As many of you may know, I snore and have severe sleep apnea. What many of you may not know is that my own struggles with breathing sleeping and nasal congestion resulted the founding of my practice, Texas Sinus and Snoring. It’s a longer tale than I need to get into here, but my story is very typical and so hitting the key points may help some people from making the same mistakes.
I am a double board certified ENT and Facial Plastic surgeon. Seven years ago I was doing mostly cosmetic surgery and treating sinus disease. I have always been a “form and function” surgeon. By this I mean I have always stressed beautiful noses that work well.
One weekend my wife said, “do you know that you are snoring every night… and it just started out of the blue”. I was surprised since I had always been an athlete and had a pretty healthy lifestyle. Did I have sleep apnea? The dreaded illness affecting millions of americans.
As an ENT doc, I was aware that I had some stuffiness in my nose that bothered me off and on. I also knew that at 50 I was finding it harder to keep my tummy flat and I was more tired during the day than a year ago. Like any husband who gets confronted with snoring…I argued a bit, but in the end, not everything in life is a battle….so….long story short, I set myself up for a sleep study to figure out how bad things were.
There weren’t any slots available so I booked it for 5 months out and promptly forgot all about it. In the interim, I took my family on our annual ski vacation in Vail. AT 8200 feet of elevation.
I set myself up for a sleep study to figure out how bad things were.
Funny thing about elevation, oxygen molecules are further apart, making the blood a bit less effective at carrying oxygen to the brain. Normal oxygen concentration at sea level is roughly 20% but at 8000 ft its more like 15%.
I knew this going into our trip. I also knew a lot about snoring and sleep apnea in general. After all my background is in ENT and I was lucky enough to work and train with some of the best ENT in the country at the University of Washington in Seattle.
Snoring and sleep apnea result from a progressive weakening of the structures of the airway usually mixed with nasal obstruction. Progressive in this case doesn’t mean political activism. Its another way of saying aging. The throat is aging and as it does it gets floppier.
Think of a straw made of paper and how it gets more difficult to use the longer it sits in fluid. As the straw becomes less rigid, it is more likely to collapse when you try to suck fluid through it.
The same thing is happening to the aging airway. What I DIDN’T know was how bad MY snoring had become in a very short period of time. (At the time of our trip my “in office” sleep study was still a month away.)
The throat is aging and as it does it gets floppier.
One of our favorite restaurants in Vail is Matsuhisa. Its pretty much a ritual for us to go there after a ski day and wind down with some fresh seafood and a bottle of sake. Sake, like all alcohol, is of course a neurodepressant and slows down the rate of breathing. Had I known that my snoring had become sleep apnea, I may have been more careful with how much sake I had… but I didn’t.
After dinner we went back to our hotel room and went to bed. Sometime around two in the morning my young daughter heard me struggling to breathe and alerted my wife. My heartbeat was irregularly irregular, the hallmark of atrial fibrillation. I was very symptomatic….sweating, light headed and unable to sit up. My wife called 911 and I was taken to the ER.
In the end, I was shocked back into rhythm and recovered without incident. However this incident served as a strong reminder to me how fragile life and health are. I could have just as easily died in my sleep with the combination of high altitude, severe sleep apnea and alcohol.
I went back home, had my sleep study and was formally diagnosed with severe sleep apnea. My doctor prescribed me a CPAP and my journey as a patient in the sleep apnea world began.
Had I known that my snoring had become sleep apnea I may have been more careful with how much sake I had…
In many ways, my story is somewhat typical. I might have a few more twists in the beginning (and more along my journey…I’ll get into those in future posts) but in general I am a typical sleep apnea patient. Hopefully my story makes it obvious that snoring and sleep apnea need to be addressed as early after onset as possible.
The physiology behind early intervention is beyond the scope of this article, but suffice it to say that the longer you snore, the worse it gets. The palate and tongue are the most common points of throat collapse as sleep apnea gets progressively worse.
However, the nose plays a critical role in the development of sleep apnea. Anything that makes the nose more restricted (allergies, deviated septum, large turbinates, nasal valve collapse) makes the sleep apnea worse. As much as the nose is central to the onset and severity of sleep apnea, a good nasal airway is absolutely vital to effective treatment.
The longer you snore, the worse it gets.
When I was diagnosed with sleep apnea, my sleep doctor prescribed a CPAP and signed off of my case. I couldn’t wear the mask because it felt like it was suffocating me. My doctor's answer was to turn up the pressure.
Fortunately as an ENT I knew to look at my nose. A friend and colleague evaluated me and helped to fix a deviated septum. The moment my nasal airway was corrected my mask worked much better and I was able to get proper sleep and begin recovering.
So, what are the take home points?
1. The nose is the key to developing snoring and sleep apnea but also treating it.
2. Treating snoring and sleep apnea is urgent because the longer you wait the worse it gets.
3. Alcohol and sleep apnea don’t mix well.
4. High altitude and low oxygen can make sleep apnea worse and potentially life threatening.