Snoring:
Not Funny, Not Hopeless
Forty-five percent of normal adults snore at least
occasionally, and 25 percent are habitual snorers. Problem snoring is more
frequent in males and overweight
persons, and it usually grows worse with age.
More than 300 devices are registered in the U.S. Patent and Trademark Office
as cures for snoring. Some are variations on the old idea of sewing a sock that
holds a tennis ball on the pajama back to force the snorer to sleep on his side.
(Snoring is often worse when a person sleeps on his back). Some devices reposition
the lower jaw forward; some open nasal air passages; a few others have been designed
to condition a person not to snore by producing unpleasant stimuli when snoring
occurs. But, if you snore, the truth is that it is not under your control whatsoever.
If anti-snoring devices work, it is probably because they keep you awake.
What Causes Snoring?
The noisy sounds of snoring occur when there is an obstruction to the free flow
of air through the passages at the back of the mouth and nose. This area is the
collapsible part of the airway (see illustration) where the tongue and upper
throat meet the soft palate and uvula. Snoring occurs when these structures strike
each other and vibrate during breathing.
People who snore may suffer from:
• Poor muscle tone in the tongue and throat. When muscles are too relaxed,
either from alcohol or drugs that cause sleepiness, the tongue falls backwards
into the airway or the throat muscles draw in from the sides into the airway.
This can also happen during deep sleep.
• Excessive bulkiness of throat tissue. Children with large tonsils and
adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or
tumors can also cause bulk, but they are rare.
• Long soft palate and/or uvula. A long palate narrows the opening from
the nose into the throat. As it dangles, it acts as a noisy flutter valve during
relaxed breathing. A long uvula makes matters even worse.
• Obstructed nasal airways. 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, and snoring results. So, snoring
often occurs only during the hay fever season or with a cold or sinus infection.
Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity
of the wall that separates one nostril from the other) can cause such an obstruction.
Is Snoring Serious?
Socially, yes! It can be, when it makes the snorer an object of ridicule and
causes others sleepless nights and resentfulness. Medically, yes! It disturbs
sleeping patterns and deprives the snorer of appropriate rest. When snoring is
severe, it can cause serious, long-term health problems,
including obstructive sleep apnea.
Obstructive
Sleep Apnea
When loud snoring is interrupted by frequent episodes of totally obstructed breathing,
it is known as obstructive sleep apnea. Serious episodes last more than ten seconds
each and occur more than seven times per hour. Apnea patients may experience
30 to 300 such events per night. These episodes can reduce blood oxygen levels,
causing the heart to pump harder.
The immediate effect of sleep apnea is that the snorer must sleep lightly and
keep his muscles tense in order to keep airflow to the lungs. Because the snorer
does not get a good rest, he may be sleepy during the day, which impairs job
performance and makes him a hazardous driver or equipment operator. After many
years with this disorder, elevated blood pressure and heart enlargement may occur.
Can Heavy Snoring be Cured?
Heavy snorers, those who snore in any position or are disruptive to the family,
should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist
will provide a thorough examination of the nose, mouth, throat, palate, and neck.
A sleep study in a laboratory environment may be necessary to determine how serious
the snoring is and what effects it has on the snorer's health.
Treatment
Treatment depends on the diagnosis. An examination will reveal if the snoring
is caused by nasal allergy, infection, deformity, or tonsils and adenoids.
Snoring or obstructive sleep apnea may respond to various treatments now offered
by many otolaryngologist-head and neck surgeons:
• Continuous Positive Airway Pressure Machine (CPAP) can
be worn during
sleep and is an effective treatment in some patients.
• Uvulopalatopharyngoplasty (UPPP) is surgery for treating
obstructive sleep apnea. It tightens flabby tissues in the throat and palate,
and expands air passages.
• Thermal Ablation Palatoplasty (TAP) refers to procedures
and techniques that treat snoring and some of them also are used to treat various
severities of obstructive sleep apnea. Different types of TAP include bipolar
cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty (LAUP)
treats snoring and mild obstructive sleep apnea by removing the obstruction in
the airway. A laser is used to vaporize the uvula and a specified portion of
the palate in a series of small procedures in a doctor's office under local anesthesia.
Radiofrequency ablation—some with temperature control approved by the FDA—utilizes
a needle electrode to emit energy to shrink excess tissue to the upper airway
including the palate and uvula (for snoring), base of the tongue (for obstructive
sleep apnea), and nasal turbinates (for chronic nasal obstruction).
• Genioglossus and hyod advancement is a surgical procedure
for the treatment of sleep apnea. It prevents collapse of the lower throat and
pulls the tongue muscles forward, thereby opening the obstructed airway.
If surgery is too risky or unwanted, 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".
A chronically snoring child should be examined for problems with his or her tonsils
and adenoids. A tonsillectomy and adenoidectomy may be required to return the
child to full health.
Self-Help
for the Light Snorer
Adults who suffer from mild or occasional snoring should try the following 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 retiring.
• Establish regular sleeping patterns
• Sleep on your side rather than your back.
• Tilt the head of your bed upwards four inches.
Remember, snoring means obstructed breathing, and obstruction can be serious.
It's not funny, and not hopeless.
