CONDITIONS

What Is Snoring

Snoring occurs when you have difficulty circulating air freely through your nose, mouth, and throat during sleep. When these passageways are restricted or narrowed, the air being forced through them causes the tissue of the palate (roof of the mouth) and throat to vibrate.  The sound varies with the degree of the obstruction.  The result of this turbulent airflow is the non-melodious sounds of snoring.


The first order of business is to understand the different types of snorers:

Nose snorers. Humans are hardwired to breathe through the nose as that organ is what filters and humidifies air entering our bodies—it is most common to breathe through our noses when sleeping. Nasal snoring is due to swelling in the nasal cavity (often caused by allergies) or a deviated septum.  When the nasal cavity is constricted or obstructed, the air is forced through these narrow passageways, causing the tissues to vibrate and ZZZZZZZ.

Mouth snorers. Sometimes people with restricted nasal passageways breathe and thus snore through the mouth, even though the problem originates with the restricted nasal passages. Generally, those whose snores emanate from the mouth are reacting to the relaxation of soft tissue at the back of the mouth, which creates the restriction of airflow through the passageway. This restriction leads to the vibration of the soft tissues that causes the snoring.


Here is an explanation of the different soft tissues:

The Soft Palate.  This muscle goes from the roof of the mouth to the back part of the mouth. While the soft palate is attached to the bones at the front and sides of the mouth it really is hanging free at the base of the mouth. Thus it can move forwards and backwards to open or close the connection between the nasal passageway and the mouth. When you are breathing, the soft palate moves forward to allow the passage of air. When eating or drinking it moves backward to prevent anything that is being ingested from entering the nasal cavity. For instance it allows salad and iced tea to go down your throat.

Uvula. The little ‘ball’ that hangs down at the back of the mouth is called the uvula. It helps the soft palate perform its jobs.

Tongue. As you know from a lifetime of experience, the tongue is not anchored tightly in the mouth.  Rather, it freely moves around in order to aid in the tasks of swallowing and speaking.


Snoring is a Common Affliction

As anyone who snores and/or sleeps with a person who ‘saws logs’ can surmise – this affliction is common. Indeed, according to the American Academy of Otolaryngology (AAO) 45 % of normal adults are occasional snorers and 25 % suffer from habitual snoring.  Snoring typically worsens with age because the muscles in the nose, mouth and throat lose tension. As the air passageway become even more easily restricted, snoring increases in frequency and volume. Perhaps this is one of the reasons of midlife marital malaise!

In all seriousness heavy snoring might be more than a nuisance to all within earshot. It can be an indication of obstructive sleep apnea. One in three men, and approximately one in five women who are habitual snorers, suffer from this malady to some degree. Obstructive sleep apnea (OSA), which causes you to temporarily stop breathing for short periods of time while you sleep, is a serious sleep disorder as well as a risk factor for health issues such as stroke, diabetes and heart disease.

What Causes Snoring

Anything that prevents you from breathing freely through your nose can cause snoring.  Culprits include:

  • Nasal congestion or deformed nasal passage. This can be caused by congestion from a cold, allergies, sinusitis, alcohol or other depressants, smoking, sleeping pills, enlarged tonsils…  All these conditions relax the throat muscles, amping up the possibility of the big S erupting.
  • Deviated septum. The septum is the bone and cartilage that splits the nose in half.  When the septum is deviated, the bone and cartilage are a bit crooked or off center. Over 80 percent of people have this condition but it typically only causes snoring when the deviation is severe.  (In these cases the snoring is due to the deviation, not air blockages in the throat.) If you snore through your nose night after night, a deviated septum might be to blame.
  • Sleep position. Lying on your back restricts the air passageway. So lie on your side and/or gently or not so gently nudge your partner onto his side to lessen the log sawing.
  • Being overweight. When you carry too much weight, you develop thicker neck tissues that cause strain on the throat. Losing weight, being active and eating healthy are good ways to lessen or eliminate the extra tissue from your airway.
  • Aging. Body parts become less toned with age, including the throat muscles.
  • Genetics. If your parents ‘gifted’ you with extra throat tissue as well as enlarged tonsils, large adenoids, long soft palate or a long uvula you will likely snore.
  • Obstructive sleep apnea. This condition can be dangerous as it involves, along with loud snoring, shallow breathing and intense periods of gasping and momentary choking while you are sleeping.  You wake up gasping for air.  If undiagnosed OSA can eventually lead to high blood pressure, heart attack and stroke.

