My uncle Charlie could snore the shingles off the roof of every house in his neighborhood. He was the nicest man on the planet, but his loud, uneven, vibratory breathing was a nighttime nuisance for everyone within earshot.
Uncle Charlie’s notorious snores were a source of amusement for my brother and me when we were growing up. However, the sad and serious truth is that Uncle Charlie likely suffered from a type of sleep disorder called obstructive sleep apnea (OSA). This condition probably contributed to his cardiac issues, diabetes and history of strokes, which inevitably shortened his life.
OSA affects all age groups but is more common among the elderly and those who are overweight. According to Dr. Steven Y. Park, otorhinolaryngoloist, sleep medicine specialist and author of Sleep, Interrupted, “It’s estimated that by age 60, 60 percent of men and 40 percent of women snore. About 35 percent of habitual snorers are found to have obstructive sleep apnea. Therefore, a person who is over 60 and snores has a one in five chance that they may have obstructive sleep apnea.”
The Signs and Symptoms of Sleep Apnea
Snoring is a common symptom of sleep apnea, but the consequences extend far beyond nighttime noise. Besides contributing to the overall fatigue of sufferers, there are several serious chronic health complications that are linked to OSA, such as high blood pressure (hypertension), diabetes, depression, anxiety, heart disease, heart attack and stroke.
Fatigue can also lower a senior’s pain threshold, which can have troubling consequences for those recovering from surgery, dealing with chronic health issues or battling cancer. Chronic sleep deprivation may result in mood swings, forgetfulness and headaches. “One must consider that fatigue, inability to focus and irritability are sometimes attributed to the beginning stages of dementia,” explains Dr. Park. “Proper diagnosis and treatment of any sleep-breathing problems may improve some or all of those symptoms, too.”
Unfortunately, OSA may not be at the top of a doctor’s priority list. This is especially true if a senior has other major medical problems that require evaluation and treatment, as these may overshadow symptoms that point to OSA.
Why Do Seniors Snore?
As people age, the muscles and other tissues at the back of the throat may lose tone and become slack, especially during sleep. This decreases the amount of open space that allows air to move freely in and out of the nose, throat and lungs. As a result, suction builds up when the person tries to breath in, further collapsing the airways and exacerbating the problem. A partial collapse produces loud snoring, whereas a complete blockage causes the person to actually experience periods of not breathing (apnea).
A lack of air also leads to a lack of oxygen, causing a person with OSA to wake repeatedly throughout the night so they can breathe more deeply or more regularly. Some people with OSA can awaken hundreds of times during a typical overnight sleep cycle. At times, a person may wake up with a choking or gasping sensation.
In many cases, people with OSA do not realize that they are snoring and cease breathing at night. Therefore, it is important for spouses and family caregivers to be aware of the symptoms of OSA so they can bring them to their loved one’s attention and act on them as quickly as possible.
How to Reduce Snoring in Seniors
If an aging loved one snores or experiences pauses in breathing while sleeping, then there are a few things you can do to improve their air flow now. “In the elderly, especially those who are immobile or bedridden, they’ll most likely be lying or sleeping on their backs. In people with OSA, this is the worst position to be in, since structures in the throat are most susceptible to collapse due to gravity,” Dr. Park says. “In general, people snore more and sleep less effectively on their backs. Most people find it uncomfortable to sleep in this position. They naturally prefer to sleep on their sides or stomach, so they can breathe better.”
Dr. Park suggests raising the head of your loved one’s bed, if possible, and helping them to find a comfortable sleeping position on either side or on their stomach. Propping the body with pillows to prevent rolling onto their back or using a wedge pillow or an adjustable mattress to slightly elevate the head are simple, non-invasive positional techniques. These changes alone could minimize snoring and improve sleep quality.
“It is a good idea to promote better nasal breathing, too,” Dr. Park adds. “Although it is not a major cause of sleep apnea, nasal congestion can sometimes aggravate the vacuum effect, worsening soft palate or tongue collapse. Allergy prevention methods like using a vacuum and air purifier with HEPA filters, using nasal saline, and taking prescription allergy medications are all conservative options for minimizing inflammation in the nasal passages.”
Getting the Right Diagnosis for Snoring and Sleep Apnea
The best way to get a definitive diagnosis of sleep apnea and other sleep disorders is by undergoing an overnight sleep study. Unfortunately, participating in a sleep study can be a difficult prospect for a senior who is bedridden or who has Alzheimer’s disease or another form of dementia. If this is the case, Dr. Park advises using a continuous oxygen monitor on the person at night as a preliminary screening technique for sleep apnea.
“A simple finger probe device that measures blood oxygen levels is worn on one finger while sleeping,” he says. “If the senior’s oxygen level keeps dropping repeatedly at night along with breathing pauses, then a more formal sleep study may be warranted.”
Many doctors never consider the possibility of sleep apnea in patients who are neither overweight nor heavy snorers, but the fact is that some people with the condition don’t exhibit either of these risk factors. Sleep apnea can aggravate underlying health conditions, so it is important to act quickly if you believe you or your loved one is experiencing sleep issues.
“If you suspect that your loved one has obstructive sleep apnea, even if the doctor dismisses it, be persistent, or seek out a second opinion,” urges Dr. Park. Treatment is available. “The best current treatment may include using a continuous positive airway pressure (CPAP) machine. This machine is used to deliver a small amount of positive pressure to keep the airways open while a person is sleeping. For certain people, a mandibular advancement device (an oral device worn while sleeping to help keep airways open) may be another option, and surgery is always possible as a last resort.”
A lack of restful sleep can contribute to daytime fatigue, reduced pain tolerance and, in some cases, dementia-like symptoms. As a family caregiver, you are the best person to monitor and advocate for your loved one and ensure that they receive the medical attention and treatment needed if they suffer from OSA or other sleep-breathing problems.