Snoring is noisy breathing due to narrowing of the upper air passages, either in the nose or in the throat, or both.
Up to 45% of adults snore at least occasionally, and 25% are thought to be habitual snorers.
Problem snoring is more common in males and overweight individuals, and it usually grows worse with age.
More than 300 devices are registered with the U.S. Patent and Trademark Office as cures for snoring- this suggests that there is no single solution to this difficult and common problem.
What causes snoring?
The noise of snoring occurs when there is partial obstruction to the free flow of air through the passages at the back of the mouth and nose.
This is the collapsible part of the airway where the tongue and tonsils meet the soft palate and uvula (the fleshy “punching bag “structure that dangles from the palate).
When these structures vibrate during breathing, the noise of snoring occurs.
Therefore, people who snore have one of the following problems-
1) Poor muscle tone in the muscles of the tongue and throat, which allows the soft tissues to be drawn or sucked into the airway. This poor muscle tone can occur in the deep sleep stages, or if the person is too relaxed from alcohol or other drugs which cause sleepiness.
2) Excessive bulkiness of the tissues in the throat, e.g. a large tongue in overweight individuals, elongated or bulky soft palate and uvula. Large tonsils and adenoids may cause snoring in children. Cysts or tumours can occur, but are rare.
3) Nasal airway obstruction-when an individual has a stuffy or blocked nose, it causes the person to mouth-breathe, which may cause the floppy tissues in the throat to collapse and narrow the airway. Causes of nasal obstruction include viral upper respiratory tract infections, sinusitis, deformities of the nose or deviations of the nasal septum (the wall that separates the 2 sides of the nose)
Is snoring serious?
Snoring may be disruptive to family life- it may cause other family members sleepless nights. Snorers become unwelcome on vacations and on business trips.
Snoring may disturb sleeping patterns of the snorer himself, so that he may not sleep restfully.
Snoring may be associated with obstructive sleep apnoea (OSA), when loud snoring is interrupted by frequent episodes of totally obstructed breathing.
If these episodes last more than 10 seconds, and occur frequently, sleep is severely disturbed, and daytime sleepiness may occur. This excessive daytime sleepiness may occur while driving a motor vehicle, or at work. OSA may also be associated with high blood pressure.
If OSA is suspected, you may need a sleep study (polysomonogram) to confirm the diagnosis.
Can snoring be treated?
Most snorers can be helped. For adults who are mild snorers, the following simple measures may help.
1) Lose weight
2) Exercise regularly- this helps to develop good muscle tone
3) Avoid tranquilisers, sleeping pills, and antihistamines
4) Avoid alcoholic beverages within 3 hours of retiring for the night
5) Avoid heavy meals within 3 hours of retiring for the night
6) Establish regular sleeping patterns
7) Sleep on your side rather than on your back- try sewing a pocket on your pyjama-back to hold a tennis ball- this may help to avoid sleeping on your back.
When do I seek medical care?
When snoring becomes disruptive to the snorer and /or the people around him, or if OSA is suspected, medical advice should be sought.
An examination of the nose, mouth, throat, palate and neck should be performed. This should include a flexible nasopharynolaryngoscopy by an ENT surgeon.
A sleep study may be required to exclude OSA.
TREATMENT
This will depend on the diagnosis. It may be as simple as managing nasal allergies or infection, surgically correcting a nasal deformity, or removing the tonsils and adenoids.
The snoring may respond to the use of a mandibular advancement splint device.
Some individuals may respond best to an operation to tighten the tissues of the palate and the back of the throat, e.g. excision of the uvula, or an operation called a uvulo-palato-pharyngoplasty (UPPP).
Some patients, especially those with OSA, may respond best to sleeping with a CPAP (continuous positive airway pressure) mask, which prevents the tissues in the throat from collapsing inwards. If CPAP fails, or is not tolerated by the patient, various forms of surgery may be helpful- this varies with individual patients, and depends on the site of obstruction.
A more recent therapy for OSA is the Provent Sleep Apnoea Therapy device- this consists of 2 plasters containing a one-way valve, which are placed over the nostrils. The device increases pressure when you exhale, thereby keeping the airway patent. The Provent device may be used as an alternative in the case of failed CPAP therapy.
Every child who snores should be thoroughly examined. Most children will improve following a tonsillectomy and adenoidectomy.
Snoring is due to obstructed breathing, and can sometimes indicate a serious problem.
YOUR CONSULTATION
If you think you suffer from snoring and/or OSA, and would like help, please book an appointment by calling 031 201 3118.
At consultation, a complete history will be taken, to ascertain whether the problem is just snoring, or whether you may have obstructive sleep apnoea (OSA). This consultation should include your bed partner, who may be able to give a description of you sleep pattern.
Examination includes endoscopy of the nose and throat, to ascertain any areas of narrowing which may be responsible for the snoring.
The treatment prescribed will depend on the history and examination findings. You may initially need a sleep study to check if you have OSA- a sleep study can be arranged through my practice, and can be done in your home.