Snoring

Snoring is the loud, unpleasant sound that occurs during sleep. The sound is produced by partial obstruction of airways during sleep. It is a very common problem and is found in all age groups.

It occurs in both males and females but is more common among men when compared to women. The problem may increase with age. It often affects the quality of sleep of the patient and his/her partner.

Snoring is found to run in families and may occur at any stage of sleep. People who do not regularly snore may snore after a viral illness or after taking certain medications.

The snoring sound is produced by the vibration of tissues at the back of the throat as air flows through them. It often occurs during inhalation and may come from the nose or/and mouth.

Snoring is often associated with sleep apnea. Obstructive sleep apnea is associated with other symptoms like snoring, daytime sleeping, headaches, sore throat, restlessness, choking at night, high blood pressure, and chest pain. Medical attention is warranted if any of the above-mentioned symptoms are present.

Snoring is caused by multiple factors like the anatomy of mouth and sinuses, allergy, body weight, alcohol consumption, and the common cold. During sleep, the tissues of the soft palate, tongue, and throat relax.

The relaxed tissues may partially block the airway, leading to vibration as air flows through it. As the narrowing increases, the force of airflow increases. Increased airflow is related to increased vibration and louder snoring.

Consuming too much alcohol before sleep may also lead to snoring by increased relaxation of the throat muscles. Deviated nasal septum and chronic congestion of nasal cavities are also implicated in snoring.

Throat tissue may remain too relaxed in sleep deprivation, resulting in snoring. Snoring is more frequent in people who sleep on their back. Major risk factors for snoring are gender, overweight, narrow airways, alcohol consumption, nasal problems, and family history.

Medical history and signs and symptoms help in identifying the actual cause of snoring. Physical examination and analyzing the severity of snoring also help in the diagnosis. Imaging studies like x-ray, CT scan, and MRI also may be suggested to identify the underlying cause.

In-depth analysis of sleep habits, called polysomnography is suggested based on other medical conditions and symptoms. This study helps to understand the brain waves, the oxygen level in blood, and heart and breathing rate during sleep.

Lifestyle changes are the first recommendations to control snoring. Maintaining healthy body weight, treating nasal congestion, and getting adequate sleep are suggested as lifestyle changes.

Oral devices are recommended to control snoring caused by obstructive sleep apnea. These devices help to advance the position of the jaw that aid in removing the block in the airways.

Continuous positive airway pressure (CPAP) is a procedure in which a pressurized mask is worn during sleep. The mask is connected to a pump that forces air through the airways.

Implanting small strands of the polyester filament in the soft palate helps to stiffen it, keeping the airways open. Traditional surgery, laser surgery, and radiofrequency tissue ablation are also used in controlling this symptom.

Snoring is caused by the vibration of tissues at the back of the throat during the flow of air through them. As the person sleeps, throat muscles relax and tongue falls backward. This makes the throat passage narrow.

During inhalation, the walls of the throat vibrate. The vibration may continue during breathing out as well, but at a lesser intensity. These tissue vibrations cause the characteristic sound of snoring. As the airways become narrower, snoring becomes louder. This is because the flow of air is more forceful in narrow airways.

Some of the most common causes of snoring include: 

Anatomy of mouth – palate that is soft and low in position is associated with narrow airways. Having extra tissues at the back of throat also makes the airways narrow. This is commonly noticed in people who are overweight.

Similarly, if the triangular tissue hanging at the back of the throat, called uvula, is larger and elongated, airways may be obstructed. This increases the vibration of the tissues, leading to snoring. Poor muscle tone in throat and tongue is also associated with snoring. As these muscles relax excessively during sleep, they collapse and obstruct the airways.

Consumption of alcohol – having too much alcohol, particularly before sleeping, increases the chances of snoring. Relaxation of throat muscles is impaired with alcohol. Moreover, consumption of alcohol affects the body’s ability to control obstruction of airways.

Nasal problems –twisted nasal septum, or deviated nasal septum, contribute to snoring. Other nasal conditions like chronic nasal congestion also increase snoring. Inflammation of nose and throat during infections and allergies are common causes of snoring.

Sleep deprivation – inability to have adequate sleep also leads to snoring it causes the throat tissue to relax further.

Sleep position – Snoring is more commonly seen among people who sleep on their back. This is probably due to narrowing of airways due to gravity.

