打鼾可能很危险的 8 个迹象（以及如何处理）

(CNN)At some point in our lives, we all snore. A cold or allergy can block nasal passages, a few drinks too close to bed will automatically relax tongue, palate and throat muscles -- and before we know it, we're unconsciously forcing air past those soft tissues, causing vibrations that escape as a snore.

"Snoring can be normal and not something to worry about," said sleep specialist Rebecca Robbins, an instructor in the division of sleep medicine for Harvard Medical School.

But snoring can also be a key sign of obstructive sleep apnea, a serious sleep disorder in which people actually stop breathing for 10 seconds or more at a time.

"When it's loud, raucous snoring, or it's interrupted by pauses in breathing, that's where we start to get concerned," Robbins said.

It's estimated that at least 25 million Americans and 936 million people worldwide may suffer from obstructive sleep apnea, with many more undiagnosed.

'It can be very, very scary'

It's called "obstructive" sleep apnea because unlike central sleep apnea -- in which the brain occasionally skips telling the body to breathe -- obstructive sleep apnea is due to a blockage of the airways by weak, heavy or relaxed soft tissues.

"You're making the effort with your belly and your chest to try to get the air in and out, but because of the obstruction in the upper airway, you can't. Often you aren't aware of this struggle, but it can be very, very scary for anyone watching," said sleep specialist Dr. Raj Dasgupta, an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California.

If left untreated, obstructive sleep apnea puts you at high risk for hypertension, heart disease, Type 2 diabetes or depression, even an early death, according to the American Academy of Sleep Medicine.

How can you tell when your snoring has become dangerous to your health? Sleep experts use a sleep questionnaire with an easy-to-follow acronym: STOP BANG.

S stands for snoring

Snoring is a key indicator, so it's a no-duh that it leads the list of potential warnings signs. But this is no pitiful, whimpy snore, and certainly not a snore that anyone could ever call "cute."

"We're talking loud, obnoxious snoring, the type that would drown out conversations or be heard through closed doors," Dasgupta said.

"Some of the very descriptive bed partners of my patients with obstructive sleep apnea describe their partners' snores as listening to a 'dying bear' or a scene from 'Jurassic Park,'" he added.

T stands for tired

Being really tired during the day is a prime indicator of poor sleep. Combined with snoring, it can be a telltale symptom of sleep apnea.

"Daytime sleepiness is one of the strong predictors of sleep apnea," Robbins said.

"Falling asleep anytime you have a moment -- sitting down for a break after lunch, in a movie theater -- those are all hallmark symptoms along with fatigue and taking the house down with your snores," said Robbins, who coauthored the book Sleep for Success! Everything You Must Know About Sleep But are Too Tired to Ask.

O stands for 'observed'

Many people -- if not most -- have no idea that they snore at night. Nor do they know they stop breathing during the night -- unless the blockage is so bad that they wake up gasping and choking.

"The O stands for observed apnea, and that's actually worse than just snoring," Dasgupta said. "An apnea means no flow of air -- no air coming in no air going out. You're not breathing. Observed apnea is really a red flag."

Bed partners are often key to the identification of obstructive sleep apnea.

"Watching your partner stop breathing, snore, cough or gasp for air are all signs the snoring might not be normal, and then it is something that deserves attention from a sleep specialist," Robbins said.

P stands for pressure -- high blood pressure

Obstructive sleep apnea can lead to hypertension. Every time a person stops breathing for a few seconds, the body's sympathetic nervous system goes into action and raises blood pressure. In addition, the body releases stress hormones called catecholamines, which can also raise blood pressure over time.

While having hypertension by itself is not a sign of a sleep disorder, it can be a warning sign when combined with other telltale signals.

Fortunately, treatments for obstructive sleep apnea, like continuous positive airway pressure, or CPAP, have not only been shown to help with sleep apnea, but they also lower blood pressure.

B stands for BMI

Body mass index is a score commonly used to indicate levels of weight. To measure BMI, health professionals use height and weight data to track changes in weight relative to height. Your weight is considered normal if your BMI falls between 18.5 and 24.9. You are deemed overweight when your BMI is between 25 and 29.9 -- and a BMI of 30 or more indicates you are obese.

People who are obese or extremely obese -- with a BMI of 35 and above -- are frequently found to suffer from obstructive sleep apnea because the extra weight in the mouth, tongue and neck collapses those soft tissues, making it more difficult to easily breathe without snoring.

