Carlos.R. Santos, M.D.

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Snoring

Whether you call it by its slang name, "sawing logs," or its medical name, "stertor," snoring is common. You snore when something blocks the flow of air through your mouth and nose. The sound is caused by tissues at the top of your airway that strike each other and vibrate. Many adults snore, especially men. Snoring may increase with age.

However, snoring can also be a sign of a serious sleep disorder called sleep apnea. This means you stop breathing for periods of more than 10 seconds at a time while you sleep. Sleep apnea is serious, but there are treatments that can help. Children can also have sleep apnea. If your child snores frequently, have your health care provider check for sleep apnea.

Here are some tips for reducing snoring:

  • Lose weight if you are overweight
  • Cut down or eliminate alcohol and other sedatives at bedtime
  • Avoid sleeping flat on your back

 

Symptoms

Depending on the cause of your snoring, your symptoms may include:

  • Noise during sleep
  • Excessive daytime sleepiness
  • Difficulty concentrating
  • Sore throat
  • Restless sleep
  • Gasping or choking at night
  • High blood pressure
  • Chest pain at night

 

Causes

Many factors, such as the anatomy of your mouth and sinuses, alcohol consumption, allergies, a cold, and your weight, can lead to snoring.

When you doze off and progress from a light sleep to a deep sleep, the muscles in the roof of your mouth (soft palate), tongue and throat relax. The tissues in your throat can relax enough that they partially block your airway and vibrate. And, the more narrowed your airway, the more forceful the airflow becomes. This causes tissue vibration to increase, which causes your snoring to grow louder.

The following conditions can affect the airway and cause snoring:

  • Your mouth anatomy. Having a low, thick soft palate can narrow your airway. People who are overweight may have extra tissues in the back of their throat that may narrow their airways. Likewise, if the triangular piece of tissue hanging from the soft palate (uvula) is elongated, airflow can be obstructed and vibration increased.
  • Alcohol consumption. Snoring also can be brought on by consuming too much alcohol before bedtime. Alcohol relaxes throat muscles and decreases your natural defenses against airway obstruction.
  • Nasal problems. Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may contribute to your snoring.
  • Sleep apnea. Snoring also may be associated with obstructive sleep apnea. In this serious condition, your throat tissues partially or completely block your airway, preventing you from breathing.

Sleep apnea often is characterized by loud snoring followed by periods of silence when breathing stops or nearly stops. Eventually, this reduction or pause in breathing may signal you to wake up, and you may awaken with a loud snort or gasping sound. You may sleep lightly due to disrupted sleep. This pattern of breathing pauses may be repeated many times during the night.

People with sleep apnea usually experience periods when breathing slows or stops at least five times during every hour of sleep.


 

Outlook.

Risk factors that may contribute to snoring include:

  • Being a man. Men are more likely to snore or have sleep apnea than are women.
  • Being overweight. People who are overweight or obese are more likely to snore or have obstructive sleep apnea.
  • Having a narrow airway. Some people may have a long soft palate, or large tonsils or adenoids, which can narrow the airway and cause snoring.
  • Drinking alcohol. Alcohol relaxes your throat muscles, increasing the risk of snoring.
  • Having nasal problems. If you have a structural defect in your airway, such as a deviated septum, or your nose is chronically congested, your risk of snoring is greater.
  • Having a family history of snoring or obstructive sleep apnea.

 

Complications

Habitual snoring may be more than just a nuisance. Depending on the cause of your snoring, it may result in:

  • Daytime sleepiness
  • Frequent frustration or anger
  • Difficulty concentrating
  • A greater risk of high blood pressure, heart conditions and stroke
  • An increased risk of behavior problems, such as aggression or learning problems, in children with obstructive sleep apnea
  • An increased risk of motor vehicle accidents due to lack of sleep
  • Disruption of bed partner's sleep

 

Preparing For Your Appointment.

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Ask your partner to describe what he or she hears or notices at night while you're sleeping.

    Or, better yet, ask your sleep partner to go with you to your appointment so that he or she can talk with your doctor about your symptoms.

  • Make a list of all medications, as well as any vitamins or supplements that you're taking.
  • Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. For snoring, some basic questions to ask your doctor include:

  • What makes me snore when I sleep?
  • Is my snoring a sign of something more serious, such as sleep apnea?
  • What kinds of tests do I need?
  • What happens during a sleep test?
  • What treatments are available for snoring, and which do you recommend?
  • What types of side effects can I expect from treatment?
  • Are there any alternatives to the primary approach that you're suggesting?
  • Are there any steps I can take on my own that will help my snoring?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

Test And Diagnosis.

To diagnose your condition, your doctor will review your signs and symptoms, and your medical history. Your doctor will also perform a physical examination.

Your doctor may ask your partner some questions about when and how you snore to help assess the severity of the problem. If your child snores, you'll be asked about the severity of your child's snoring.

