The snoring had gotten so bad that other people in the house were complaining about it.

Lori Porterfield had snored for most of her adult life. The Whiteland resident would wake up groggy and feel tired throughout the day. She learned to live with it.

But soon it wasn’t just disturbing her rest, it was affecting those around her.

“My husband and my grandkids, they kept telling me that they couldn’t sleep,” she said. “They made me go to get checked out.”

Porterfield’s snoring was caused by sleep apnea, a condition suffered by millions of people in the U.S. A good night’s sleep is next-to-impossible when you stop breathing in the middle of the night. More than just buzzsaw-like snoring and tossing and turning, apnea occurs when the upper airways collapse during sleep and prevent air from getting into the lungs.

Sleep apnea, which studies suggest affects up to 25 percent of the population, has the immediate effect of making people groggy and lethargic due to lack of rest. But over time, the consequences can range from hypertension to strokes to strain on personal relationships and depression.

“What happens is, their oxygen levels are dropping down. It’s been determined that even a small decrease in oxygenation can cause some major physiological problems in the body,” said Mike Merrick, supervisor at the sleep care center at Johnson Memorial Hospital.

On a computer screen in the sleep care center at Johnson Memorial, Merrick pointed out what sleep apnea looks like.

He had pulled up a patient’s sleep diagnostic test. Graphs measured the normal rhythms of sleep. The machine tracked the patient’s heart rate and brain function during sleep. It could sense eye movement, body position and muscle activity in the chin and legs.

“We need to find out when they’re asleep,” Merrick said. “We can see when they drift off, and watch them during the deep levels of sleep.”

Measuring oxygen level

One of the most telling factors was oxygen level in the body. Sensors can detect how hard the body is trying to breathe and when air is moving in and out of the lungs.

When the patient started suffering from apnea, the graph’s up and down movement ended.

“During apnea, we’ll see this go flat,” Merrick said. “They’re still trying to breath, but their airways are physically closed off, so they cannot move any air.”

At that point, other sensors picked up movement. The patient’s legs started kicking slightly, and the chin moved in an effort to breath.

Sleep apnea is a condition in which a person’s airway closes involuntarily during rest. It occurs in a part of the upper throat called the orophranyx, between the nasal passages and mouth.

“There’s not cartilage there to support the airway, it’s just soft muscle tissue,” Merrick said. “So, for a number of reasons, that can become compromised — smoking, strokes, weight gain.”

Apnea events can happen every second, subtly enough that a person doesn’t even know they’re happening. But without air, apnea disrupts the normal cycles of sleep that the body desperately needs.

“There is a good correlation between sleep apnea and higher blood pressure, heart rate, increasing your risk of stroke and heart failure,” said Dr. Sultan Niazi, a pulmonary and critical care physician at Community Physician Network and board-certified in sleep medicine. “There’s an increased cardiovascular morbidity and even a mortality.”

Often undiagnosed

Research in the medical community indicates that at least 5 to 7 percent of the population have sleep apnea, Niazi said. But the increasing body of research shows that number is likely much higher, maybe as much as 25 percent.

“It’s a common condition, and more times than not it goes undiagnosed. People don’t want to go to a doctor or a sleep lab, so they ignore it for many years,” Niazi said.

Sleep apnea is linked to such health problems as diabetes, strokes and heart attacks. A 2014 study from the University of Wisconsin revealed that people with severe, untreated sleep apnea died at rates three times greater than those without apnea.

The condition also has social consequences as well that can impact people’s lives.

“We put that on the back burner, that the patient’s partner who doesn’t have sleep apnea can’t get a good night’s sleep as well,” Niazi said. “That had an impact on their health and their relationship.”

Snoring is a sign that you may have sleep apnea. But it’s not necessarily an absolute indicator. Niazi described it to being conditions on the same spectrum of problems — apnea is just more serious.

With sleep apnea patients, the snoring is not constant. Instead, it sounds like a person gasping to breath, followed by silence, Merrick said.

“If you have snoring, you may not have sleep apnea,” he said. “You may have a deviated septum or sinus conditions. That kind of snoring is going to sound different.”

At sleep centers throughout Johnson County, specialists work with patients on apnea and other problems related to it.

Better sleep, better testing

Physicians will refer patients who are struggling with sleep loss to the center. Weight, body mass index and restfulness are all conditions that doctors factor in to determine who might be suffering from sleep apnea.

Porterfield’s physician referred her to the sleep care center at Johnson Memorial Hospital, where she underwent a sleep study.

