Snoring

Snoring is a sound generated during sleep when the roof of the mouth vibrates.

Description

Snoring is one symptom of a group of disorders known as sleep disordered breathing. It occurs when the soft palate, uvula, tongue, tonsils, and/or muscles in the back of the throat rub against each other and generate a vibrating sound during sleep. Twenty percent of all adults are chronic snorers, and 45% of normal adults snore occasionally. As people grow older, their chance of snoring increases. Approximately half of all individuals over 60 snore regularly.

In some cases, snoring is a symptom of a more serious disorder called obstructed sleep apnea (OSA). OSA occurs when part of the airway is closed off (usually at the back of the throat) while a person is trying to inhale during sleep, and breathing stops for more than 10 seconds before resuming again. These breathless episodes can occur as many as several hundred times a night.

People with OSA almost always snore heavily, because the same narrowing of the airway that causes snoring can also cause OSA. Snoring may actually attribute to OSA as well, because the vibration of the throat tissues which occurs in snoring can cause the tissue to swell.

Causes and symptoms

There are several major causes of snoring, including:

• Excessively relaxed throat muscles. Alcohol, drugs, and sedatives can cause the throat muscles to become lax, and/or the tongue to pull back into the airway.
• Large uvula. The piece of tissue that hangs from the back of the throat is called the uvula. Individuals with a large or longer than average uvula can suffer from snoring when the uvula vibrates in the airway.
• Large tonsils and/or adenoids. The tonsils (tissue at the back of either side of the throat) can also vibrate if they are larger than normal, as can the adenoids.
• Excessive weight. Overweight people are more likely to snore. This is frequently caused by the extra throat and neck tissue they are carrying around.
• Nasal congestion. Colds and allergies can plug the nose, creating a vacuum in the throat that results in snoring as airflow increases.
• Cysts and tumors. Cysts and/or tumors of the throat can trigger snoring.
• Structural problems of the nose. A deviated septum or other nasal problems can also cause snoring.

Diagnosis

A patient interview, and possibly an interview with the patient's spouse or anyone else in the household who has witnessed the snoring, is usually enough for a diagnosis of snoring. A medical history which includes questions about alcohol or tranquilizer use; past ear, nose, and throat problems; and the pattern and degree of snoring will be completed, and a physical exam will be performed to determine the cause of the problem. This will typically include examination of the throat to look for narrowing, obstruction, or malformations. If the snoring is suspected to be a symptom of a more serious disorder such as obstructive sleep apnea, the patient will require further testing. This testing is called a polysomnography study, and is conducted during an overnight stay in a specialized sleep laboratory. The polysomnography study include measurements of heart rate, airflow at the mouth and nose, respiratory effort, sleep stage (light sleep, deep sleep, dream sleep, etc.), and oxygen level in the blood.

Treatment

Several surgical procedures are available for treating chronic snoring. These include:

• Uvulopalathopharyngoplasty (UPPP), a surgical procedure which involves removing excess throat tissues (e.g., tonsils, parts of the soft palate) to expand the airway.
• Laser-assisted uvulopalatoplasty (LAUP) uses a surgical laser to remove part of the uvula and palate.
• Palatal stiffening is a minimally-invasive surgical technique where a laser or a cauterizer is used to produce scar tissue in the soft palate in order to stop the vibrations that produce snoring.
• Radiofrequency ablation is another technique which uses scarring to shrink the uvula and/or soft palate. A needle electrode is used to shrink and scar the mouth and throat tissues.

Alternative treatment

There are a number of remedies for snoring, but few are proven clinically effective. Popular treatments include:

• Mechanical devices. Many splints, braces, and other devices are available which reposition the nose, jaw, and/or mouth in order to clear the airways. Other devices are designed to wake an individual when snoring occurs.
• Nasal strips. Nasal strips that attach like an adhesive bandage to the bridge of the nose are available at most drugstores, and can help stop snoring in some individuals by opening the nasal passages.
• Continuous positive airway pressure (CPAP). Some chronic snorers find relief by sleeping with a nasal mask which provides air pressure to the throat.
• Decongestants. Snoring caused by nasal congestion may be successfully treated with decongestants. Some effective herbal remedies that clear the nasal passages include golden rod (Solidago virgauria) and golden seal (Hydrastis canadensis). Steam inhalation of essential oils of eucalyptus blue gum (Eucalyptus globulus) or peppermint (Mentha x piperata) can also relieve congestion.
• Weight loss. Snoring thought to be caused by excessive weight may be curtailed by a sensible weight loss and exercise program.
• Sleep position. Snoring usually worsens when an individual sleeps on his or her back, so side sleeping may alleviate the problem. Those who have difficulty staying in a side sleeping position may find sleeping with pillows behind them helps them maintain the position longer.
• Bed adjustments. For some people, raising the head of the bed solves their snoring problem. A slight incline can prevent the tongue from retracting into the back of the throat. Bricks, wooden blocks, or specially designed wedges can be used to elevate the head of the bed approximately 4–l6 in (10–41 cm).

Prevention

Adults with a history of snoring may be able to prevent snoring episodes with the following measures:

• avoid alcohol and sedatives before bedtime.
• remove allergens from the bedroom.
• use a decongestant before bed.
• sleep on the side, not the back.