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Snoring: Not Funny, Not Hopeless
Forty-five percent of normal adults snore at least occasionally, and 25
percent are habitual snorers. Problem snoring is more frequent in males and
overweight persons, and it usually grows worse with age.
More than 300 devices are registered in the U.S. Patent and Trademark Office
as cures for snoring. Some are variations on the old idea of sewing a sock that
holds a tennis ball on the pajama back to force the snorer to sleep on his side.
(Snoring is often worse when a person sleeps on his back). Some devices
reposition the lower jaw forward; some open nasal air passages; a few others
have been designed to condition a person not to snore by producing unpleasant
stimuli when snoring occurs. But, if you snore, the truth is that it is not
under your control whatsoever. If anti-snoring devices work, it is probably
because they keep you awake.
What Causes Snoring?
The noisy sounds of snoring occur when there is an obstruction to the free
flow of air through the passages at the back of the mouth and nose. This area is
the collapsible part of the airway (see illustration) where the tongue and upper
throat meet the soft palate and uvula. Snoring occurs when these structures
strike each other and vibrate during breathing.
People who snore may suffer from:
- Poor muscle tone in the tongue and throat. When muscles are too relaxed,
either from alcohol or drugs that cause sleepiness, the tongue falls backwards
into the airway or the throat muscles draw in from the sides into the airway.
This can also happen during deep sleep.
- Excessive bulkiness of throat tissue. Children with large tonsils and
adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or
tumors can also cause bulk, but they are rare.
- Long soft palate and/or uvula. A long palate narrows the opening from the
nose into the throat. As it dangles, it acts as a noisy flutter valve during
relaxed breathing. A long uvula makes matters even worse.
- Obstructed nasal airways. A stuffy or blocked nose requires extra effort
to pull air through it. This creates an exaggerated vacuum in the throat, and
pulls together the floppy tissues of the throat, and snoring results. So,
snoring often occurs only during the hay fever season or with a cold or sinus
infection.
Also, deformities of the nose or nasal septum, such as a deviated septum (a
deformity of the wall that separates one nostril from the other) can cause such
an obstruction.
Is Snoring Serious?
Socially, yes! It can be, when it makes the snorer an object of ridicule and
causes others sleepless nights and resentfulness.
Medically, yes! It disturbs sleeping patterns and deprives the snorer of
appropriate rest. When snoring is severe, it can cause serious, long-term health
problems, including obstructive sleep apnea.
Obstructive Sleep Apnea
When loud snoring is interrupted by frequent episodes of totally obstructed
breathing, it is known as obstructive sleep apnea. Serious episodes last more
than ten seconds each and occur more than seven times per hour. Apnea patients
may experience 30 to 300 such events per night. These episodes can reduce blood
oxygen levels, causing the heart to pump harder.
The immediate effect of sleep apnea is that the snorer must sleep lightly and
keep his muscles tense in order to keep airflow to the lungs. Because the snorer
does not get a good rest, he may be sleepy during the day, which impairs job
performance and makes him a hazardous driver or equipment operator. After many
years with this disorder, elevated blood pressure and heart enlargement may
occur.
Can Heavy Snoring be Cured?
Heavy snorers, those who snore in any position or are disruptive to the
family, should seek medical advice to ensure that sleep apnea is not a problem.
An
otolaryngologist will provide
a thorough examination of the nose, mouth, throat, palate, and neck. A sleep
study in a laboratory environment may be necessary to determine how serious the
snoring is and what effects it has on the snorer's health.
Treatment
Treatment depends on the diagnosis. An examination will reveal if the snoring
is caused by nasal allergy, infection, deformity, or tonsils and adenoids.
Snoring or obstructive sleep apnea may respond to various treatments now
offered by many otolaryngologist-head and neck surgeons:
- Uvulopalatopharyngoplasty (UPPP) is surgery for treating
obstructive sleep apnea. It tightens flabby tissues in the throat and palate,
and expands air passages.
- Thermal Ablation Palatoplasty (TAP) refers to procedures
and techniques that treat snoring and some of them also are used to treat
various severities of obstructive sleep apnea. Different types of TAP include
bipolar cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty
(LAUP) treats snoring and mild obstructive sleep apnea by removing the
obstruction in the airway. A laser is used to vaporize the uvula and a
specified portion of the palate in a series of small procedures in a doctor's
office under local anesthesia. Radiofrequency ablation—some with temperature
control approved by the FDA—utilizes a needle electrode to emit energy to
shrink excess tissue to the upper airway including the palate and uvula (for
snoring), base of the tongue (for obstructive sleep apnea), and nasal
turbinates (for chronic nasal obstruction).
- Genioglossus and hyod advancement is a surgical procedure
for the treatment of sleep apnea. It prevents collapse of the lower throat and
pulls the tongue muscles forward, thereby opening the obstructed airway.
If surgery is too risky or unwanted, the patient may sleep every night with a
nasal mask that delivers air pressure into the throat; this is called continuous
positive airway pressure or "CPAP".
A chronically snoring child should be examined for problems with his or her
tonsils and adenoids. A tonsillectomy and adenoidectomy may be required to
return the child to full health.
Self-Help for the Light Snorer
Adults who suffer from mild or occasional snoring should try the following
self-help remedies:
- Adopt a healthy and athletic lifestyle to
develop good muscle tone and lose weight.
- Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
- Avoid alcohol for at least four hours and heavy meals or snacks for three
hours before retiring.
- Establish regular sleeping patterns
- Sleep on your side rather than your back.
- Tilt the head of your bed upwards four inches.
Remember, snoring means obstructed breathing, and obstruction can be serious.
It's not funny, and not hopeless.
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