The sleep center is set up like a small hotel. Patients have their own private room, with a bed and bathroom of their own. They’ll spend the night in the hospital, coming in around 8:30 p.m. and leaving the next morning.

Everything is designed to make people feel like they’re staying in their own bedroom, with minimal medical equipment in the room itself.

“You don’t want to feel like you’re sleeping in a hospital, so it makes for better sleep and better testing,” Merrick said.

Merrick will begin by giving patients a sleep study, which measures body systems while a patient is sleeping. From those measurements, he can determine how severe a problem is, and start formulating ideas to address it.

‘Couldn’t breathe out’

Losing weight and increasing exercise are ways to treat the mildest cases of sleep apnea. Surgery and custom-designed mouthpieces are other options to keep airways open and clear is someone is dealing with more serious cases.

But the most severe cases of sleep apnea can be corrected with a continuous positive airway pressure machine, or CPAP. The device consists of a mask that patients wear over their mouth and nose.

Air is pumped in at a constant pressure, ensuring that the throat and other breathing passages are open.

During the initial sleep study, specialists will adjust the pressure on the machine up and down, until they reach a level where a patient’s airways stay open during sleep.

For Porterfield, who also suffered from chronic obstructive pulmonary disease and asthma, it required a special mask that took all of her respiratory issues into account.

“I was breathing in fabulously, but I couldn’t breathe out,” she said. “But they really helped me find the right mask to help me.”

She’s noticed a marked difference in the way she feels since going to the sleep center. She is less tired when she wakes up, sleeps throughout the night without interruption and doesn’t snore at all any more.

Porterfield didn’t realize how bad her problem was, but is thankful that she was finally treated at the sleep center.

“I sleep great now,” she said. “They did a great job. I might have given up if I didn’t have someone who was helping me.”

Sleep Apnea 101

Sleep apnea

What is it: A condition where your breathing pauses while you are asleep because your airway has become narrowed or partly blocked.

What causes it:

  • When a person sleeps, all of the muscles of the body become more relaxed, including the muscles that help keep your throat open so air can flow into your lungs.
  • Normally, your throat remains open enough during sleep to let air pass by. However, in some people the tissues close in and block the airway. This stop in breathing is called apnea.

What are the symptoms

Snoring heavily soon after falling asleep, which becomes very loud. That snoring is interrupted by a long silent period while your breathing stops, followed by a loud snort and gasp, as you attempt to breathe. This pattern repeats throughout the night.

Signs you have sleep apnea?

  • Wake up unrefreshed in the morning
  • Feel sleepy or drowsy throughout the day
  • Act grumpy, impatient or irritable
  • Be forgetful
  • Fall asleep while working, reading or watching TV
  • Feel sleepy while driving or even fall asleep while driving
  • Have hard-to-treat headaches

Other problems that may occur include:

  • Depression
  • Hyperactive behavior, especially in children
  • Difficult to treat high blood pressure
  • Leg swelling

How to test for it:

  • The health care provider will take your medical history and do a physical exam, checking your mouth, neck and throat.
  • You may be asked about daytime sleepiness, how well you sleep and bedtime habits.
  • You may be give a sleep study to confirm obstructive sleep apnea.

How to treat it:

Lifestyle changes may help relieve symptoms in people with mild sleep apnea:

  • Avoid alcohol or medicines that make you sleepy before bedtime. They can make symptoms worse.
  • Avoid sleeping on your back.
  • Lose excess weight.

Continuous positive airway pressure devices work best to treat obstructive sleep apnea in most people.

  • You wear a mask over your nose while you sleep.
  • The mask is connected by a hose to a small machine that sits at the side of your bed.
  • The machine pumps air under pressure through the hose and mask and into your airway while you sleep. This helps keep your airway open.

The possible complications of sleep apnea:

  • Anxiety and depression
  • Loss of interest in sex
  • Poor performance at work or school
  • Daytime sleepiness because of sleep apnea can increase the risk of motor vehicle accidents from driving while sleepy or industrial accidents from falling asleep on the job.

In most cases, treatment completely relieves symptoms and problems from sleep apnea.

Untreated obstructive sleep apnea may lead to or worsen heart disease, including:

  • Heart arrhythmias
  • Heart failure
  • High blood pressure
  • Stroke

SOURCE: University of Maryland Medical Center

Ryan Trares is a reporter for the Daily Journal. He can be reached at or 317-736-2727.