TeenFX.com Interview with Dr. Allan Pack

GUEST:
0
FX Points

Back To Interview List

Dr. Allan Pack

What is your occupation and position?

I am a Professor of Medicine at the University of Pennsylvania. I am also the Director of the Sleep Center at the University of Pennsylvania.

What are some of your major professional accomplishments? For example: positions, publications or awards?

I have published about 150 papers and I have edited 2 books. I have won a number of awards, this year I won the William Dement award for Academic Achievement In Sleep.

What is snoring and what produces the sound of snoring?

Common snoring is the vibration of the upper airways. When you go to sleep the upper airway narrows and in some people it narrows to a point that it actually vibrates and that produces snoring. The soft palate in the back of your throat vibrates, making a musical tone.

The other type of snoring is the kind that occurs at the end of an episode of obstructed breathing. This is caused by the airways narrowing so much that they are blocked. When this happens there is actually no noise and the person sucks hard to try and breath. When eventually the airway opens they make a loud gasping noise as the air rushes in. This is also considered snoring, but it is a somewhat different kind. It is an intermittent, very loud noise that people make. It is a grunting noise at the end of an apnea episode.

What are common causes of snoring in teenagers?

Snoring is very age dependent, so snoring itself would not be particularly common in teenagers. If you heard snoring in teenagers you would think of what are the risk factors.

In teenagers, there would be two major risk factors. One would be the persistent enlargement of tonsils and adenoids. By the time you get to your teenage years usually your tonsils and adenoids have decreased in size but for some reason they may have increased.

The second reason is, something has caused changes in nasal obstruction, so the nose is blocked for some reason. Septal deviation for example. You usually breath through your nose when you are asleep. If the muscle at the back of your throat gets floppy when you fall asleep, you need to suck harder through your nose. The suction effect can help narrow the airways, thereby causing the snoring. I believe the two most common causes for snoring in teenagers would be the persistent increase in tonsils and adenoids, and some problem that causes nasal obstruction.

Why should teenagers be interested in snoring?

There are two reasons teenagers should be interested in snoring.

One reason would be for them, if they snore, but the prevalence is probably quite low.

The second reason would be because of their parents. Snoring is going to be much more common in their parents, and in their parents it may be a symptom or a sign of obstructed sleep apnea. This is a very common condition in the middle-aged years.

The prevalence of sleep apnea is also very age dependent and it is also a very common condition. It is something that if teenagers knew a bit more about, they may be able to identify it in their parents.

How would a teen know if they had a problem with snoring or sleep apnea?

It is something that you would not know you had it yourself. It is something that someone would have to tell you about. The snoring that you have to be most concerned with is the snoring that is loud and habitual. In other words, snoring that is loud and that is there night after night, and can be heard in another room. This is not the type of snoring that happens occasionally, this is also the type of snoring that someone would have to tell you about.

In sleep apnea, someone would actually tell you that they saw you stop breathing. There would be a period of quiet and it would look like the person was not breathing.

The other symptoms with sleep apnea are; you wake up a few times at night, and when you wake up in the morning you’re not refreshed. You do not feel that you slept very well, and then during the day you’re excessively sleepy and you might fall asleep in all sorts of circumstances.

How serious can snoring and sleep apnea be?

You need to differentiate between what is socially unacceptable snoring without sleep apnea, and then sleep apnea.

Just take simple snoring, that is, you don’t know when it occurs and it is vibration without any episodes where your breathing stops. This, I think, is not very serious. In the sense that there are no major medical consequences. It may be an indication that in the future you could develop sleep apnea. I don’t believe it is a serious medical condition in the absence of sleep apnea, but it can be very socially disruptive.

Sleep apnea is a significant issue; it can lead to two things. Sleep apnea can lead to sleep interruption because every time you have episodes of stopping breathing, you keep waking up and so your sleep is very fragmented. You wake up and you are still excessively sleepy. The major consequence of being excessively sleepy is falling asleep while driving. There is substantial data to show that people with sleep apnea have an increased risk of motor vehicle crashes.

