they try to sleep.
Dr Tan recommends senior citizens go for the palatal lift surgery if they are healthy. If not, then he suggests trying the CPAP machine.
Dr Tan stresses the importance of having OSA treated.
“You may prevent a heart attack or stroke if you get the sleep apnoea treated now. It’s common sense – what is more precious than oxygen?” he asks.
How much sleep do seniors need?
WE have all heard that senior citizens need less sleep, but how true is this?
Dr Tan says that this is a myth.
“It’s not true that you need less sleep as you get older. Seniors get less sleep because they have more medical problems which interfere with their sleep,” says Dr Tan.
He explains that prostate or bladder problems would cause you to wake up often to go to the toilet.
The amount of sleep you need daily remains the same whether you are 50, 60 or 70 – seven to nine hours a night.
In addition, a short afternoon nap (15-20 minutes) is good for the heart.
According to Dr Tan, a study looking at 23,000 men and women in Greece over a six-year period found that people who took a short nap in the afternoon had a 64% decreased risk of getting heart disease.