"Weight loss can be a big part of the recommendation from a health care provider for addressing sleep apnea," Robbins said.

Obstructive sleep apnea has been on the rise around the world as obesity has reached epidemic proportions, but it wasn't seen as frequently before the 1970s, she added.

"In sleep medicine we joke that Humpty Dumpty was one of the first cases of obstructive sleep apnea because he had a big belly and probably extra tissue around the soft palate. He was at risk for falling asleep all the time and falling off the wall," Robbins said.

"That was a nursery rhyme and at the time, an anomaly. But now, unfortunately, it is becoming increasingly common with the increased body mass index we're seeing across the country and the world," she added.

A is for age

Muscle tone weakens as we age, including in our soft palate and neck. So being over age 50 is another potential signal that your snoring may be -- or turn into -- obstructive sleep apnea.

There is some good news -- studies are beginning to find that sleep apnea in the elderly tends to be of a mild to moderate kind, with the more severe cases occurring at younger ages.

N is for neck

Having a large neck circumference, either from being overweight or genetics, is also a key indicator of potential obstructive sleep apnea.

"Now you don't want to be a weirdo and start measuring your loved one's neck build at night," Dasgupta said. "The rule of thumb is always going to be a collar size of greater than 17 inches (43 centimeters) for a male, and greater than 16 inches (40.6 centimeters) for a female will put you at a higher risk for sleep apnea."

G is for gender

Are you a man? Then unfortunately, that, too, makes you at increased risk for obstructive sleep apnea. Some of the reasons may be that men tend to have fatter tongues and carry more fat in their upper bodies than women, especially in the neck. Men also tend to have more "belly fat," which can make breathing in general more difficult.

"However, we definitely see a lot more obstructive sleep apnea in women after menopause," Dasgupta said.

High-risk needs evaluation

Now it's time to score your risk. Give yourself a point for every "yes" answer. If you scored between 5 and 8, you are at high risk of having obstructive sleep apnea and should be evaluated by a sleep specialist.

"Sleep tests nowadays are much, much easier to get than in prior years when you could only go to a sleep lab," Dasgupta said. "You don't have to be stuck in the lab with all these wires on you, looking like Frankenstein. You can do an at-home sleep test in your own bed, which is nice."

But don't ignore your symptoms, as the negative effects on health should not be ignored, says the American Academy of Sleep Medicine: "Like a fire alarm, snoring is a warning of danger that demands your attention."

If your score is between 0 and 2, your risk is obviously low, so snoring isn't likely to be a big concern for your health. A score of 3 to 4 puts you at an intermediate risk, but that doesn't mean you should ignore your symptoms, especially if you share your bed with a loved one, Dasgupta said.

"It's always good to be a nice person, and if it affects your bed partner, I think it's worthwhile getting evaluated," he said. "If your bed partner is wakened multiple times during the night by your snoring or can't fall asleep because of your snores, then that bed partner is going to be sleep deprived, and that is not good for their health. So it's not always about yourself."

Treatments

The treatment of choice for sleep apnea is the use of a continuous positive airway pressure, or CPAP. By pushing air into the lungs through a nose mask, the device helps keep the airway unobstructed throughout the night.

Weight loss can significantly decrease -- or even eliminate obstructive sleep apnea, as the loss of tissue mass in the mouth, tongue and neck eases pressure on the airway. Doctors can also prescribe an oral appliance designed to enlarge the airway by moving the tongue or jaw forward.

If anatomical issues, such as nasal polyps, enlarged tonsils or adenoids or a deviated septum, are contributing to the apnea, surgery may be recommended.

Mild cases of sleep apnea may respond to "positional therapy," a fancy way of saying keeping sleepers on their sides instead of back during sleep, which can improve airway flow and reduce snoring.

"I'm a big fan of simple, homemade solutions, such as sewing tennis balls into the back of pajamas to keep people from turning onto their backs," Dasgupta said.

"You can get even more creative by putting a bra on someone in reverse and then putting tennis balls in in the cups," Robbins suggested.