The other part is the continuous repetitive drops in oxygen that occurs with these episodes. When you stop breathing your oxygen level drops, and when you start breathing it goes up again.

There is growing data of the cardiovascular consequences of obstructive sleep apnea. There is definite data showing that sleep apnea is a risk factor for increased blood pressure, hypertension, and suggestive data that it is an increase risk factor for heart attack and stroke.

There is a very large study going on right now in the United States called the Sleep Heart Health Study that is documenting this relationship.

What tests are available for the diagnosis of sleep apnea?

The test that is available for the diagnosis of sleep apnea is a sleep study. This is an all-night study where you monitor sleep with EEG’s, you continuously monitor oxygen levels and breathing levels. It is called a polysomnogram. This is an all night study that is done in a place called, a sleep center. There are a lot of sleep centers throughout the United States, most being listed with the American Academy of Sleep Medicine.

What treatments are available for sleep apnea?

There are three types of treatments available. There are no simple medications that can be taken. All the treatments are related to mechanical interventions.

The most commonly used treatment is something called the nasal CPAP, which stands for Continuous Positive Airway Pressure. This is a device that you put over your nose; it is a mask that you wear. The mask has to be well sealed and it is attached to a machine with a blower in it that generates a pressure.

The pressure goes through your nose to the back of your throat and pushes the airway open and holds it open. This prevents you from having any apnea episodes because the airway cannot narrow or collapse. So it abolishes snoring and it abolishes sleep apnea. It is a good treatment for sleep apnea, in the sense that people will feel less sleepy. It is not a particularly good treatment just for snoring.

The second type of treatment is something dentists or facial surgeons do which is called, an Intra-Oral Device. This is something that goes in your mouth over your teeth and it pulls your jaw forward.

As a result of your jaw moving forward your airway becomes bigger, even though it narrows with sleep it does not get as narrow as without the device.

An oral device is not as effective as CPAP; it works for some people but not others. It works best in mild cases, but it can be a very effective treatment in mild apnea and in abolishing snoring.

The third type of treatment is surgical. There are many different kinds of surgical treatments available. The most commonly known one is the laser surgery. This is where a laser is put in the back of your throat and it burns off a part of the soft palate called, the Uvula.

This is not a particularly good treatment for sleep apnea, as it does not make a lot of difference to the level of breathing disturbance, but it can be effective in reducing the noise of snoring.

Should a teenager get their tonsils out at a young age?

I don’t think there is any data that says you should routinely get your tonsils out. It is not going to make a difference in the future. The peak age of getting your tonsils out is about the age of 5 or 6. However, the commonest indication for doing this now is sleep apnea in children.

There is a whole phenomenon of pediatric sleep apnea that relates to enlarged tonsils and adenoids. The treatment for sleep apnea in children is to take out the tonsils and adenoids because that is the largest single risk factor.

What can a teen do to prevent snoring or sleep apnea?

There are certain things that you can do to prevent and certain things that you cannot do. We know that there are a number of different risk factors for sleep apnea. We know that a genetic predisposition to nasal obstruction and an underactive thyroid are risk factors.

The biggest single risk factor in adults is overweight. So the most important thing a teenager can do to prevent sleep apnea in the future is not to become overweight.

The other thing that makes apnea worse is the drinking of alcohol in the evenings. Alcohol preferentially suppresses the activity of the upper airway muscle to keep the airway open. So two things that teenagers can do to prevent snoring or sleep apnea are to keep a healthy body weight, and avoid alcohol intake before going to sleep.

Where would a teen go to get more information about snoring and sleep apnea?

There are a number of places a teen can go to get information. There are many web sites that provide information online, and that have brochures. Some of the web sites are the American Academy of Sleep Medicine, National Sleep Foundation, which is a non-profit organization in Washington, and the National Center For Sleep Disorders Research, which is part of the National Institute of Health.