Obstructive sleep apnea – this condition is characterized by partial or complete obstruction of airways by the tissues of the throat. It is a serious condition and often causes loud snoring. The snoring sound is followed by a short pause in breathing, which awakens the person who wakes up with a snort or a loud gasp.

Some factors are known to increase the risk of snoring, this includes: 

• Gender – men are more likely to snore when compared to women.
• Overweight or obesity – these conditions increase the chance of snoring and sleep apnea. Being overweight and obesity are associated with more tissue tone in the throat that obstruct the airways.
• Narrow airways – People with large tonsils, large adenoids, and long soft palate have an increased risk of narrow airways and snoring.
• The family history of snoring – snoring is found to run in families and people who have close relatives who snore have increased the risk of developing this symptom.
• The family history of obstructive sleep apnea – sleep apnea is associated with snoring and the risk of developing this condition increases with family history.

A complete medical history and physical examination are performed for evaluating snoring as a symptom. The patient is asked about sleep habits, sleep pattern, daytime sleepiness, awakening in the night, and other associated symptoms.

During the physical examination, the patient’s body weight and neck circumference are taken. Throat, nasal and oral cavities are checked to determine to narrow of airways.

Partners often gave important clues on other symptoms like sudden gasping or snorting followed by awakening. Leg kicking during sleep may indicate restless leg syndrome. If sleep apnea is suspected, a sleep specialist may be consulted.

A sleep study is used to identify sleep apnea and other problems that cause sleep disturbance. Most of the people with poor sleep in the night have excessive daytime sleepiness. Sleepiness is measured using objective tests like multiple sleep latency test and maintenance of wakefulness test.

Imaging studies like x-ray, CT scan, and MRI are recommended, in some cases, to check for problems in airways. These studies are useful in studying conditions like deviated nasal septum. In-depth analysis of sleep is done by a sleep study.

In this procedure called polysomnography, the body is connected to many devices during sleep. The devices measure many parameters like brain waves, the oxygen level in blood, heart and breathing rate, and stages of sleep.

Movements of legs and eyes during different stages of sleep are also recorded. A sleep study is recommended depending on other medical conditions and suspected condition that lead to snoring.

The first step in the treatment of snoring is lifestyle changes. Major changes suggested are losing excess body weight, avoiding alcohol, and taking home remedies for nasal congestion. Developing good sleep habits is equally important in controlling snoring. For snoring caused by sleep apnea, different treatment methods are suggested.

Some common treatment methods for controlling snoring are: 

• Oral appliances – appliances or devices that help to advance the jaw help to keep the airways open throughout. This reduces snoring.
• Continuous positive airway pressure – or CPAP, as it is commonly known as, is a procedure in which a pressurized mask is placed over the nose during sleep. The mask is connected to an air pump which keeps the air flow continuous without obstruction.
• Palatal implants – implantation of polyester filament strands into the palate stiffens the soft palate and reduces snoring.
• Surgical repair – uvulopalatopharyngoplasty is a surgical procedure in which the excess tissues from the throat is removed. In laser-assisted uvulopalatopharyngoplasty, the laser is used to remove the excess tissue from the throat.
• Somnoplasty – in this procedure, low-frequency radio waves are used to shrink the tissue that blocks the airways.

Some lifestyle tips and home remedies that would be of help in reducing the symptom include: 

• Lose excess body weight – this reduces the extra throat tissue that blocks airways
• Change sleep position – sleeping on side prevents the fall of the tongue back into the throat, blocking the airways. This reduces the obstruction of airways, reducing snoring.
• Keep the head in raised position while sleeping
• Use nasal strips – adhesive nasal strips are now available that helps in increasing the nasal passage and improving breathing
• Treat nasal congestion – nasal congestions and allergies increase the chance of snoring. An oral decongestant is often suggested but for a short period. Prescription steroid sprays are recommended for persistent nasal congestion.
• Limit alcohol consumption – alcoholic drinks should be limited, particularly before bedtime. Alcohol and sedatives cause relaxation of throat muscles that causes snoring.
• Quit smoking – smoking increases chances of snoring and hence should be reduced or stopped.
• Get adequate sleep and rest – without adequate sleep, the tissues undergo further relaxation, narrowing the airways.