The Fatal Snore

Medical research shows snoring could be threatening more than just family harmony, as Kate Robertson discovers. School camp was a nightmare for Marshall Caliph. No one wanted to share a cabin with the boy nicknamed "Foghorn" because of his snoring. Fast forward 40 years and the IT consultant from Glenroy is happily married with a seven-year-old son and a wife who is happy to share her bed with him - and his nasal pump.
Marshall has sleep apnoea, which literally means "absence of breathing". Snoring is caused by the sound of air vibrating in a narrowed space when the muscles of the upper airway relax during sleep. However, Marshall's airway narrows to the point that it actually blocks, and he stops breathing for a few seconds until he unconsciously rouses himself - an exhausting process that is repeated continually throughout his sleep. Marshall's wife knew what she was getting into before they married - he'd warned her when they met. So, rather than listening to him snore, she sleeps to the low level hum that the CPAP (Continues Positive Airway Pressure) machine beside the bed makes as it pumps oxygen through his clear plastic nasal mask.
The pump prevents Marshall's airway from collapsing and ensures he has a regular supply of oxygen during his sleep, but it's not very sexy. Not surprisingly, compliance is often a problem for snorers. But for Marshall and his wife, the inconvenience is overwhelmingly outweighed by the benefit of allowing him to sleep soundly through the night. "It's improved my life one-thousand- fold," he says.
Professor Rob Pierce, medical director of the Institute of Breathing and Sleep at Austin Health, first met Marshall 20 years ago when he had to wake him up in the clinic waiting room. Before he was diagnosed, Marshall had crashed his car several times after falling asleep at the wheel; waking, he would find he was veering onto the shoulder of the road or heading towards an oncoming vehicle. His daytime sleepiness was so severe he would fall asleep mid-sentence. "One time I nodded off during an interstate phone call...it cost me $200," he says. Professor Pierce says Marshall is typical of patients with sleep apnoea who fail to realise the significance of their snoring. "One-third of the population snores at some time, at least intermittently, and conventionally it's been thought snoring is a bit of a joke. But now we know it is a potentially serious medical condition... and we have to treat it seriously because with the epidemic of obesity, it's becoming more common," Professor Pierce says.
Snoring is a common health complaint: three in five adults snore, according to figures from the Austin Hospital. About 5 per cent of men and 3 per cent of women suffer from sleep apnoea. It's also big business. Resmed, a manufacturer of CPAP machines and other anti-snoring devices, trades in 65 countries, earned $732 million in the 2006 financial year, and is listed on the stock exchange.
The severity of sleep apnoea is gauged by how many times an hour the sufferer stops breathing, or has reduced breathing, for more than 10 seconds.
"We have some people who stop (breathing) 100-plus times an hour," Professor Pierce says. "These people have incredibly fragmented sleep, which impacts on many aspects of their daytime." Impaired work performance, mental dysfunction, depression, relationship problems and a greatly enhanced risk of car accidents are just some of the results. "It's probably a major cost factor in industrial and transport accidents," Professor Pierce says.
It has been a couple of decades since Marshall took part in the overnight sleep clinic that changed his life. "When I woke up it was amazing. For the first time in about 20 years I felt like I'd slept. I almost kissed him (the technician). "
On a quiet Monday evening a couple of weeks ago, Marshall returned to the sleep clinic to help with research into an improved nasal CPAP pump. Marshall is anxious to help Professor Pierce in whatever way he can - he credits the man with saving his life.
Sleep Scientist Emma Clark is based in the control room. Clark prepares the patients, mainly males, for the study, attaching up to 17 electrodes to each person's head, chest and a finger. The data collected from the electrodes provide information on whether the patient is asleep, how deeply asleep, their brain activity, airflow, heartbeat, and their body position. Even noise is monitored, although "sometimes the champion snorers can be heard through the door", says Clark.
When it is time for bed, the patients are shown to what are very much hospital rooms, with metal electric beds, wood veneer wardrobes, white walls and vinyl floors, but with the addition of a camera recording their every movement. The rooms don't seem all that relaxing, but Clark says very few patients are unable to sleep. "It's pretty rare," she says. "People do go to sleep because they are tired - that's why they are here." In the morning, sleep scientists evaluate every 30 seconds of each patient's sleep and report back to the sleep physician for a diagnosis. The main factor leading to referral is usually excessive daytime sleepiness. The most common diagnosis is snoring or sleep apnoea, but the clinic also sees cases of periodic limb movement disorder (restless legs), insomnia and a range of disordered sleep patterns. Professor Pierce says most snorers end up at the clinic after their partner has urged them to do something about it. "The partners say, 'he snores, he stops breathing, we have to jab him into breathing, he goes to sleep at the dinner table...'." Fortunately, the treatments for both snoring and sleep apnoea are effective: "We get letters of appreciation from the spouses because now they can get a good night's sleep in the same bed as their husband." The most common treatment for sleep apnoea sufferers is the nasal CPAP machine - wearing a nose mask and air pump to bed. Other patients are prescribed medication to keep nasal stuffiness in check, have their tonsils removed, or are given support to tackle risk factors such as being overweight, smoking and drinking alcohol.
For some it is as easy as avoiding sleeping on their back. "Position is important. Many people only snore when they are on their back," says Professor Pierce. "Sometimes a tennis ball in a sock pinned to the back of our pyjamas provides relief - especially for the spouse who doesn't have to keep kicking them."
If snoring or sleep apnoea is an issue for you or your partner, Professor Pierce recommends you ask your GP for a referral to a sleep specialist.

Snoring/Sleep Apnoea Risk Factors:
* Obesity or weight gain
* Alcohol
* Nose or throat problem
* Sleeping tablets
* Being male

[SMH]