Is there anything teenagers can do to help people or a parent that they recognize to have sleep apnea?

The thing to think about first of all is that the people who commonly get sleep apnea are usually overweight, although you don’t have to be. If someone is overweight, particularly if they have a large collar size (over 17 inches). This is a risk factor that you can easily identify.

The second thing is, if there is loud habitual snoring. That is, night after night, and that can be heard in another room.

The third is the presence of witnessed apnea episodes, where the person actually stops breathing and there is a period of quiet followed by a loud grunting noise.

This interview was made possible by an unrestricted educational grant from Fisher & Paykel Inc.

Post a Comment
	Tessa	10-17-05

I am 100% sure that sleep apnea has cardiovascular consequences. My dad had it, and he died. His heart was enlarged, partially due to sleep apnea. That was 8 years ago! I can't believe how unsure they still are about this!


	erin	09-06-04

Does he test on animals?


	Kay	03-08-04

My stepfather has sleep apnea and he scares my mother to death because she'll wake up and he won't be breathing. I've been doing some basic research on the topic and I must say that this has taught me some new things.


	Dallas	01-05-04

Snoring seems to be the in thing! My parents snore, my aunts and uncles snore, but my grandparents are the worst. They seem to snore in unison. Yet, when we mention it to them they look so innocent and unbelieving. Do Dr.s have gift cards? Everybody else does. Anyway, a Sleep Specialist Gift Card for each of their birthdays is the way we need to go. Staying over is like murder on the eardrums!


	Kaydee	07-29-03

My daddy snores like you don't believe. He's done it since he was a teenager. I never thought he could have a disease, until now. THANK YOU for ing me understand sleep apnea and that it IS a common disease amongst elders. THANK YOU dr.


	Cassie	07-08-03

Tahomai have never snored in my life!!


	Anita	05-10-03

wow..


	tracy	01-28-03

My cousin snores really loud and you can hear it throughout the house. Does being overweight have anything to do with it?


	Nicole	07-24-02

Would having your tonsils removed prevent snoring and sleep apnea in a teenager?


	Joey	07-10-02

My dad is a snorer. He once took my friend and I to the movie and he fell asleep and was snoring in the theatre, it was so embarrassing. This is a great interview, there was some great information. Thanx!


	Summer	07-03-02

Interesting, who knew that there snoring could cause that.


	Andrew	06-27-02

I would be interested to know the statistics for teen snorers verses adult snorers. Adults are much bigger (many overweight) so their statistics will be much higher.


		06-25-02

Do many teens suffer from sleep apnea? I think Sleep Apnea would be mainly in adults. As for adults they all seem to snore so the statistics must be way up for sleep apnea! I've heard our cat and dog snoring and they sound so ny.


	Sara	06-20-02

I never knew if you snore you have a problem.


	Joey	06-13-02

That's ny becuase most people in my family snore and it's sooo ny.


	Charmelle	02-27-02

THANK YOU FOR INFORMING ME OF SOME NEW AND INTRESTING FACTS ABOUT SNORING...


	Libby	01-25-02

My step dad snors so loud and now I now why


	~Chelsea~	01-13-02

Why do mostly men snore loudest?


	Janet	01-02-02

You want to hear my grandparent's loud snoring - what a noise they make! Of course, they don't believe that they snore at all.


	Chris	12-11-01

I would snore when I was little but then my tonsils were removed and I stopped snorring


	Markia	12-07-01

This interview gives some good helpful tips on how to prevent snoring. I think this would help a lot of teenagers know that snoring is curable.


	Amber	12-05-01

i noticed my step dad snores alot and its annoying and i try to tell him about it and then he gets mad because he doesnt believe me


	Heather	12-04-01

My dad snores really bad, and I have been told by friends at sleepovers that I snore.


	TIM	12-04-01

My dad snores like that. I'll have to tell him about this.