6 - snoring

Snoring Overview

Snoring is the noise produced during sleep by vibrations of the soft tissues at the back of your nose and throat. The noise is created by turbulent flow of air through narrowed air passages. In general and in most cases, snoring has no medical significance unless it keeps you or others from sleeping. However, a more serious problem related to snoring can occur when those same soft tissues block the air passages at the back of the throat while you are sleeping. This interferes with the ability to breathe. This condition is obstructive sleep apnea (OSA), and it can directly affect your health.

Snoring Causes

• The prevalence of obstructive sleep apnea increases with age.
• In people aged 30–60 years, 2% of all women and 4% of all men have OSA. Up to 60% of the elderly have the condition.
• Most people diagnosed with obstructive sleep apnea are obese. Increased neck fat is thought to narrow the airway, making breathing more difficult.
• Men are 7-10 times more likely to have obstructive sleep apnea than women.

More Snoring Symptoms

Obstructive sleep apnea is an extreme form of snoring in which your upper airway closes while you are asleep, causing an obstruction that prevents you from breathing for a brief period.

• The soft tissues of the throat, your soft palate, and the tongue collapse onto the back wall of the upper airway, forming a blockage that prevents air from entering your lungs.

• The negative pressure of inhaling pulls harder on your soft tissues, sealing the airway even more tightly.

• To breathe and get air to your lungs, you must awaken or arouse slightly and create tension in your muscles—including the tongue and throat—and open the airway.

• This process causes a distinctive snorting, startling, and awaking pattern.

o If you have sleep apnea, you begin snoring, then stop breathing for at least 10 seconds (apnea). The apnea temporarily quiets the snoring, after which you awaken with a large snort. This pattern occurs in 95% of people with sleep apnea.

o Each cycle of blockage (apnea) and awakening can last from 20 seconds to 3 minutes, repeating many times throughout the night. Five episodes per hour per night are common. More than 15 episodes per hour per night are the criteria used to diagnosis the condition referred to as sleep apnea.

o Some snorers can have anywhere from 100-600 episodes or cycles of sleeping and waking per night.

o Although people with sleep apnea may be completely unaware of this repeating sleep-snore-apnea-wake pattern, it is very disruptive to normal sleep patterns. Usually, it is the bed partner who is most aware of the condition. Relationships, along with school and job performance, often suffer because of persistent daytime fatigue that develops as a result of continuously disrupted sleep.

• Characteristics of obstructive sleep apnea
• Movement in the bed when you wake and change position to breathe more easily
• Excessive daytime sleepiness with napping that often does not fully rest you
• Mood changes such as anxiety and irritability
• Decreased sexual drive and depression

• The repeated cycles of snoring, apnea, and waking that characterize OSA can lead to adverse physical changes and complications such as these:
• High blood pressure
• Coronary artery disease, heart attacks, strokes
• Pulmonary hypertension
• Confusion
• Loss of memory
• Psychiatric disorders and impotence

• Americans have OSA than do whites.
• Most people with obstructive sleep apnea are older than 40 years. Weight gain and a decrease in muscle tone occur with aging, and these may play a role in increasing the incidence of OSA.
• Sleep apnea is more common in postmenopausal women.
• Family history and genetics play a role.
• Polio and muscular dystrophy increase the chance of obstructive sleep apnea, as do other medical conditions such as sinus infections, allergies, colds and nasal tumors, and hypothyroidism (underactive thyroid gland).

When to Seek Medical Care

If you or someone close to you is not sleeping well because of snoring or sleep apnea, visiting your doctor may be helpful. This should be by appointment, because these are not emergency cases and sometimes extra time is scheduled for the evaluation.

A doctor's visit may be particularly important if you are doing any of the following:

• Falling asleep during normal waking hours

• Becoming irritable

• Losing concentration

• Becoming depressed

Exams and Tests

A doctor will complete a general physical examination, paying particular attention to your nose and throat.

• Your weight and blood pressure will be evaluated. Your blood may be tested for thyroid function.

• An otolaryngologist (ear, nose, and throat doctor) can look into your airway with a fiberoptic device to see if the nasal passages are open or partially blocked (septal deviation) or if there are any masses (tumors) present in your nose, throat, or upper airway that may be causing the snoring.

• For severe cases, you may be referred for a sleep laboratory test. This overnight test monitors up to 16 different bodily functions while you sleep. The results of these tests can help define the level and severity of sleep apnea if it is present.

Snoring Treatment

Self-Care at Home

Many remedies are available over-the-counter in drug stores, but most do not help correct snoring or sleep apnea.

• Because you tend to snore more when sleeping on your back, one useful technique is to try to keep from sleeping in that position. One way is to wear a pocket T-shirt backward with a tennis ball in the pocket. You will be less likely to sleep on your back because it is very uncomfortable to sleep on a tennis ball.

• Try losing some weight. As little as 10 pounds might make the difference.

• Avoid alcohol, especially in the 4 hours before going to sleep.

• Avoid using sedatives and narcotic medications. Alcohol, sedatives, and narcotics cause relaxation of your throat muscles and increase the tendency for airway obstruction related to snoring.

Medical Treatment

For mild forms of snoring caused by swelling of the lining of your nose, a doctor may prescribe an inhaled steroid preparation.

For more severe forms of sleep apnea, surgical procedures (see Surgery) or continuous positive airway pressure may be tried:

• Continuous positive airway pressure (CPAP)
• CPAP is a device that includes a mask that fits snugly over your nose and mouth and is held in place with head straps. The mask is connected to a blower that generates pressurized air. You wear it while sleeping.
• The controlled pressure works as an air splint to keep the soft tissue of the nose and throat in place and the airway open.
• This noninvasive therapy works for 95% of people with sleep apnea.

Surgery

• Somnoplasty: This is an outpatient surgical procedure performed with the patient under local anesthetic. It takes about a half-hour. During the procedure, a small electrode is placed in your anesthetized soft palate and heated up. The heat that is generated by the electrode causes the extra soft tissue at the back of the throat to shrink and contract over a few weeks.
• Tonsillectomy and adenoidectomy involves removing the tonsils and adenoids from the back of the throat.
• Your doctor may recommend cutting out certain tissues of the soft palate to remove the obstructing tissue.

Next Steps

Outlook

With proper treatment, most people with snoring-related problems improve. People who have obstructive sleep apnea will most likely benefit greatly with treatment. Any improvement in the condition will most likely result in more restful sleep and a reduction in daytime fatigue.

• Sleeping partners appreciate almost any reduction in snoring-related noise.

• It is generally well worth the effort to have this condition evaluated.

Synonyms and Keywords

snoring, obstructive sleep apnea, OSA, fatigue, irritability