Risk Factors For Snoring

Risk factors for snoring include:

  • Being overweight
  • Narrow airway
  • Drinking alcohol
  • Family history of snoring or obstructive sleep apnea  
  • Nasal problems (i.e.: deviated septum)

Diagnosing Snoring

To diagnose whether your snoring poses a threat to your health the doctor will ask about your medical history, go over your symptoms and talk to your partner for specifics about your snoring. If warranted your doctor will request an imaging test–x-ray, scan, or magnetic resonance imaging. The purpose is to examine the structure of your airway for problems such as a deviated septum.

If your issues are severe, a sleep study might be ordered. This is conducted at home or if necessary at a sleep clinic. The study, called a polysomnography, and conducted by a team of specialists, involves an in-depth examination of your sleep habits.  In-depth meaning, you are connected to several devices so that your brain waves, blood oxygen level, heart rate, breathing rate, sleep stages, eye and leg movements can be observed and recorded overnight.


Diagnosing Your Snoring Disorder 

There are two types of snoring – Primary and Obstructive Sleep Apnea.

Primary. This is the best type to have, as it’s not associated with the more serious sleep apnea.  Related to blockages of air passages in the nose and throat, primary snoring is characterized by loud respiratory breathing. There is no pausing or cessation of breathing.   A polysomnography will show normal breathing and sleep patterns. Those with this disorder do not suffer from insomnia or excessive fatigue, as their snoring doesn’t wake them during the night, as is the case with OSA-caused snoring.

Sleep apnea. Derived from the Greek language, “apnea” translates to “without breath.”  During sleep you might stop breathing partially or completely. This stoppage can last for several seconds or minutes.  You fall back asleep and the process repeats.

According to the National Sleep Foundation, sleep apnea affects 18 million people—most commonly men, those who are overweight, and people over 40. But it can strike anyone. There are three types of sleep apneas, which can be diagnosed by a polysomnography.

  • Obstructive Sleep Apnea. Caused by a blockage of the airway, typically when soft tissue in the rear of the throat collapses and closes during sleep. The most common type of apnea, affecting 2 % to 9 % of people in the United States.
  • Central Sleep Apnea. Although the airway is not blocked, the brain doesn’t signal the muscles to move. Much more rare than OSA, snoring typically doesn’t happen with people who have CSA.
  • Mixed Sleep Apnea. A combination of the two. Sleeping is fragmented.

Symptoms of Snoring

Symptoms of snoring include:

  • Noise during sleep
  • Sore throat
  • Excessive daytime sleepiness
  • Nightly gasping and/or choking
  • High blood pressure
  • Difficulty focusing
  • Morning headaches

Prognosis

In cases where OAS is not involved, if you are diligent with making and maintaining lifestyle changes such as promptly treating breathing problems such as a stuffy nose caused by a cold or allergies, using a nasal dilator (nasal strips) and raising the head of your bed 4 inches to 6 inches by placing bricks under the legs of the bed, you have a very good prognosis.

Living With Snoring

If you suffer from mild or occasional snoring, that is, snoring not associated with obstructive sleep apnea, upper airway resistance, insomnia, or an underlying disease, then behavioral remedies will usually suffice. Try avoiding:

  • Alcohol for four hours before bedtime
  • Heavy meals for three hours before bedtime, and
  • Sleeping  on your back  (try sleeping on your side)

Prevention

Here are some top tips to help prevent snoring:

  • Drop weight. If you are overweight you would be well served to drop excess pounds.
  • Avoid the temptation of late night snacking and alcoholic drinking.  Drinking causes throat muscles to slacken.
  • Don’t sleep on your back. Instead, lie on your side.  If this is difficult, attach a tennis ball to the back of a pajama top or t-shirt. Or wedge a pillow stuffed with tennis balls behind your back. The ball(s) will be uncomfortable if you lie on your back, prompting you to turn on your side.
  • Sleep without a pillow as pillows bend your neck out of alignment, which can contribute to obstruction of the airway.
  • Don’t smoke as this causes nasal and lung congestion—a contributor to snoring.
  • Avoid sleeping pills. Sedatives relax your neck muscles and can thus exacerbate snoring.
  • Exercise. This tones muscles, including the ones in the throat.

