WARNING SIGN SNORING IS NOT JUST AN ANNOYING FACT OF LIFE; IT CAN MEAN DANGER AHEAD FOR THOSE WHO DO IT.

Byline: La Rue Novick Staff Writer

Imagine a foghorn blasting, a chain saw buzzing, a diesel truck downshifting on a slanted grade or a garbage disposal gurgling.

Some dear souls must live with sounds like these every night as they fitfully sleep beside snoring spouses.

While some snorers nonchalantly dismiss concerns, jests and punches about the cacophony of sounds they make each night, they might want to take heed. Snoring is a symptom. And for some, the real problem is obstructive sleep apnea (commonly referred to as sleep apnea).

According to the National Sleep Foundation, 90 million Americans snore, 37 million habitually. And of those, 12 million to 18 million and possibly many more have sleep apnea.

``Awareness is growing about sleep apnea, but a lot (of people) go undiagnosed,'' said Dr. Ralph Downey, director of the sleep disorder center at Loma Linda University Medical Center.

Yolayne Lapis slept many years in other rooms because her husband kept her awake at night with his loud snoring. After their divorce (for reasons other than snoring), Lapis learned she was snoring, too.

Before she found out, she said she'd been feeling physically rotten. She was tired all the time. She was overweight. And, she'd wake up with grinding headaches every morning.

Lapis underwent a sleep study at Pomona Valley Hospital Medical Center and discovered she was not only snoring, but she had sleep apnea.

``I was probably as close as possible to death as one can be,'' the 57-year-old Claremont woman said. ``And I was putting a major tax on my heart.''

People who snore typically have what doctors call primary or simple snoring, or, like Lapis, they have sleep apnea. It's important to know which one. Sleep experts suggest concerned individuals - especially those whose snoring is associated with obesity, daytime sleepiness or pauses in breathing - undergo a sleep study.

Primary snoring is caused by the vibrating of tissue in the back of the throat as it narrows and partially blocks airflow.

``The way to think about it is the party favor that you blow and the paper rolls out and flaps at the end,'' said Dr. Robert Reyna, a sleep specialist at Kaiser Permanente Medical Center, Fontana. ``The narrowing creates a greater pressure and so the air going past it tends to pull on it enough to cause the fluttering of tissue.''

Primary snoring generally doesn't cause severe health problems but recent studies have shown loud snoring could be linked to high blood pressure and heart disease, according to the American Academy of Sleep Medicine. And that's not even mentioning all the unhappy spouses who have to sleep next to their snoring counterparts.

``I've had many situations where couples have divorced over their partner's snoring problem,'' said Dr. Dennis Nicholson, medical director of the Sleep Disorders Center at the Pomona Valley Hospital Medical Center. ``I've had them move out of rooms and wear ear plugs.''

People with sleep apnea don't just snore, they often gasp for air. Apnea literally means ``without breath.'' The muscles in the back of the throat relax and aren't able to keep the throat open, despite efforts to breathe. Gravity pulls the tongue back and all that extra tissue blocks the airway, causing pauses in breathing, or apneas, that can last at least 10 seconds per episode. In severe cases, a person can experience up to 60 episodes in one hour.

Studies show that because sleep apnea causes the oxygen level in the blood to drop and it taxes the heart, it can lead to other health problems such as high blood pressure, heart attack, stroke, diabetes, depression, decreased interest in sex, memory loss and even eye disease.

In children, sleep apnea has been linked to poor school performance, behavioral problems and even high blood pressure.

Because people with sleep apnea continually get inadequate or fragmented sleep (they wake up to gasp for air, whether they know it or not), their driving is inevitably impaired. The resulting daytime sleepiness significantly cuts driving response time down - sometimes ending in fatal automobile crashes.

Experts say it's one thing for people to ignore their own health, but a tragedy to ignore others.

``If you're driving next to someone (and cause an accident), you take out more than just yourself,'' Downey said.

In people with sleep apnea, the most common solution is positive airway pressure delivered through a mask worn over the nose (and sometimes the mouth, too). There are three levels: continuous (CPAP), Bi-level (BiPAP) and auto-adjusting (APAP). The most commonly used is the CPAP. Each machine gently flows air into the back of the throat to keep the air passage from collapsing.

``The feeling is the same as if you're driving in your car with your head out the window going about 20 miles per hour,'' Reyna said. ``It might take some getting used to, but people feel so much better with the machine because they're sleeping better.''

According to Nicholson, CPAP machines work about 85 percent to 90 percent of the time.

``The biggest issue with it is not whether it works. It almost always does,'' he said. ``It's working with patients to make sure they're comfortable and compliant with it.''

