MEN ASLEEP: A LITTLE-KNOWN BENEFIT OF AGEING
There is a small pleasure in store for partners of the average homegrown male. As he ages, he will probably become a quieter bedmate. While fit young men don’t snore much, by the time they have broadened out and hit their forties, they are often extremely noisy sleepers. Between the ages of 40 and 60 they can snore like nobody else on earth. Most exceed 38 decibels, which is the level of light highway traffic, and more than 10 per cent are so loud they would break city ordinances against night-time noise pollution.
These two decades are the peak of male snoring. Then, just when partners are at their wits’ end, men miraculously begin to sleep more quietly
After 60 male snoring goes into decline. Fortunately most men are just ‘simple snorers’. They snore intermittently, especially if they have a cold or have been drinking, and their sleep is not particularly disrupted.
Usually they can’t hear themselves doing it and are amazed when their nocturnal noises are played back to them on a tape recorder. One Australian study, which used microphones to gather evidence, found that 80 per cent of middle-aged men, compared to 25 per cent of women of the same age, snore.
Men have different snoring styles. Some make soft, hesitant sounds, some snore thunderously and others sound like a saw going backwards and forwards.
Patterns differ too. There are men who are at it consistently throughout the night. They sleep deeply and are not perturbed by what they don’t hear.
Sleep is quite a different experience for ‘heroic snorers’, who literally snore themselves to a standstill. Typically, these men start off quietly and get louder, eventually reaching a crescendo that ends abruptly, as they are caught in an episode of sleep apnoea.
Men suffering from sleep apnoea stop breathing for between 10 and 40 seconds, after which time they jerk awake and desperately start gulping in oxygen. This is not a restful activity.
While apnoea is virtually always preceded by heavy snoring, heavy snoring does not always lead to apnoea. If your partner reports that you snore deeply with every breath throughout the night, you may suffer no apnoea at all. Snoring is just breathing through a narrow airway. Apnoea is a blockage of the airway that causes breathing to stop.
Sleep apnoea is more than an acoustic nuisance. It can produce a range of problems, including daytime sleepiness, insomnia, nocturia (frequent passing of water at night) and impairments to mood. There is increasing evidence it may be a risk factor for cardiovascular disease – especially high blood pressure.
Worryingly, it can also impair driving performance. A reputable study recently found that people with sleep apnoea are at least five times more likely to have a traffic accident than those without the disorder.
This presents doctors with a dilemma. Should they report apnoea patients to driver-licensing authorities or should they just warn the patient not to drive until their condition has been fully investigated and treated?
Apnoea is a problem for partners too and has been recognised as a factor in divorce. As well as disrupting their partner’s sleep to an extent that might exacerbate marital problems, men suffering from sleep apnoea are usually not much fun to live with because they are sleepy, unmotivated and have poor social function.
Men are far less tolerant of snoring and apnoea than women. In Western society it seems to be culturally more acceptable for a man to snore than for a woman.
Over the years innumerable treatments have been tried for sleep breathing disorders but surgeons keep coming back to the one technique, which is basically the same as the procedure vets use to control bothersome breathing in bulldogs.
Initially when performed on humans, this procedure involved removing part of the soft palate and the uvula (the piece of tissue that hangs at the back of the mouth). First used in the fifties in Japan it later fell into disuse, only to become popular again in the USA in the early eighties.
Called ‘uvulopalatopharyngoplasty’, or UPPP, this operation never lived up to expectations. It required great caution because if too much tissue was removed, the patient could be left with new problems such as nasal regurgitation and changes to their speech.
UPPP is still sometimes used today to help heavy snorers, but it is no longer indicated for sleep apnoea. As snoring originates in upper airways, it may respond to tissue changes in this area. But apnoea originates lower down the airways – predominantly behind the tongue and out of range of the UPPP.
Recently, a modified version of UPPP became popular. Instead of using a scalpel, doctors began using lasers. The lasers aim to stiffen palatal tissue rather than completely remove it.
Floppy tissue is a prerequisite for snoring. Snoring occurs when a floppy soft palate and other loose upper-airways tissue vibrate. The narrower the airway the more turbulent the airflow and the more likely it is to set up vibrations in the floppy tissue.
When middle-aged men broaden, they don’t realise they are putting on weight around their tongues too and that fatter tongues narrow airways and contribute to snoring.
For a period the use of laser UPPP became widespread, its popularity driven by heavy promotion in the media. But like conventional UPPP, its benefits have not been supported by objective research and little work has been done on long-term effects.
Now, the procedure is being modified yet again. This time US surgeons are using radio waves to heat excess tissue in the nose, palate and tongue. Heating kills the tissue. This procedure is called ‘somnoplasty’ and apparently works well on pigs’ tongues. It is being tested on humans.
Before opting for surgery, heavy snorers should lose weight, give up smoking, reduce their alcohol consumption and have nasal or other obstructions to breathing removed. If this doesn’t help they can have a custom-made dental device constructed. The most popular treatment for apnoea is still the nCPAP device that uses air pressure to keep the throat open during sleep. This enables sufferers to breathe through the night so they can wake refreshed and smiling.
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