00:00For people who snore, the most dangerous moment isn't when they're snoring.
00:03It's the seconds when they suddenly go quiet.
00:05You've probably had this experience.
00:07It's the middle of the night, and the person next to you is snoring loudly.
00:10You're about to nudge them awake, when suddenly, the sound stops.
00:13A strange, unsettling silence.
00:15You relax, roll over, and fall back asleep.
00:18Those few seconds of silence are actually the most dangerous moment of the entire night.
00:22To understand why, we first need to understand what snoring actually is.
00:25When you fall asleep, the muscles around your throat relax.
00:28Your soft palate, your tongue, the walls of your airway all sag downward, and your airway narrows.
00:33Air still has to squeeze through this narrowed passage, vibrating those loose tissues back and forth.
00:37That vibration is snoring.
00:39So the snoring sound itself is telling you something, this airway is already narrowed.
00:42But it's not blocked yet.
00:44Air is still getting through.
00:46So what does it mean when that sound suddenly stops?
00:49Two possibilities.
00:51One, the person rolled over and the airway opened up again.
00:53Two, the airway is now completely blocked.
00:56As they go down, their chest is still rising and falling.
00:59The diaphragm is still working.
01:00They're desperately trying to inhale.
01:02But the airway above is sealed shut, and not a single breath of air can get in.
01:06In medicine, this is called sleep apnea.
01:08The diagnostic criterion, airflow completely stops for 10 seconds or more.
01:12Right now, you can hold your breath and count to 10.
01:14That sensation is what this person experiences, over and over, many times every single night.
01:19How many times?
01:20There's a metric called AHI, the apnea hyponia index.
01:23It counts how many times per hour you experience apnea, or severely reduced airflow.
01:27Fewer than 5 per hour is normal.
01:295 to 15 is mild.
01:3115 to 30 is moderate.
01:33Above 30 is severe.
01:34Above 30.
01:36And that's per hour.
01:37If you sleep 7.
01:38Hours a night, that's more than 200 events.
01:41In clinical practice, patients with an AHI above 60 aren't rare either, that's more than 400 events a night.
01:46On average, that's one event every minute.
01:48This is the hardest part of this disease to understand.
01:51A person gets choked 200 times a night, and has no idea.
01:54The next morning, he'll tell you he slept great.
01:56It's not that he's stubborn.
01:58He genuinely doesn't know.
01:59Because each time, his brain saves him.
02:02In most cases, when blood oxygen drops to a certain level, the brain pulls an alarm.
02:06It lifts the depth of sleep, tightening the throat muscles again, forcing the airway open.
02:10Air rushes in, often with a particularly loud gasp, or a sharpened hail.
02:14This is why people who snore are often quiet for a while, then suddenly gasp.
02:17This process is called a micro-arousal.
02:19The key point, it never reaches consciousness.
02:22The brain pulls the person out of.
02:24Deep sleep, handles the emergency, then puts them back, without ever notifying them.
02:28So the next day, they have no memory of it.
02:30They just feel one thing, tired.
02:33They slept 8 hours, and they're still exhausted.
02:35And it doesn't always work.
02:36Studies find that about 1 in 5 apnea events, and oxygen drops, come with no arousal at all.
02:42Those are pure oxygen deprivation.
02:44That night, they never truly slept.
02:46So after years of this, what's the price?
02:48Every apnea event drops blood oxygen.
02:50Every micro-arousal jerks the sympathetic nervous system awake.
02:53Heart rate up.
02:55Blood pressure up.
02:56200 times a night, that's 200 blood pressure spikes.
02:59Repeat this for 10 or 20 years, and your blood vessels can't hold up.
03:02That's why studies list it as an independent risk factor for hypertension.
03:05More than half of these patients also have high blood pressure.
03:08And nearly a third of all hypertension patients have this disease.
03:11It's also linked to coronary heart.
03:13Disease, stroke, diabetes, and arrhythmia.
03:16In severe cases, it can cause sudden death at night.
03:19Speaking of sudden death, here's something that stopped me the first time I read it.
03:22A professor at Peking University People's Hospital shared a clinical observation.
03:26The most severe patients with this disease are concentrated between 30 and 50 years old.
03:30And severe cases over 65 are actually rarer.
03:33Sounds like good news, doesn't it?
03:34Like maybe it just gets better with age.
03:36No.
03:37His explanation, death caused by sleep apnea is actually quite common.
03:41Some patients die suddenly at night, and it's attributed to cardiac causes.
03:45Others die from the obesity, diabetes, and hypertension caused by long-term oxygen deprivation.
03:49So the reason there are fewer severe patients over 65 isn't because they got better.
03:53It's because the worst of them didn't make it to 65.
03:55And sleep apnea was never written on any death certificate.
03:58And here's the scale of the problem.
04:00Current estimates say about 176 million.
04:03People in China are affected by this disease.
04:05And of those, only about 1% get timely treatment.
04:08Now, to be fair, otherwise I'd be scaring people for no reason.
04:12Snoring does not equal sleep apnea.
04:13Plenty of people just snore.
04:15Their airway never collapses to that degree, and they don't experience oxygen deprivation.
04:19Their health risk is much smaller.
04:21These two things have to be separated.
04:23I'm describing the mainstream medical consensus.
04:25Whether a specific person has one or the other, only a sleep study can answer.
04:29So how do you tell which kind the person next to you is?
04:31Current practice looks at three things.
04:331.
04:34Habitual loud snoring.
04:352.
04:36Someone has actually witnessed them stop breathing, gasping, or waking up choking.
04:403.
04:40They have high blood pressure.
04:42If they meet two of these three criteria, plus obvious daytime sleepiness, dozing off
04:46in meetings, falling asleep watching TV, even getting drowsy while driving, then they're
04:49in the high-risk group.
04:50That needs to be checked.
04:52By the way, daytime sleepiness has consequences beyond just embarrassment.
04:55One study shows that if you set up systematic screening and treatment for certain populations,
04:59related traffic accidents can be reduced by 73%.
05:02Getting checked isn't complicated either.
05:04A hospital sleep center can do polysomnography.
05:06Sleep one night, get a full report, the AHI and your lowest blood oxygen are right there.
05:11Smartwatches and fitness bands can do preliminary screening, but a diagnosis must come from
05:14medical-grade equipment in a healthcare facility.
05:17Don't draw your own conclusions from the numbers on your wrist.
05:19And one more thing I have to say up front, this disease is treatable.
05:22There's more than one treatment.
05:24But which one is right for a specific person is a decision for the doctor, after they read
05:27the full sleep report.
05:28That's not something this video can answer.
05:31So, finally.
05:32Tonight, you can do one very small thing.
05:34Listen to your dad snoring.
05:36Your mom's.
05:37The.
05:38Person sleeping next to you.
05:40Don't listen to the loud part.
05:41Listen to the quiet part.
05:43If that silence lasts 10, 20 seconds, and then gets broken by a sudden gasp, that's not
05:47them sleeping well.
05:48That's them being pulled up out of the water.
05:50But the real challenge comes after that.
05:52You have to tell someone who has spent decades convinced he sleeps wonderfully, someone who
05:55might even be a little proud of how loudly he snores, that this isn't good sleep.
05:59He needs to spend a night in the hospital and get checked.
06:01I'm guessing most of you will get pushed back with the same answer.
06:04I sleep fine.
06:05I'm not going.
06:06So the question I really want to ask you is this, if he refuses to go,
06:09what are you going to do about it?
06:10What are you going to do about it?
06:10What are you going to do about it?
06:11What are you going to do about it?
06:11What are you going to do about it?
06:11What are you going to do about it?
06:11What are you going to do about it?
