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Snoring

Definition

Snoring is the hoarse or harsh sound that occurs when your breathing is partially obstructed in some way while you're sleeping. Sometimes snoring may indicate a serious health condition. In addition, snoring can be a nuisance to your partner.

As many as half of adults snore sometimes. Snoring occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe, which creates those irritating sounds.

Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or sleeping on your side, can help stop snoring.

In addition, medical devices and surgery are available that may reduce disruptive snoring. However, these aren't suitable or necessary for everyone who snores.

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

When to see a doctor
See your doctor if:

  • Your snoring is so loud it's disrupting your partner's sleep
  • You wake up choking or gasping

These may indicate your snoring is caused by a more serious condition, such as obstructive sleep apnea.

If your child snores, ask your pediatrician about it. Children can have obstructive sleep apnea too. Nose and throat problems such as enlarged tonsils and obesity often can narrow a child's airway, which can lead to your child developing sleep apnea. Treating these conditions may help your child in many ways.

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.

Snoring occurs when air flows past relaxed tissues, such as your tongue, soft palate and airway, as you breathe. The sagging tissues narrow your airway, causing these tissues to vibrate. ...

Risk factors

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

You're likely to first see your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in treating sleep disorders or an ear, nose and throat specialist.

Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • 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.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin snoring?
  • Do you snore every night or only once in a while?
  • Do you often wake up during the night?
  • Does anything you do seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Does your bed partner ever tell you that you have pauses or irregularities in your breathing during sleep?

What you can do in the meantime
While you're waiting to see your doctor, here are some tips you can try:

  • Don't drink alcohol or take sedatives before bed.
  • Try over-the-counter nasal strips.
  • Sleep on your side, instead of your back.
  • If nasal congestion is an issue, try an over-the-counter decongestant for a day or two.

Tests 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.

Treatments 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.

Continuous positive airway pressure (CPAP)

Illustration of continuous positive airway pressure (CPAP) mask
Enlarge Image
Your doctor may recommend continuous positive airway pressure (CPAP) to eliminate snoring and prevent sleep apnea. A CPAP machine delivers just enough air pressure to a mask to keep your upper airway ...

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.

Alternative medicine

Because snoring is such a common problem, there are numerous products available, such as nasal sprays or homeopathic therapies. However, most of the products haven't been proved effective in clinical trials. For example, MSM (methylsulfonylmethane) is marketed in a nose drop formula to treat snoring, but there's no evidence it has any effect on snoring.

Therapies that might help ease your snoring include:

  • Didgeridoo. Playing the didgeridoo, a musical instrument that produces a droning sound, may help train muscles of the upper airway and lessen daytime sleepiness. Researchers have evaluated the use of the instrument by those with sleep apnea who complained about snoring.

    Research has shown that those who played the instrument for about 25 minutes a day most days of the week experienced less daytime sleepiness a complication of sleep apnea and snoring. However, this research is preliminary and needs more study. Also, the same benefits haven't been found in studies of wind or brass instrument players.

  • Singing. Singing may help improve muscle control of the soft palate and upper throat. One preliminary study found some decrease in snoring in participants who sang prescribed singing exercises for 20 minutes a day for three months. These participants all began snoring as adults, had no nasal problems and were not overweight. More study of this technique is needed.

Coping and support

If your partner is the one who's snoring, you may sometimes feel frustrated as well as fatigued. Suggest some of the home remedies mentioned, and if those don't help quiet your partner's nocturnal noisemaking, have your partner make a doctor's appointment.

Updated: 11/7/2012

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