Snoring

• Snoring is the noise produced during sleep by vibrations of the soft tissues at the back of your nose and throat.
• The noise is created by turbulent flow of air through narrowed air passages.
• In general, snoring is now being recognized for its potential to disturb the individuals sleep and in association with other health problems.
• In patients who snore, a more serious problem related to snoring can occur when those same soft tissues block the air passages at the back of the throat while you are sleeping.
• This interferes with the ability to breathe. This condition is obstructive sleep apnea (OSA), and it can directly affect your health.

• The prevalence of obstructive sleep apnea increases with age.
• Most people diagnosed with obstructive sleep apnea are obese. Increased neck fat is thought to narrow the airway, making breathing more difficult.
• Men are 7-10 times more likely to have obstructive sleep apnea than women.
• More African Americans have OSA than do whites.
• Most people with obstructive sleep apnea are older than 40 years, although it is also common in children with loarge tonsils. Weight gain and a decrease in muscle tone occur with aging, and these may play a role in increasing the incidence of OSA.
• Sleep apnea is more common in women who are postmenopausal.
• Family history and genetics play a role.
• Certain neuromuscular conditions may increase the chance of obstructive sleep apnea, as do other medical conditions such as sinus infections, allergies, colds and nasal obstruction, and hypothyroidism (underactive thyroid gland).

Obstructive sleep apnea (OSA) is an extreme form of snoring in which your upper airway closes while you are asleep, causing an obstruction that prevents you from breathing for a brief period.

• The soft tissues of the throat, your soft palate, and the tongue collapse onto the back wall of the upper airway, forming a blockage that prevents air from entering your lungs.
• The negative pressure of inhaling pulls harder on your soft tissues, sealing the airway even more tightly.
• To breathe and get air to your lungs, you must awaken or arouse slightly and create tension in your muscles-including the tongue and throat-and open the airway.
• This process causes a distinctive snorting, startling, and awaking pattern.
• If you have sleep apnea, you may begin snoring, then stop breathing for at least 10 seconds (apnea). The apnea temporarily quiets the snoring, after which you awaken with a large snort. This pattern occurs in 95% of people with obstructive sleep apnea.
• Each cycle of blockage (apnea) and awakening can last from 20 seconds to a couple minutes, repeating many times throughout the night. Five episodes per hour per night are common. More than 15 episodes per hour per night are the criteria used to diagnosis the condition referred to as sleep apnea.
• Some snorers can have anywhere from 100-600 episodes or cycles of sleeping and waking per night.
• Although people with sleep apnea may be completely unaware of this repeating sleep-snore-apnea-wake pattern, it is very disruptive to normal sleep patterns. Usually, it is the bed partner who is most aware of the condition. Relationships, along with school and job performance, often suffer because of persistent daytime sleepiness that develops as a result of continuously disrupted sleep.
• Characteristics of obstructive sleep apnea
  • Movement in the bed when you wake and change position to breathe more easily
  • Excessive daytime sleepiness with napping that often does not fully rest you
  • Mood changes such as anxiety and irritability
  • Decreased sexual drive and depression
• The repeated cycles of snoring, apnea, and waking that characterize OSA can lead to adverse physical changes and complications such as these:
  • High blood pressure
  • Coronary artery disease, heart attacks, strokes
  • Pulmonary hypertension
  • Confusion
  • Loss of memory
  • Psychiatric disorders and impotence

If you or someone close to you is not sleeping well because of snoring or sleep apnea, visiting your doctor may be helpful. This should be by appointment, because these are not emergency cases and sometimes extra time is scheduled for the evaluation.

A doctor's visit may be particularly important if you are doing any of the following:

• Falling asleep during normal waking hours
  • Becoming irritable
  • Losing concentration
  • Becoming depressed

A doctor will complete a general physical examination, paying particular attention to your nose and throat.

• Your weight and blood pressure will be evaluated. If other clinical conditions are present, your blood may be tested to rule out thyroid dysfunction.
• An otolaryngologist (ear, nose, and throat doctor) can look into your airway with a fiberoptic device to see if the nasal passages are open or partially blocked (septal deviation) or if there are any masses (tumors) present in your nose, throat, or upper airway that may be causing the snoring.
• For most cases, you should be referred for a sleep laboratory test. This overnight test may take place in a specialized sleep lab monitored by a technician measuring up to 16 different bodily functions while you sleep. Home sleep apnea tests are also available from many sleep centers and allow many patients to be tested in their own sleep environment. The results of these tests can help define the level and severity of sleep apnea if it is present.

• Treatment for snoring  first involves making sure the patient does not have obstructive sleep apnea.
• Some treatments for primary snoring can be as simple as changing sleeping positions or losing a few pounds.
• Other cases may require treatment for sleep apnea such as continuous positive airway pressure (CPAP) or even surgery.
• Sometimes, a doctor may prescribe an inhaled steroid if snoring is traced to swelling of the nasal lining.

Many remedies are available over-the-counter in drug stores, but most do not help correct snoring or sleep apnea.

• Because you tend to snore more when sleeping on your back, one useful technique is to try to keep from sleeping in that position. One way is to wear a pocket T-shirt backward with a tennis ball in the pocket. You will be less likely to sleep on your back because it is very uncomfortable to sleep on a tennis ball.
• Try losing some weight. As little as 10 pounds might make the difference.
• Avoid alcohol, especially in the 4 hours before going to sleep.
• Avoid using sedatives and narcotic medications. Alcohol, sedatives, and narcotics cause relaxation of your throat muscles and increase the tendency for airway obstruction related to snoring.
• Snoring may be more common after 1 or more days of sleep deprivation, so getting regular sleep is better.
• Myofunctional or throat exercises may be helpful for some patients.

For mild forms of snoring caused by swelling of the lining of your nose, a doctor may prescribe an inhaled steroid preparation.

For more severe forms of sleep apnea, surgical procedures or continuous positive airway pressure may be tried:

• Continuous positive airway pressure (CPAP)
  • CPAP is a device that includes a mask that fits snugly over your nose and mouth and is held in place with head straps. The mask is connected to a blower that generates pressurized air. You wear it while sleeping.
  • The controlled pressure works as an air splint to keep the soft tissue of the nose and throat in place and the airway open.
  • This noninvasive therapy works for 95% of people with sleep apnea.

• Most snoring procedures are focused on stiffening the soft tissues of the palate or roof of the mouth. This can be done through a variety of methods that generate scar tissue.
• Somnoplasty: This is an outpatient surgical procedure performed with the patient under local anesthetic. It takes about a half-hour. During the procedure, a small electrode is placed in your anesthetized soft palate and heated up. The heat that is generated by the electrode causes the extra soft tissue at the back of the throat to shrink and contract over a few weeks.
• Tonsillectomy and adenoidectomy involves removing the tonsils and adenoids from the back of the throat. This is not commonly done in adults with snoring being the primary indication. However, in children this is a common method to address sleep disordered breathing including frequent, recurrent snoring.
• Your doctor may recommend cutting out certain tissues of the soft palate to remove the obstructing tissue.

With proper treatment, most people with snoring-related problems improve. People who have obstructive sleep apnea will most likely benefit greatly with treatment. Any improvement in the condition will most likely result in more restful sleep and a reduction in daytime fatigue.

• Sleeping partners appreciate almost any reduction in snoring-related noise.
• It is generally well worth the effort to have this condition evaluated.