打鼾可能很危险的 8 个迹象（以及如何处理）

(CNN) 在我们生命中的某个时刻，我们都会打鼾。感冒或过敏会阻塞鼻腔，在离床太近的地方喝几杯饮料会自动放松舌头、上颚和喉咙的肌肉——在我们意识到之前，我们在不知不觉中迫使空气通过这些软组织，导致振动作为鼾。

“打鼾是正常现象，无需担心，”哈佛医学院睡眠医学系讲师、睡眠专家丽贝卡罗宾斯说。

但打鼾也可能是阻塞性睡眠呼吸暂停的一个关键迹象，这是一种严重的睡眠障碍，人们实际上一次停止呼吸 10 秒或更长时间。

罗宾斯说：“当响亮的鼾声或被呼吸暂停打断时，这就是我们开始担心的地方。”

据估计，全世界至少有 2500 万美国人和 9.36 亿人可能患有阻塞性睡眠呼吸暂停，还有更多未被确诊。

“这可能非常、非常可怕”

它被称为“阻塞性”睡眠呼吸暂停，因为与中枢性睡眠呼吸暂停不同——大脑偶尔会跳过告诉身体呼吸——阻塞性睡眠呼吸暂停是由于气道被虚弱、沉重或松弛的软组织阻塞所致。

“你正在用腹部和胸部努力让空气进出，但由于上呼吸道阻塞，你不能。通常你没有意识到这种挣扎，但它南加州大学凯克医学院临床医学副教授、睡眠专家 Raj Dasgupta 博士说，对于任何观看的人来说都非常非常可怕。

根据美国睡眠医学会的数据，如果不及时治疗，阻塞性睡眠呼吸暂停会使您患高血压、心脏病、2 型糖尿病或抑郁症的风险很高，甚至会导致早逝。

你怎么知道你的打鼾何时对你的健康有害？睡眠专家使用带有易于理解的首字母缩略词的睡眠问卷：STOP BANG。

S代表打鼾

打鼾是一个关键指标，因此它在潜在警告信号列表中居于首位是不言而喻的。但这不是可怜的、异想天开的鼾声，当然也不是任何人都可以称之为“可爱”的鼾声。

达斯古普塔说：“我们正在大声说话，令人讨厌的打鼾，那种会淹没谈话或隔着门听到的声音。”

“我的阻塞性睡眠呼吸暂停患者的一些非常描述性的床伴将他们的伴侣的打鼾描述为听'垂死的熊'或'侏罗纪公园'的场景，”他补充道。

T代表累

白天真的很累是睡眠不佳的主要指标。结合打鼾，它可能是睡眠呼吸暂停的明显症状。

“白天嗜睡是睡眠呼吸暂停的强烈预测因素之一，”罗宾斯说。

“只要有时间就睡着了——午饭后坐下来休息，在电影院里——这些都是标志性的症状，伴随着疲劳和打鼾声，”罗宾斯说，他是《睡眠》一书的合著者。为了成功！关于睡眠你必须知道的一切，但太累了，无法问。

O 代表“观察到的”

许多人——如果不是大多数人——不知道他们在晚上打鼾。他们也不知道他们在夜间停止呼吸——除非阻塞严重到他们醒来时会喘气和窒息。

“O 代表观察到的呼吸暂停，这实际上比打鼾更糟糕，”达斯古普塔说。 “呼吸暂停意味着没有空气流动——没有空气进来，没有空气出去。你没有呼吸。观察到的呼吸暂停真的是一个危险信号。”

床伴通常是识别阻塞性睡眠呼吸暂停的关键。

“看着你的伴侣停止呼吸、打鼾、咳嗽或喘气都是打鼾可能不正常的迹象，这值得睡眠专家注意，”罗宾斯说。

P代表压力——高血压

阻塞性睡眠呼吸暂停可导致高血压。每当一个人停止呼吸几秒钟时，身体的交感神经系统就会开始活动并升高血压。此外，身体会释放称为儿茶酚胺的压力荷尔蒙，随着时间的推移，它也会使血压升高。

虽然高血压本身并不是睡眠障碍的征兆，但当与其他警示信号结合时，它可能是一个警告信号。

幸运的是，阻塞性睡眠呼吸暂停的治疗，如持续气道正压通气或 CPAP，不仅已被证明有助于睡眠呼吸暂停，而且还能降低血压。

B代表BMI

体重指数是通常用于表示体重水平的分数。为了测量 BMI，卫生专业人员使用身高和体重数据来跟踪体重相对于身高的变化。如果您的 BMI 介于 18.5 和 24.9 之间，则您的体重被认为是正常的。当您的 BMI 介于 25 和 29.9 之间时，您被视为超重——而 BMI 为 30 或更高则表明您肥胖。

