Nothing epitomizes the state of sleep as much as the sound of snoring. So, it may surprise you to know that many people report snoring while awake!
Snoring is often assumed as an innocuous by-product of a good night of rest. However, snoring can occur while they’re still wide awake, or during the process of ‘nodding off’. This snoring can also be accompanied by changes in the rhythm and depth of breath, leading to noticeably loud or trouble patterns of breathing. Interestingly, it’s often the case that the individual won’t notice this snoring or change in breathing, but usually, those around them are quick to highlight it…
But what causes this daytime snoring?
What is snoring?
Before delving into the underlying causes of this phenomenon, it’s important to clarify what snoring is.
That unmistakable sound of snoring is caused by vibrations within the nasal and respiratory passages during sleep. When we sleep, all of our muscles become relaxed (sometimes to the extent of paralysis). This relaxation includes the muscles of the neck and throat. Occasionally, this relaxation can narrow the respiratory passages and increase air pressure within the lungs nose and throat. As a result, vibrations (and that well-known sound of snoring) are produced.
As bizarre as snoring while awake sounds, the phenomena shouldn’t be taken lightly. Unfortunately, episodes of snoring while awake can indicate a serious and dangerous underlying condition called sleep apnea. Although snoring often seems innocuous, some studies have reported as many as 87% of ‘snorers’ suffer from sleep apnea. Moreover, many patients report snoring and other breathing difficulties while awake.
What is sleep apnea?
Sleep apnea is a particularly dangerous condition that manifests as periods of shallow or complete pauses to breathing during sleep. Sleep apnea is categorized into two main forms:
- Obstructive Sleep Apnea (OSA): In OSA, breathing is disrupted by a physical blockage in airflow. In general sufferers of OSA have substantially narrower air passages. This means that breathing can be difficult under normal circumstances, but is a particular issue when muscles are relaxed.
- Central Sleep Apnea (CSA): CSA is slightly more complex, in which regular breathing rhythms which are unconsciously controlled by the ‘limbic’ system of the brain, simply stop without a fully understood cause. This type of sleep apnea is much less common than OSA, and is usually associated with other medical conditions that affect brain function; for example, damage to the brainstem or limbic system through stroke or tumors.
Can sleep apnea occur while awake?
Despite the word ‘sleep’ being present in the name of the condition, this isn’t the only time when symptoms of sleep apnea can occur. The term ‘apnea’ is defined as “the cessation of breathing, during which there is no movement of the muscles of inhalation and the volume of the lungs remains unchanged”.
Apnea itself can occur whenever there are periods of extensive muscle relaxation (OSA) or neurological pauses to breathing (CSA). While symptoms are usually more severe while lying down at night, apnea can occur during the day. Sleep apnea sufferers often have higher circulating levels of carbon dioxide in their blood as a result of poor, paused or shallow breathing at night. These elevated levels contribute to difficulties breathing during the day, creating somewhat of a ‘vicious cycle’ if left untreated.
Obstructive apnea while awake
Obstructive apnea can occur even when the patient is awake. Essentially, in a similar way as it takes place when asleep, the airways of a patient become physically disrupted. This causes changes in the patterns and depth of breathing and can result in loud breathing, and even snoring while awake.
There are a variety of risk factors obstructive apnea while awake. In particular, neuromuscular weakness, a condition in which nerve fibers which control muscles become dysfunctional and do not exchange information with the muscle normally. Other conditions, such as ALS, muscular dystrophy, genetic conditions, and obesity, can contribute to daytime sleep apnea and snoring as well.
In this circumstance, even though the muscles aren’t paralyzed by normal processes of sleep, they aren’t strong enough to conduct inhalation and exhalation of air at a normal rate or pressure.
Central apnea while awake
In normal conditions, we don’t have to think about regulating our breathing because the limbic system of our brains takes control of all of this. This is the case whether we’re awake and asleep.
In the case of central apnea, the normal cue from the brain which triggers our diaphragm to breath is disrupted for a short period. This results in a momentary pause in breathing which can occur while we’re awake.
Sufferers of central apnea report snoring while wide awake as occurring numerous times per day. This event doesn’t seem to be related to day-time sleepiness or ‘nodding’ off, because the condition is unrelated to how relaxed airway muscles are.
Pregnancy and apnea
In recent years, research has highlighted a group which is particularly at risk of developing apnea; pregnant women. While some disruption to sleep and general tiredness is to be expected during pregnancy, it’s becoming more apparent that sleep apnea poses a great risk to many pregnant women.
A 2017 study indicated excessive weight gain and gestational diabetes during pregnancy as key risk factors. This study, which included over 3,000 women, highlighted that around 8.3% of all women suffered from OSA by mid-pregnancy; a much higher rate than the general population. This is likely because during pregnancy levels of estrogen are elevated. This elevation causes the mucus membranes of the nose to swell and leads to congestion. Ultimately, this obstruction to the airways can constrict airflow and cause difficulties with breathing. Again, while this condition generally manifests at night, pregnant women can also experience snoring while awake and daytime apnea.
Diagnosis and adequate treatment of apnea is critical during pregnancy, both for the mother and child. In particular, pregnant women with apnea appear to be more likely to suffer from preeclampsia and gestational diabetes; conditions which can be dangerous to both mother and child. Another study discovered that pregnant women who suffered from apnea had increased risk of congestive heart failure, pulmonary embolism, and in-hospital death.
In terms of the direct health of the child, mother’s with apnea are more likely to have to deliver by cesarean and experience complications surrounding birth. In particular, it has been reported that newborns from mothers with apnea are more likely to require neonatal intensive care, often due to breathing problems in the child.
Apnea of any kind, whether fast asleep or wide awake, is a serious and dangerous condition. If you think you or a loved one may be experiencing the symptoms of sleep apnea, you must take steps toward a quick diagnosis and treatment from a medical professional.