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Snoring

Note: We have prepared a comprehensive website specifically addressing snoring and sleep apnea, which includes a free online book, multiple Q&As, and much more. Click here to access the New Jersey Center for Snoring and Sleep Apnea. Below is a summary of information on snoring.

Almost one out of every two American adults snore occasionally, and one in four snore regularly. Snoring is more common in males and in those who are overweight. Snoring is a problem that gets worse with age.

Snoring occurs when there is a blockage of free air flow through the back of the mouth and nose. This area is collapsible - when the structures in this area of the breathing pathway strike each other and vibrate during breathing, snoring is the result.

People who snore may suffer from a nasal problem: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat. Snoring results. Deformities of the nose or nasal septum, such as a deviated septum, nasal polyps, enlarged adenoids, sinusitis, and other abnormalities can cause such an obstruction.

People who snore may suffer from a throat problem: Children with large tonsils and adenoids often snore. In adults, a long palate or uvula can also narrow the throat. This tissue can dangle in the throat and flutter with breathing, causing snoring. Overweight people have bulky neck tissue and often snore too. Other rare causes, such as cysts or tumors, require evaluation by the specialist. When the muscles in the tongue and throat are too relaxed, the tongue falls backwards into the airway, and/or the throat muscles draw in from the sides into the airway, causing snoring and in some cases even obstruction of breathing. This can happen during deep sleep. This can also happen as an effect of alcohol or drugs that cause sleepiness, or from other causes.

Is Snoring Serious?

Anyone who shares a room with a snorer knows the answer to this question! It can cause sleepless nights and resentment for the non-snoring roommate or spouse.

Snoring can also be a sign of a medically serious problem called Obstructive Sleep Apnea. People who snore should be evaluated by a specialist.

Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal blockage, sinusitis, enlarged tonsils and adenoids, or some other nose and throat problem.

Snoring may respond to various treatments now offered by snoring specialists. At the Nose and Sinus Center, we can perform a fiberoptic endoscopic examination to assess possible causes of snoring. Recent technology has made treatment more effective, safer, and more comfortable than ever before.

For more information on technology, Click here.

Questions and Answers

Question: What causes snoring and how common is it?
Answer:
When we breathe (inhale and exhale) air flows in a smooth, laminar manner. Obstructions that occur along the path of airflow lead to irregular, turbulent air movement. Air turbulence is often accompanied by irregular vibration of structures of the upper airway. Snoring occurs when there is a blockage of free air flow through the back of the mouth and nose. This area is collapsible - when the structures in this area of the breathing pathway strike each other and vibrate during breathing, snoring is the result. The resultant sound, snoring, may range from mild to severe.

Snoring is believed to affect as many as 50% of adults including both men and women; over 45 million Americans. Almost one out of every two Americans adults snore occasionally, and one in four snore regularly. Snoring is more common in males and in those who are overweight. Snoring is a problem that gets worse with age. While it is well known that snoring increases with age, it is less well known that the impact on younger patients may also be significant.

Question: Does snoring come from the nose or the throat?
Answer:
People who snore may suffer from a nasal problem:

  • A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat. Snoring results.
  • Deformities of the nose or nasal septum, such as a deviated septum, nasal polyps, enlarged adenoids, sinusitis, and other abnormalities can cause such an obstruction.

    People who snore may suffer from a throat problem:

  • Children with large tonsils and adenoids often snore. In adults, a long palate or uvula can also narrow the throat. This tissue can dangle in the throat and flutter with breathing, causing snoring. Overweight people have bulky neck tissue and often snore too. Other rare causes, such as cysts or tumors, require evaluation by the specialist.
  • When the muscles in the tongue and throat are too relaxed, the tongue falls backwards into the airway, and/or the throat muscles draw in from the sides into the airway, causing snoring and in some cases even obstruction of breathing. This can happen during deep sleep. This can also happen as an effect of alcohol or drugs that cause sleepiness, or from other causes.

Question: Is Snoring Serious?
Answer:
Anyone who shares a room with a snorer knows the answer to this question! It can cause sleepless nights and resentment of the non-snoring roommate or spouse.

Snoring can also be a sign of a medically serious problem called Obstructive Sleep Apnea. People who snore should be evaluated by a specialist.

Snoring has a negative impact both on the individual who snores, as well as on that person's bed partner. Patients who snore often awake after an unsatisfying, disrupted sleep to encounter a day of sleepiness and fatigue. Drowsiness, irritability, and decreased libido may all be associated with snoring. In addition to these lifestyle challenges, patients who snore have been shown to have increased rates of hypertension (elevated blood pressure) when compared to patients who do not snore. Studies have also documented a positive correlation between loud snoring and risk of heart attack and stroke.

A 2008 study found that "objectively measured heavy snoring is an independent risk factor for early carotid atherosclerosis, which may progress to be associated with stroke." Another study evaluated over 1500 patients who suffered acute myocardial infarcts (heart attaches), and found that "heavy snoring is associated with case fatality and short-term mortality in patients with a first acute myocardial infarction." Yet another study found snoring to predispose patients for the development of hypertension. Anatomically, snoring may also lead to an enlarged uvula (the "punching bag" that hangs down from your soft palate), and increased episodes of acid reflux. An enlarged uvula may - in turn - lead to increased snoring, coughing, and even to a choking sensation. Others have documented the association between snoring and chronic bronchitis.

