HEALTH TALK: Snoring

Many of us snore, but almost all of us who do will vigorously deny it except, of course, when we’re caught on tape.

OVERVIEW

On your part or your partner’s, loud and frequent snoring may seem unavoidable during your nighttime sleep time.  But this nighttime – or daytime, for that matter – annoyance may indicate a more serious health condition, and may even disrupt your household and, yes, strain your relationships.

About 33% (one third) of older adults snore.  Snoring occurs when air flows past relaxed tissues in your throat, causing those tissues to vibrate as you breathe, creating hoarse or harsh sounds.

To restore peace and quiet and domestic harmony, simple changes, such as losing weight or sleeping on your side can help.  Now, laser surgery may reduce disruptive snoring.  But of course, this is not suitable for everyone who snores, such as people with sleep apnea, a potentially serious disorder in which breathing stops and starts during sleep.

WHAT CAUSES SNORING?

As you doze off and progress from a lighter sleep to deep sleep, the muscles in the roof of your mouth (back part, the soft palate), tongue and throat relax.  If those muscles in your throat relax enough, they vibrate and may partially obstruct your airway.

The more narrowed your airway, the more forceful the airflow becomes.  Tissue vibration increases, and your snoring gets louder.

A low, thick soft palate or enlarged tonsils or tissue in the back of your throat (adenoids) can narrow your airway.  Also, if the triangular piece of tissue hanging from the soft palate (uvula) is enlarged, airflow can be obstructed and vibration increased.  Excessive weight contributes to narrowing of your throat tissues.

Snoring can also occur if you consume too much alcohol before bedtime.  Alcohol acts as a sedative, relaxing throat muscles.  Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may be the reason.  Snoring may be an occasional problem, or it may be a habit.

Snoring may be associated with sleep apnea.  In this serious condition, excessive sagging of throat tissues causes your airway to collapse, preventing you from breathing.  Sleep apnea breaks up loud snoring with 10 seconds or more of silence.  Eventually the lack of oxygen and an increase in carbon dioxide signal you to wake up, forcing your airway open with a loud snort.

DO I NEED TO CHECK THE DOCTOR?

Well, the thing is, you may not be aware that you snore, but your partner is very likely aware.  And it’s not the most pleasant sound coming from someone next to you in bed.  Many a marriage has left the bed and gone on the rocks for snoring.  Seeing your doctor about it can benefit both of you.

For you, snoring may indicate another health concern, such as sleep apnea, nasal obstruction, or obesity.  For your partner, your seeking medical advice about your snoring may result in being able to get a restful night of sleep.

If your child snores, check with your pediatrician.  Nose and throat problems, and obesity often are underlying factors in your child’s habitual snoring.  Treating these conditions could help your child sleep better at night.

SCREENING AND DIAGNOSIS

The severity of your snoring can determine the best treatment.  To diagnose its severity, snoring is graded from the bed partner’s point of view:

Grade 1: Heard only if you listen close to the face.

Grade 2: Heard in the bedroom.

Grade 3: Heard just outside the bedroom with the door open.

Grade 4: Heard outside the bedroom with the door closed. (This is some serious snoring).

Parents are asked about the severity of a child’s snoring.  As for the person who snores, doctor will do a physical examination and take a medical history (ask a bunch of questions).  Your primary care doctor may then refer you to an ENT doctor or sleep specialist for additional studies and evaluation.  In places where these exist, you may be required to stay overnight at a sleep center, where you undergo in-depth analysis of your sleep habits by a team of specialists.

ANY COMPLICATIONS?

Habitual snoring may be more than just a nuisance and a cause of daytime sleepiness.  Untreated, persistent snoring may raise your lifetime risk of developing health problems such as diabetes, high blood pressure, and even heart failure and stroke.  In children, snoring may increase their risk of attention-deficit /hyperactivity disorder (ADHD).

TREATMENT

When lifestyle changes don’t eliminate snoring, your doctor may suggest:

Traditional surgery.  The surgeon will tighten and trim excess tissues.  The procedure reduces snoring intensity most of the time.  Even though you are put to sleep to have it done, it can be painful afterward.  You need to be in hospital for one to three days and need about two weeks to recover.

Laser surgery.  By a procedure called laser assisted uvulopalatoplasty (LAUD), a small hand-held laser beam is used to shorten the soft palate and remove the uvula.  Removing excessive tissue enlarges your airway and reduces vibration.  Treatments depend on the severity of your snoring.  You may need two to five sessions, each lasting about 30 minutes.  Treatments occur four to six weeks apart.  This surgery isn’t advised for occasional or light snoring, but it should be considered if your snoring is loud and disruptive.  It is not recommended for sleep apnea.

Radiofrequency tissue volume reduction (somnoplasty).  This is where a low-intensity radiofrequency signal is used to remove part of the soft palate to reduce snoring.  It’s done as an out-patient procedure under local anesthesia (deadening of the site).  Slight scarring of the soft palate results, which may help to reduce snoring.

Dental devices and nasal strips.  Dental devices are formfitting mouthpieces that help bring forward the position of your tongue and soft palate to keep you air passage open.  Nasal strips help many to increase the area of their nasal passage, thereby enhancing their breathing.

Continuous positive airway pressure (CPAP).  In this case, one wears a pressurized mask over one’s nose while one sleeps.  The mask is attached to a small pump that forces air through your airway to keep it from collapsing.  CPAP eliminates snoring and prevents sleep apnea.  It is the preferable method of treating this latter problem, but it is cumbersome and uncomfortable.

WHAT YOU CAN DO FOR YOURSELF?

To prevent or quiet snoring, try these little tips.

• If you’re overweight, lose it.  Excess weight is the most common cause of snoring.  Flabby throat tissues are more likely to vibrate as you breathe.

• Sleep on your side. Lying on your back allows your tongue to fall backward into your throat, narrowing your airway and partially obstructing airflow.  To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.  Hey, whatever works, know what I mean?

• Treat nasal congestion or obstruction.  Allergies or a deviated septum can limit airflow through your nose, forcing you to breathe through your mouth, hence increasing the likelihood of snoring.  Use and oral or spray decongestant for no more that three days in a row for acute congestion.  Adhesive strips applied to your nose (you’ve seen these on TV) widen nasal passages and may help to reduce congestion or obstruction.  Surgery may be needed to correct a deviated septum.

• Limit or avoid alcohol and sedative.  These depress your central nervous system, causing excessive relaxation of muscles, including the tissues in your throat.  In addition, they can increase the duration of stoppages of breathing by blunting the brain’s ability to arouse from sleep and restart breathing.

Bet you never thought a discussion on snoring could be so stimulating.  Just one of the small wonders of medicine.

See you next week. For those of you who had questions about the menopause article, I’ll see what I can do next week; I’m kind of pressed for time right now.

Dr. Victor Emanuel has been an educator of medical professionals in training, and the public, for over 20 years in Dominica. The contents of his articles are based on facts and research conducted, and not of his opinion.