The Snoring Sickness

For Norman Siegel, a stocky, 40-year-old English teacher from Bridgeport, Conn., drowsiness had been a curse since high school days. He could fall asleep and indeed often did, at almost any time -in front of his class, at the wheel of his car and even while giving driver-training instruction. For years, despite spending thousands of dollars looking for a cure and being twitted by his friends about his intermittent stupors, he was unable to do anything about his affliction.

Siegel was one of the 50,000 or more Americans who suffer from a little-known, and often misdiagnosed disorder called sleep apnea (literally, want of breath). During a single night, they may wake up 400 or 500 times. These interruptions are so brief, only a few seconds or so, that apnea victims are usually totally unaware of them and at a loss to explain the morning-after blahs. When these patients take their complaint to a doctor, they usually get no help. The problem is that the physician sees the patient in the daytime and has no way of knowing the underlying cause of the malaise. Often the most he can do is to prescribe some sleeping pills, which generally prove totally ineffectual and can be dangerous. Now, as a result of the emergence of a whole new specialty that deals only with sleep disorders, the ailments that tortured Siegel and hundreds of other patients are finally being properly diagnosed and brought under control.

First, the sleep clinicians probe deeply into a patient's sleep habits -for example, by questioning his bed partner. They also video-tape his slumber behavior in special sleeping rooms, where patients spend the night hooked up to a polygraph, a lie-detector-like machine that monitors sleep-related physiological functions (breathing, muscle twitching, rapid eye movement*).

After Siegel had spent only a single night at the new sleep-wake clinic of New York's Montefiore Hospital and Medical Center, Neurologist Elliot Weitzman's suspicions about him were confirmed; as soon as Siegel fell asleep, the functioning of the muscles of his upper respiratory tract became so impaired that breathing would come to a total halt for as long as a minute (doctors are uncertain whether excessive muscle relaxation or contraction is responsible). Then Siegel would awake with a start, and in his groggy state would gasp for air with a loud snore. The loud gasping and snoring were repeated hundreds of times during the night, seriously disturbing his sleep.

Sudden Death. The primary cause of this breathing failure remains unclear, though sometimes it appears to be linked with obesity. In any case, drowsiness is only the mildest byproduct. The disorder can lead to hypoxia (low blood oxygen), hypertension (high blood pressure), heart disease and in some cases sudden death. Nor is it easily treatable. Conventional sleeping pills can actually worsen the problem by increasing the breathing difficulty. Removing the tonsils and adenoids to make a larger breathing passage seems to work only in children. Shedding weight makes little difference. Jokes the still overweight Siegel: "I've lost 3,000 pounds over the years."

What did finally help Siegel was a new variant of an old emergency surgical procedure: the tracheotomy -cutting an opening into the windpipe and thus totally bypassing the blocked breathing passage. First introduced in apnea a decade ago, such operations . have now been performed on about 30 Americans at the 20 U.S. sleep centers now in existence. The procedure is relatively simple, but leaves the patient with a hole in his throat.

During the day, the patient simply plugs up the inconspicuous little breathing tube in the incision -thus assuring normal speech. He usually can conceal the surgical paraphernalia by wearing a turtleneck sweater. At night the plug is removed, and only a few days or so after the operation, nocturnal breathing usually is dramatically improved. The apnea itself is not cured, and might return if the hole were closed at night. But the operation clearly makes life bearable again. Siegel, for example, is now functioning wide-awake during the day and sleeping soundly at night -without snoring -for the first time in years. Says he: "My wife is still trying to get used to the silence."

* The sign of one of the states of sleep, known as REM. characterized by intensive dreaming.

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