Snoring may have a severe impact on inter-personal relationships. According to one study of 4900 couples, as many as 80% of snoring couples end up in separate bedrooms.� Another study of women who sleep with men who snore found that these women were almost twice as likely as women who sleep with non-snorers to report problems with insomnia, daytime fatigue, daytime sleepiness, awakening unrefreshed from sleep, and morning headache. Yet another study of 10 married couples performed at the Mayo Clinic found that the bed-partner of the snoring patient gained an additional 74% to 87% of sleep per night after their partner's snoring was corrected. Another study from the Mayo clinic showed that snoring also seems to be associated with reduced sexual satisfaction in men. It is clear that snoring impacts both the patient who snores as well as his or her bed-partner. Fortunately, several studies have documented statistically significant improvements in marital relations after a patient's snoring was corrected

Question: What is Obstructive Sleep Apnea (OSA)?
Answer:
When loud snoring is interrupted by frequent episodes of totally blocked breathing, it is known as obstructive sleep apnea (OSA). When episodes of blocked breathing last more than ten seconds each and occur more than seven times per hour, this is considered quite serious. OSA patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.

In order to breathe, the snorer with obstructive sleep apnea sleeps lightly and keeps his or her muscles tense and the airway open. Because the OSA patient sleeps this way, they do not get a good rest. They may be sleepy during the day, which impairs job performance and makes them hazardous drivers or equipment operators. After many years with this disorder elevated blood pressure, heart enlargement, and other serious conditions may occur.

A high percentage of patients who snore also may have obstructive sleep apnea (OSA). It is for this reason that patients who snore should have a sleep study for diagnosis. OSA is well-documented to have a serious impact on a patient's quality of life, work efficiency, and driving safety. Untreated OSA may also lead to hypertension, coronary artery disease, memory impairment, stroke, and adult onset diabetes. In one study, snoring was found to be associated with elevation in blood glucose markers, potential signs of impending diabetes. Almost 40% of patients with OSA have elevated blood pressure. Moreover, it appears that patients with OSA have a 2 to 3 times increased risk of heart attack and stroke. Americans who have OSA are more likely to die suddenly of cardiac causes between 10 p.m. and 6 a.m. than during the other 16 hours of the day combined, according to findings of a Mayo Clinic study.

Question: What treatments are available for snoring and OSA?
Answer:
Heavy snorers, those who snore in any position, and those who are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem, and to see what treatments are available for their snoring. A snoring specialist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study may be necessary to determine how serious the snoring is and what effects it has on the snorer's health. This may be performed in a specialized laboratory, or in your own home, depending on the situation.

Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal blockage, sinusitis, enlarged tonsils and adenoids, or some other nose and throat problem.

Snoring may respond to various treatments now offered by snoring specialists:

A. Self-Help for the Light Snorer

Adults who suffer from mild or occasional snoring may try self-help remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  • Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
  • Avoid alcohol for at least four hours and heavy meals or snacks for three hours before going to bed.
  • Establish regular sleeping patterns.
  • Sleep on your side rather than your back.
  • Tilt the head of your bed upwards four inches.

B. Medical Devices

There are some medical devices that are effective for snoring. Existing oral appliances may help. Also, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or "CPAP." Many snoring patients do not like these devices, and prefer a more definitive treatment if possible.

C. Office Procedures for Snoring

Recent years have seen the introduction of minimally invasive procedures -- radiofrequency ablation and the Pillar Procedure -- with increased efficacy and decreased patient recovery time and morbidity. In the appropriate patient, these procedures may have a large positive impact.

The Pillar Procedure, for example, is performed under local anesthesia and takes around 20 minutes to perform in the clinic setting with most patients. While data continues to be collected, some studies have shown a significant decrease in patient snoring intensity with associated decreases in daytime sleepiness and significant improvements in lifestyle after patients underwent the Pillar Procedure. Other studies have demonstrated bed partner satisfaction with the reduction in snoring after the Pillar Procedure at 80% or higher. Studies of patients with OSA demonstrate approximately 80% of patients with a reduction in their AHI (sleep index), and results were sustained at one year after palatal implants/Pillar Procedure. Another study has documented significant improvement in snoring and sleep apnea with insertion of palatal implants in patients who had failed surgical intervention with prior uvulapalatopharyngoplasty

D. Surgical Treatments for Snoring

Surgical treatments include nasal surgery, adenoid and tonsil surgery, palate surgery, and jaw surgery (mandibular advancement). Some of these surgeries may be performed with the laser (laser-assisted uvulopalatoplasty, or LAUP). Many of the surgeries involving the oral cavity (tonsils, palate, jaw) and pharynx have significant pain and morbidity and lengthy patient recovery times.

A chronically snoring child should be examined for problems with his or her tonsils and adenoids. If the chronically snoring child has enlarged tonsils and adenoids, and if they have excessive daytime sleepiness affecting their performance at school, a tonsillectomy and adenoidectomy may be required to return the child to full health and full function.

If a patient is not just a snorer but also has obstructive sleep apnea, this condition is more serious and may require more invasive procedures. Your doctor will discuss these with you.

To download our book chapter on "Snoring", Click here

 
 
 
 
 
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