Imaging
Your doctor may request an imaging test, such as an X-ray, a computerized tomography scan or magnetic resonance imaging, to check the structure of your airway for problems, such as a deviated septum.

Sleep study
Depending on the severity of your snoring and other symptoms, your doctor may want to conduct a sleep study. Often, sleep studies may be done at home. However, depending upon your other medical problems and other sleep symptoms, you may need to stay overnight at a sleep center to undergo an in-depth analysis of your sleep habits by a team of specialists during a sleep study, called polysomnography.

In polysomnography, you're connected to many devices and observed overnight. During the sleep study, your brain waves, blood oxygen level, heart rate and breathing rate, sleep stages, and eye and leg movements will be recorded during your sleep.

When a home sleep study doesn't provide the needed information, polysomnography may be needed.

Treatment and Drugs.

To treat your condition, your doctor likely will first recommend lifestyle changes, such as losing weight, avoiding alcohol close to bedtime and changing sleeping positions. If lifestyle changes don't eliminate snoring, your doctor may suggest:

  • Oral appliances. Oral appliances are form-fitting dental mouthpieces that help advance the position of your tongue and soft palate to keep your air passage open.

    If you choose to use an oral appliance, visit your dental specialist at least once every six months during the first year, and then at least annually after that, to have the fit checked and to make sure that your condition isn't worsening. Excessive salivation, dry mouth, jaw pain and facial discomfort are possible side effects from wearing these devices.

  • Continuous positive airway pressure (CPAP). This approach involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway, which keeps it open. CPAP (SEE-pap) eliminates snoring and treats sleep apnea.

    Although CPAP is the most reliable method of treating obstructive sleep apnea, and it's effective, some people find it uncomfortable or have trouble adjusting to the noise or feel of the machine. Your doctor may be able to make adjustments to the device if you're having trouble adjusting to the machine, such as adding a heated humidifier or nasal pillows, that might help make you more comfortable.

  • Palatal implants. In this procedure, known as the pillar procedure, doctors inject braided strands of polyester filament into your soft palate, which stiffens it and reduces snoring. Palatal implants don't have any known serious side effects; however, the benefits and safety of the procedure are still being studied.
  • Traditional surgery. In a procedure called uvulopalatopharyngoplasty (UPPP), you're given general anesthetics and your surgeon tightens and trims excess tissues from your throat — a type of face-lift for your throat. The risks of this procedure include bleeding, infection, pain and nasal congestion.

  • Laser surgery. In laser-assisted uvulopalatopharyngoplasty (LAUPPP), an outpatient surgery for snoring, your doctor uses a small hand-held laser beam to shorten the soft palate and remove your uvula. Removing excess tissue enlarges your airway and reduces vibration. You may need more than one session to get your snoring under control.

    Laser surgery and palatal implants aren't generally recommended as treatment for sleep apnea, because they haven't been proved effective for sleep apnea. Possible risks from these procedures include pain, infection, bleeding and nasal congestion.

  • Radiofrequency tissue ablation (somnoplasty). In this outpatient procedure, you'll be given local anesthetic. Doctors use a low-intensity radiofrequency signal to shrink tissue in the soft palate to help reduce snoring. The effectiveness of this newer procedure needs further study. Generally, this procedure is less painful than other types of snoring surgery.

 

Lifestyle and Home Remedies.

To prevent or quiet snoring, try these tips:

  • If you're overweight, lose weight. People who are overweight may have extra tissues in the throat that contribute to snoring. Losing weight can help reduce snoring.
  • Sleep on your side. Lying on your back allows your tongue to fall backward into your throat, narrowing your airway and partially obstructing airflow. Try sleeping on your side. If you find that you always end up on your back in the middle of the night, try sewing a tennis ball in the back of your pajama top.
  • Raise the head of your bed. Raising the head of your bed by about four inches may help.
  • Nasal strips. Adhesive strips applied to your nose help many people increase the area of their nasal passage, enhancing their breathing. These strips aren't effective for people with sleep apnea, however.

  • Treat nasal congestion or obstruction. Having allergies or a deviated septum can limit airflow through your nose. This forces you to breathe through your mouth, increasing the likelihood of snoring.

    Don't use an oral or spray decongestant for more than three days in a row for acute congestion unless directed to do so by your doctor. Long-term use of these medications can have a rebound effect and make your congestion worse. Ask your doctor about a prescription steroid spray if you have chronic congestion.

    To correct a structural defect in your airway, such as a deviated septum, you may need surgery.

  • Limit or avoid alcohol and sedatives. Avoid drinking alcoholic beverages at least two hours before bedtime, and let your doctor know about your snoring before taking sedatives.

    Sedatives and alcohol depress your central nervous system, causing excessive relaxation of muscles, including the tissues in your throat.