Chronic Snoring

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Snoring can be an irritation to the snorer and to others in the house who have to hear him or her. It can also be a potentially serious problem requiring medical attention.  Snoring is not the same as apnea, although they can be confused for each other.

Snoring occurs as the result of a narrowing of the upper airway. The soft tissue and muscles of the sleeper’s throat relax, and the diameter of the airway is reduced. This reduction can result in snoring just like air flowing through a whistle. The most common site of obstruction is where the back of the tongue comes in contact with the throat. In addition, snoring is more likely with narrowing of the nasal airways. If the nasal passages are compromised, the lungs must inhale with greater force to achieve the same amount of airflow into the body. This increased force can result in collapse of the upper throat area as well causing snoring.

A large soft palate or uvula contributes to the probability of snoring, which is part of the reason overweight people snore more. Drinking alcohol (or consuming another sedative) can contribute to snoring. It makes your muscles relax, including your mouth and throat muscles. That’s why some people snore more when they are drunk, and loud snoring is a hallmark of someone who has passed out drunk.

It has also been shown that in the low-gravity environment of space, snoring is eliminated and the number of microarousals declines, probably due to fewer sleep-disordered breathing problems

People of all ages, sexes, and body mass indices snore, although it is more common in men than women and more common in heavier people. It is estimated that 45% of adult men and 30% of women in the US suffer from chronic snoring; some of those have sleep apnea.

Chronic snoring is associated with an increased incidence of heart and brain-related diseases. Chronic snorers who do not have apnea nevertheless have twice the incidence of excessive daytime sleepiness. More snoring means more daytime fatigue, lower daytime performance, and greater likelihood for drowsy driving. Snoring is also associated with greater rates of diabetes, heart disease, and stroke, although this may be a case where extra body fat contributes to all those diseases. Loud snoring was found to be a risk factor for metabolic syndrome.

The American Association of Oral and Maxillofacial Surgeons recommends starting with the simple things like weight loss (even a minor loss can reduce snoring), changing sleep positions to the extent that this is possible, and laying off the sedatives (sleeping aids, alcohol, big meals before bedtime) and stimulants (caffeine).

Do overweight sleepers always snore?

No, not always. Different people have different anatomies, different sleep positions, different configurations of their uvulas, different muscle tones. However, both anecdotal evidence and more formal studies show a correlation between snoring and obesity.

Women and Children

The stereotypical snorer is an adult male, perhaps over 30 and overweight. Women and kids can snore, too. One in three pregnant women start snoring with the increased weight and body changes during pregnancy. According to the National Heart, Lung, and Blood Institute, 10 to 15 percent of young children snore. One reason for tonsil removal is to alleviate snoring, and enlarged adenoids can get in the way of air passages. As with childhood apnea, snoring is associated with negative cognitive effects and poor school performance.

Snoring Therapies

Chronic snoring can be treated.  Not only does it have the potential for developing into more serious sleep conditions for the snorer, but it detrimentally affects others’ sleep environment. The biggest challenge may be convincing the person who snores that he or she needs intervention. Positional therapies, to manipulative devices, and surgeries are employed in the treatment of snoring.

The first options include general health measures such as improved muscle tone through exercise, weight control, and addressing concurrent medical problems. More advanced treatments that doctors can consider are chosen taking into account the severity of the snoring, individual preference, and individual anatomy.

Because of gravity, the tongue causes the biggest problem when the sleeper is supine. The tongue falls back into the throat area, and snoring ensures. As a result, some people respond well simply by avoiding this position. While using pillows to tilt the body off its back is an option, special wedge pillows can accomplish this more effectively. In addition, special sleepwear is available that promotes sleep on the side. For instance, some nightshirts have a tennis ball sown in the area that fits between the shoulder blades so that the discomfort stimulates you to move onto your side even while sleeping.

Other therapies focus on the nasal passages and airways. Nasal strips that are placed externally on the nose bridge flatten the nose and enhance nasal airflow by increasing the opening of the nostrils and adjacent nasal passages. These work pretty well. Decongestants can work if nasal congestion is causing inflammation and swelling that hinders normal airflow through the nose. In addition, surgical treatment can address nasal conditions such as a deviated septum that likewise may be limiting airflow. Any of these can result in “mouth-breathing” at night, and as the jaw opens, the mechanics of the throat and jaw can further compromise the airway diameter.

Other devices are mechanical. CPAP, or continuous positive airway pressure, machines are usually used when sleep apnea syndromes are also present. Sleep apnea syndrome represents a spectrum of conditions in which the same airway obstruction that cause snoring worsens to the point that arousals occur and sleep for the patient is disrupted. CPAP machines generate air pressure through a mask on the nose and mouth to form an air splint in the throat while the user sleeps. The pressure keeps the airway from collapsing and prevents snoring. Various masks are available that can help individualize this treatment.

Oral appliances are specially formed and fitted dental mouth pieces that can pull the tongue forward, advance the lower jaw, or both. The airway in the throat area opens wider, reducing or preventing snoring. While some appliances are available without medical guidance, many dentists tailor them for patients. The company SnoreRx makes an oral device designed to move your lower jaw forward. The user is able to adjust the offset of the jaw in 1 millimeter increments.

Oral appliances are often more effective than CPAP machines. Effectiveness is a combination of efficacy and compliance (i.e. whether the patient uses the device.) CPAP machines suffer from notoriously low usage rates because they are so uncomfortable.

Zephyr makes an oral appliance. (We have no experience with their product and do not endorse it.)

Surgery for Snoring

Lastly, there are surgical options geared at correcting the anatomy that is causing the snoring itself. Otolaryngologists – ear, nose, and throat doctors – are the specialists who often get involved. In additional to nasal surgery, techniques that target the throat or pharynx are employed. Standard surgeries like uvulopalatopharyngoplasty (UPPP) remove the uvula hanging from the roof of the soft palate along with some of the soft palatal tissue to expand the opening of the throat. Similar surgeries that are easier to perform also now include Laser Assisted Uvulopalatoplasty (LAUP). Uvuloplasty is surgery that removes the uvula to open the airway behind the palate. This is usually outpatient surgery and does not require a hospital stay. There have also been trials with radio wave treatment to shrink the tissue blocking the airway.

Somnoplasty, along with another surgical technique called coblation-channeling, uses heat to damage and shrink throat tissues, allowing expansion of the airway. Several treatments are needed. Another option is the injection of sclerosing agents into the soft palate. These agents cause the tissues of the pharynx to scar, and as the scar evolves, the tissues also shrink. While all of these measures can reduce snoring, relapse occurrence of snoring years later is relatively high with all of these techniques..

Some clinicians has found a combination of pseudoephedrine and domperidone can help snoring and apnea. Pseudoephedrine is a common cold medicine that reduces nasal congestion and domperidone suppresses nausea and vomiting.

Alcohol and Sleep

Sleep and obesity

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