肥胖或极度肥胖的人——BMI 为 35 及以上——经常被发现患有阻塞性睡眠呼吸暂停，因为口腔、舌头和颈部的额外重量使这些软组织塌陷，使其更难以呼吸没有打鼾。

“减肥可能是医疗保健提供者为解决睡眠呼吸暂停而提出的建议的重要组成部分，”罗宾斯说。

她补充说，随着肥胖症达到流行程度，阻塞性睡眠呼吸暂停在世界范围内呈上升趋势，但在 1970 年代之前并不常见。

“在睡眠医学中，我们开玩笑说 Humpty Dumpty 是第一批阻塞性睡眠呼吸暂停病例之一，因为他的肚子很大，软腭周围可能还有多余的组织。他一直处于睡着状态并从墙上摔下来的风险， ”罗宾斯说。

“那是一首童谣，在当时是一种反常现象。但不幸的是，现在随着我们在全国和世界各地看到的体重指数增加，这种情况变得越来越普遍，”她补充道。

A是年龄

随着年龄的增长，肌肉张力会减弱，包括软腭和颈部。因此，超过 50 岁是另一个潜在信号，表明您的打鼾可能是——或变成——阻塞性睡眠呼吸暂停。

有一些好消息——研究开始发现老年人的睡眠呼吸暂停往往是轻度到中度的，更严重的病例发生在年轻的时候。

N代表脖子

由于超重或遗传，颈围较大也是潜在阻塞性睡眠呼吸暂停的关键指标。

“现在你不想成为一个怪人并在晚上开始测量你所爱的人的脖子结构，”达斯古普塔说。 “根据经验，男性的领子尺寸总是大于 17 英寸（43 厘米），女性的领子尺寸大于 16 英寸（40.6 厘米）会使您面临更高的睡眠呼吸暂停风险。”

G代表性别

你是男人吗？不幸的是，这也会增加您患阻塞性睡眠呼吸暂停的风险。部分原因可能是与女性相比，男性的舌头往往更胖，上半身携带的脂肪更多，尤其是颈部。男性也往往有更多的“腹部脂肪”，这通常会使呼吸更加困难。

“然而，我们肯定会在更年期后的女性中看到更多的阻塞性睡眠呼吸暂停，”达斯古普塔说。

高风险需求评估

现在是对您的风险进行评分的时候了。为每个“是”的答案给自己加分。如果您的得分在 5 到 8 之间，则您患阻塞性睡眠呼吸暂停的风险很高，应该由睡眠专家进行评估。

“现在的睡眠测试比前几年你只能去睡眠实验室容易得多，”达斯古普塔说。 “你不必带着所有这些电线被困在实验室里，看起来像弗兰肯斯坦。你可以在自己的床上进行在家睡眠测试，这很好。”

但是不要忽视你的症状，因为它对健康的负面影响不应该被忽视，美国睡眠医学会说：“就像火警一样，打鼾是一种需要你注意的危险警告。”

如果您的分数在 0 到 2 之间，那么您的风险显然很低，因此打鼾不太可能成为您健康的大问题。 Dasgupta 说，3 到 4 分会让您处于中等风险，但这并不意味着您应该忽略您的症状，尤其是当您与所爱的人同床共枕时。

“做个好人总是好的，如果它影响到你的床伴，我认为值得评估，”他说。 “如果你的床伴在夜间被你的鼾声惊醒多次，或者因为你的鼾声而无法入睡，那么那个床伴就会被剥夺睡眠，这对他们的健康不利。所以并不总是这样关于你自己。”

治疗

睡眠呼吸暂停的首选治疗方法是使用持续气道正压通气或 CPAP。通过鼻罩将空气推入肺部，该设备有助于整夜保持呼吸道通畅。

体重减轻可以显着减少——甚至消除阻塞性睡眠呼吸暂停，因为口腔、舌头和颈部组织质量的减少减轻了气道的压力。医生还可以开出一种口腔矫治器，旨在通过向前移动舌头或下巴来扩大气道。

如果解剖学问题，例如鼻息肉、扁桃体肥大或腺样体或中隔偏曲，是导致呼吸暂停的原因，则可能建议进行手术。

轻度睡眠呼吸暂停病例可能对“体位疗法”有反应，这是一种奇特的说法，即在睡眠期间让睡眠者侧卧而不是仰卧，这可以改善气道流动并减少打鼾。

达斯古普塔说：“我非常喜欢简单的自制解决方案，例如将网球缝在睡衣的背面，以防止人们翻身。”

罗宾斯建议说：“通过将胸罩反向穿在某人身上，然后将网球放入杯子中，你可以变得更有创意。”