Medication And Treatment

Treatment for snoring depends on the level of upper airway narrowing. If tests determine you do not have serious snoring issues or OAS, the doctor will likely recommend behavioral changes such as:

  • Avoid alcohol, certain medications and muscle relaxants. These substances can relax the throat or tongue muscles, which can cause snoring. If a medication you are taking is causing you to snore, ask your primary physician if there is another option.
  • Don’t sleep on your back.
  • If you are overweight, lose some weight.
  • Don’t smoke

If tests conclude that you have OAS, surgical treatments include:

  • CPAP.  This is a nasal mask worn during sleep. The device exerts a small amount of pressure to open the airway.
  • UPPP. Uvulopalatopharyngoplasty is surgery for treating snoring and OAS by removing excess soft tissue palate and opening the airway.  This causes the remaining tissue to stiffen, minimizing the tissue vibration. Sometimes a tonsillectomy is performed simultaneously, which further enlarges the air passage.
  • Thermal ablation procedures. This is a common option for both snoring and OAS.  It may be done in the operating room. The purpose is to reduce tissue bulk in the nasal turbinates, tongue base and/or soft palate.   Methods of thermal ablation include laser, radiofrequency, and bipolar cautery. Several treatments may be required.
  • Pillar implants. This increases the stiffness of the soft palate without removing tissue, rather by inserting stiffening rods.

Non-surgical options include:

  • Snoring devices. Visit your doctor to see which is best for you.  These range from anti-snoring pillows to mouthpieces and chin straps.  Also earplugs for your partner!

Complementary and Alternative Treatment

Here are some promising alternative treatments outlined by the Mayo Clinic to limit or prevent snoring:

  • Singing.  Do-re-me-ing can help you stop snoring.  Participants in a preliminary study who sang prescribed singing exercises 20 minutes daily for three months were found to have some decrease in snoring.  All had started snoring as adults, didn’t have nasal problems and weren’t overweight.
  • Playing the Didgeridoo.  This musical instruction produces a droning sound.  Research is being done with sleep apnea sufferers playing 25 minutes a day, most days of the week. The supposition is that playing the Didgeridoo may aid in training muscles of the upper airway, and decrease daytime sleepiness. The research is preliminary.

Numerous over-the-counter products are available such as:

  • Nasal sprays
  • Special pillows
  • Homeopathic remedies.

While many report success, there is no scientific proof any of these are effective.

When To Contact A Doctor

You and/or your partner can determine if a doctor visit regarding your snoring and snoring related-issues (i.e.: disruption of sleep) is warranted.  See a doctor if you:

  • Gasp and/or choke during sleep
  • Kick or jerk your legs during sleep (this could be restless leg syndrome)
  • Have difficulty waking up in the morning or a feeling you are not sleeping enough
  • Are irritable
  • Frequently lose focus
  • Become depressed

Questions For A Doctor

When you see your doctor, it’s good to have a list of things you want him or her to know as well as questions you’d like answered. For example:

  • Discuss any symptoms you are having, even if they don’t seem related to snoring. Your partner can describe what he or she notices or— more likely hears!—each night.
  • Give the doctor a list of the medications, vitamins and supplements you take.

Ask questions, such as:

  • What makes me snore?
  • Is my snoring a sign of something more serious, like sleep apnea?
  • What kind of tests do I need?
  • What can I do on my own to alleviate the problem?
  • What treatments are available, and what do you recommend?
  • What types of side effects are there from the treatments?
  • I have other health issues. How can I manage the snoring and those other conditions?
  • Are there websites or printed material you recommend I read?

Resources

For more information, please see:

National Sleep Foundation

Sleep Education – a sleep health information resource by the American Academy of Sleep Medicine