Two years ago Maurice Leclerc almost died in his sleep. Maurice was a little overweight, enjoyed a glass of wine or two with dinner and he snored; in fact his snoring was so bad it very nearly killed him. At four o'clock one winter's morning Maurice went into fibrillation, he was a rushed to a Sydney hospital, stabilised and diagnosed with Obstructive Sleep Apnea (OSA).

Maurice is not alone, over 5 percent of the population suffer from sleep apnea - a sleep disorder that can lead to very serious health problems.

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We all snore at some time in our lives - after a big night or when we have a cold. Babies snore, as do sports lovers stretched out on thousands of couches around Australia every Sunday afternoon. Normally during sleep the muscles that control the tongue and soft palate hold the airway open, but when these muscles relax, or there is excess tissue in their throat and neck, as in the case of overweight people - the airway is partially blocked causing snoring and breathing difficulties.

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Sleep apnea can produce twenty to sixty or more involuntary breathing pauses, or apneic episodes per hour. These pauses can last from ten seconds to two minutes, until the brain realises there is a lack of oxygen and alerts the body to wake up. Most sufferers gasp for air, or snort and start breathing again. In severe apnea cases this cycle repeats hundreds of times a night, severely disrupting the sleep and health of the sufferer.

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Men are twice as likely to develop sleep apnea as women, and except in extreme cases the condition is usually identified by symptoms such as fatigue, daytime sleeping, sore throats and frequent dreams about choking or drowning.

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As in the case of Maurice, partners of heavy snorers often move out of the bedroom so that they can get a goodnight's sleep and this disrupts the relationship, as does the irritability that comes with lack of sleep. Sleep disorders can result in sexual dysfunction, then there's the danger of daytime sleepiness and morning headaches.

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In more severe cases sleep apnea may lead to hypertension, which can result in a stroke, heart disease and other heart conditions. A major study published in the February 2000 issue of the <i>Journal of the American College of Cardiology</i>, found that 33 percent of 71,779 female nurses who snored regularly were more at risk of developing cardiovascular disease than those who didn't snore.

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Brain dysfunction due to hypoxemia (low blood oxygen levels) is also a possible of side effect of sleep apnea, as is obesity in adults and poor weight gain in children.

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<b>Treatments</b>
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Professor Collin Sullivan from the Faculty of Medicine at Sydney University developed the first really effective, non-surgical treatment for OSA in 1981. Now used worldwide, the Nasal Continuous Positive Airway Pressure (CPAP) machine supplies continuous airflow through a tube that connects to mask worn during sleep.  "My life is completely changed through the CPAP machine," says Maurice. "I no longer feel cranky and tired all the time and I feel reassured somehow that I will not have to go through another scare with my heart."
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Patients report improved alertness, memory, concentration and general health using the CPAP, yet despite its effectiveness the inconvenience of sleeping with a mask has lead to a 41 percent drop off rate in long-term users.

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Surgery for sleep apnea is only recommended in specific cases. The treatment focuses on removing the excess tissue causing the obstruction by cutting it away or cauterising and shrinking the tissue. A similar approach called somnoplasty, involves inserting a needle into the back of the tongue, heating it and shrinking it as it heals into scar tissue.

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Perhaps the simplest way to deal with mild sleep apnea is to train yourself to sleep on your side. Some patients report reducing their apneas from eighty down to zero through shifting to their sides. Sleep specialists in the United States recommend sewing a pocket into the back of pyjamas and placing a tennis ball inside so that whenever you turn on your back you automatically turn yourself over again.

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And if your are a snorer and you've experienced the classic apneic episode - when you wake sharply and momentarily with a snort or a gasp before returning to sleep, all specialists agree that you should avoid drinking alcohol at least four hours before sleep, stop taking sedatives and try losing some weight.

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<i>References:
Cardiovascular Study conducted at the John Hopkins School of Hygiene and Public Health, Baltimore, Dr Javed Nieto.

American Sleep Apnea Association
Sleep Disorders Australia, NSW Branch: 02 99903514</i>
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By Wendy Champagne