Ever since I was a little girl, I amazed my parents with my powerful snoring. Sometimes I wake myself at night. Other times, however, I wake up gasping for air. I used to scare my husband when we were first married. He said I would be snoring loudly, then suddenly the room would be dead silent. I didn't breathe for such an extended period that he would shake me to see if I was okay. Twenty years ago I consulted an ear, nose and throat specialist. He could find no cause for my snoring. My question is: Do I have sleep apnea?

R.S.

Here is the quick answer to your question: Maybe.
Now for the details: You suffer from either snoring or obstructive sleep apnea. (Apnea, by the way, means "no breath.") The difference between the two conditions is one of degree. A snorer makes everyone else in the house miserable but sleeps well and has no ill health effects as a result of the snoring. A person with obstructive sleep apnea (OSA) makes everyone else in the house miserable, AND sleeps poorly, AND (if the OSA is sufficiently severe) may develop high blood pressure, bedwetting (not just in children!), right-sided heart failure and pulmonary hypertension (high blood pressure in the pulmonary vessels). Patients with even moderately severe OSA have an increased risk of dying prematurely of heart attack, stroke or an accident (for example, by falling asleep behind the wheel).

Snoring is usually due to "rattling" of the uvula and soft palate against the back of the throat during inhalation. OSA is a more extreme problem. In some patients, the uvula and soft palate block the airway, while in other patients, the tongue falls backward, blocking the airway. Still others have obstruction at both levels. The person is unable to take a breath and may struggle mightily. This wakes the person, who "catches her breath" (often with a loud gasp), then goes back to sleep without realizing that she was ever awake. In patients with extremely severe OSA, this process may repeat 100 or more times each hour!

Patients with OSA often (but not always) complain of daytime sleepiness. However, many patients come to medical attention only because their spouses are frightened by the nocturnal airway calisthenics. You might think it would be easy to determine who has OSA and who is just an "innocent snorer" based on the description provided by the spouse or the patient ... but it is not at all easy. The ONLY way to make this determination is with a sleep study ("polysomnogram," or PSG).

During a sleep study, the patient is connected to a variety of monitors, which record the electrocardiogram (electrical activity of the heart), electroencephalogram (electrical activity of the brain), pulse, respiratory rate and oxygen saturation (the amount of oxygen in the blood). A wealth of information is derived from the sleep study. How many apneas does the patient have per hour, and how many hypopneas per hour? (Hypopneas are episodes of dangerously shallow breathing, but breathing does not cease, as it does in apnea.) How often does the patient's blood oxygen content drop to dangerous levels, and how low does it get? Does the patient have any heart-rhythm problems during sleep? How poorly does the patient sleep? Most important, Does the patient have obstructive sleep apnea?

We've come a long way in the understanding of OSA in the last 20 years. I suggest you find an ear, nose and throat specialist or pulmonary-medicine specialist who can evaluate and treat you for OSA. By the way, beware the doctor who proposes to treat you without first obtaining a sleep study: doing so is definitely below the standard of care.