``The first time I wore (the CPAP), I called the hospital the next day and I told them I feel like a brand-new person,'' said Lapis, who has also dropped 100 pounds and 12 dress sizes (to a size 8).

Dan Perry of Chino Hills has had a terrible time trying to solve his snoring problem. Not only did he have his tonsils and uvula removed, but the surgery caused some other problems.

``It didn't work. In fact, it made it worse,'' said his wife, Tami Perry, 42, a nurse at Chino Valley Medical Center. ``And sometimes, when he eats, he chokes on his food.''

Perry was fitted with a CPAP machine and wears it, but his wife said he snores around it.

``CPAP doesn't work for everybody,'' Downey said. ``It's really important to have a doctor who recognizes that one size doesn't fit all on the CPAP machine.''

People who are using CPAP machines that aren't working properly should go back to their doctors to make sure their masks are fitted right, they're using the right machine or they have the right mask.

Some people with sleep apnea have trouble with their CPAP machines. (For CPAP troubleshooting, visit www.sleepapnea.org.)

Positive airway pressure is the usual treatment for sleep apnea, but sometimes an oral device that pushes the lower jaw forward, creating a larger airway, can help. Losing weight is a big must for sleep apnea patients.

``A big reason for the increase in sleep apnea is the number of individuals considered obese or overweight,'' Reyna said.

Sometimes making lifestyle changes can help reduce or even stop snoring. Some of these changes include losing weight, limiting alcohol consumption, quitting smoking, changing sleeping positions and ridding your bedroom of allergens such as dust and pet hair.

The road to sleeping well

The following advice from sleep experts and the National Sleep Foundation will help people reduce or stop primary snoring, but those with sleep apnea can benefit, too.

-- Change sleeping positions. Some people are just positional snorers and only snore when they're on their backs. Some organizations sell T-shirts with a pocket sewn onto the middle of the back where a tennis ball fits. It helps keep the person lying on his or her side.

-- Lose weight. Overweight and obesity can be primary causes for primary snoring and sleep apnea. There's more tissue and fat around the neck area encroaching on the muscles of the throat.

Avoid sedatives, smoking and alcohol. These only increase the chances of snoring. Sedatives and alcohol relax the throat muscles and smoking inflames the tissue in the mouth and throat.

-- Fix nasal obstructions and allergies. Some people who have snoring without sleep apnea can sometimes be helped by treating nasal allergies.

-- Oral appliances fitted by dentists can sometimes help reduce snoring. But go to a specialist.

--Remove tonsils. In children, snoring is often caused by enlarged tonsils. Removing them is effective in 90 percent of children, Nicholson said.

-- Consider chin surgery. Some people with shorter chins might benefit from surgery to pull the chin forward to create a bigger airway.

---- Consider implants. Silicone beads called palatable implants can be injected into the soft palate to stiffen it up in people with primary snoring. Again, insurance most likely will not cover the procedure because it's considered cosmetic.

Who's at risk

According to the National Sleep Foundation, risk factors for sleep apnea include the following:

-- Having a smaller upper airway, a large tongue, tonsils or uvula

-- Being overweight or obese

-- Having a small jaw or receding chin

-- Having a large overbite 

-- Having a large neck size (17 inches or greater in a man; 16 inches or greater in a woman)

-- Smoking and alcohol use

-- Being age 40 or older

-- Ethnicity (African-Americans, Pacific-Islanders and Latinos)

Do breathing strips work?

Commercials and Internet sites tout the use of nasal strips and sprays to stop snoring. But do they really work?

A study published a year ago in ``Otolaryngology - Head and Neck Surgery Journal'' concluded these products don't help because snoring happens when the throat muscles relax and the tongue falls back, which obviously has nothing to do with the nose.

If snoring is a direct result of congestion or a deviated septum, then nasal dilators, strips, sprays and decongestants might help.

Anti-snoring throat sprays might help a little. They contain oils, so using them is similar to oiling a squeaky hinge. But these sprays don't last long and can be dangerous for people with sleep apnea, said Dr. Robert Reyna, director of the sleep clinic at Kaiser Permanente Medical Center, Fontana.

Children should not use throat sprays, he cautioned.

- L.N.

CAPTION(S):

drawing, photo, 3 boxes

Drawing:

(cover -- color) Sound and alarm

Chronic snorers may carry serious health risks

Illustration by Betts Griffone/Staff Artist

Photo:

no caption (man sleeping and woman with hand over her forehead)

Photo illustration by Tina Burch/Staff Photographer

Box:

(1) The road to sleeping well (see text)

(2) Who's at risk (see text)

(3) Do breathing strips work? (see text)