Snoring

Overview

Snoring is the hoarse or harsh sound that occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe. Nearly everyone snores now and then, but for some people it can be a chronic problem. Sometimes it may also indicate a serious health condition. In addition, snoring can be a nuisance to your partner.

Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or sleeping on your side, can help stop snoring.

In addition, medical devices and surgery are available that may reduce disruptive snoring. However, these aren't suitable or necessary for everyone who snores.

Symptoms

Snoring is often associated with a sleep disorder called obstructive sleep apnea (OSA). Not all snorers have OSA, but if snoring is accompanied by any of the following symptoms, it may be an indication to see a doctor for further evaluation for OSA:

• Witnessed breathing pauses during sleep
• Excessive daytime sleepiness
• Difficulty concentrating
• Morning headaches
• Sore throat upon awakening
• Restless sleep
• Gasping or choking at night
• High blood pressure
• Chest pain at night
• Your snoring is so loud it's disrupting your partner's sleep
• In children, poor attention span, behavioral issues or poor performance in school

OSA often is characterized by loud snoring followed by periods of silence when breathing stops or nearly stops. Eventually, this reduction or pause in breathing may signal you to wake up, and you may awaken with a loud snort or gasping sound.

You may sleep lightly due to disrupted sleep. This pattern of breathing pauses may be repeated many times during the night.

People with obstructive sleep apnea usually experience periods when breathing slows or stops at least five times during every hour of sleep.

When to see a doctor

See your doctor if you have any of the above symptoms. These may indicate your snoring is associated with obstructive sleep apnea (OSA).

If your child snores, ask your pediatrician about it. Children can have OSA, too. Nose and throat problems — such as enlarged tonsils — and obesity often can narrow a child's airway, which can lead to your child developing OSA.

Causes

Snoring can be caused by a number of factors, such as the anatomy of your mouth and sinuses, alcohol consumption, allergies, a cold, and your weight.

When you doze off and progress from a light sleep to a deep sleep, the muscles in the roof of your mouth (soft palate), tongue and throat relax. The tissues in your throat can relax enough that they partially block your airway and vibrate.

The more narrowed your airway, the more forceful the airflow becomes. This increases tissue vibration, which causes your snoring to grow louder.

The following conditions can affect the airway and cause snoring:

• Your mouth anatomy. Having a low, thick soft palate can narrow your airway. People who are overweight may have extra tissues in the back of their throats that may narrow their airways. Likewise, if the triangular piece of tissue hanging from the soft palate (uvula) is elongated, airflow can be obstructed and vibration increased.
• Alcohol consumption. Snoring can also be brought on by consuming too much alcohol before bedtime. Alcohol relaxes throat muscles and decreases your natural defenses against airway obstruction.
• Nasal problems. Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may contribute to your snoring.
• Sleep deprivation. Not getting enough sleep can lead to further throat relaxation.
• Sleep position. Snoring is typically most frequent and loudest when sleeping on the back as gravity's effect on the throat narrows the airway.

Risk factors

Risk factors that may contribute to snoring include:

• Being a man. Men are more likely to snore or have sleep apnea than are women.
• Being overweight. People who are overweight or obese are more likely to snore or have obstructive sleep apnea.
• Having a narrow airway. Some people may have a long soft palate, or large tonsils or adenoids, which can narrow the airway and cause snoring.
• Drinking alcohol. Alcohol relaxes your throat muscles, increasing the risk of snoring.
• Having nasal problems. If you have a structural defect in your airway, such as a deviated septum, or your nose is chronically congested, your risk of snoring is greater.
• Having a family history of snoring or obstructive sleep apnea. Heredity is a potential risk factor for OSA.

Complications

Habitual snoring may be more than just a nuisance. Aside from disrupting a bed partner's sleep, if snoring is associated with OSA, you may be at risk for other complications, including:

• Daytime sleepiness
• Frequent frustration or anger
• Difficulty concentrating
• A greater risk of high blood pressure, heart conditions and stroke
• An increased risk of behavior problems, such as aggression or learning problems, in children with OSA
• An increased risk of motor vehicle accidents due to lack of sleep

Diagnosis

To diagnose your condition, your doctor will review your signs and symptoms, and your medical history. Your doctor will also perform a physical examination.

Your doctor may ask your partner some questions about when and how you snore to help assess the severity of the problem. If your child snores, you'll be asked about the severity of your child's snoring.

Imaging

Your doctor may request an imaging test, such as an X-ray, a computerized tomography scan or magnetic resonance imaging. These tests check the structure of your airway for problems, such as a deviated septum.

Sleep study

Depending on the severity of your snoring and other symptoms, your doctor may want to conduct a sleep study. Sleep studies may sometimes be done at home.

However, depending upon your other medical problems and other sleep symptoms, you may need to stay overnight at a sleep center to undergo an in-depth analysis of your breathing during sleep by a study, called a polysomnography.

In a polysomnography, you're connected to many sensors and observed overnight. During the sleep study, the following information is recorded:

• Brain waves
• Blood oxygen level
• Heart rate
• Breathing rate
• Sleep stages
• Eye and leg movements

Treatment

To treat your snoring, your doctor likely will first recommend lifestyle changes, such as:

• Losing weight
• Avoiding alcohol close to bedtime
• Treating nasal congestion
• Avoiding sleep deprivation
• Avoiding sleeping on your back

For snoring accompanied by OSA, your doctor may suggest:

• Oral appliances. Oral appliances are form-fitting dental mouthpieces that help advance the position of your jaw, tongue and soft palate to keep your air passage open.

  If you choose to use an oral appliance, you'll work with your dental specialist to optimize the fit and position of the appliance. You'll also work with your sleep specialist to make sure the oral appliance is working as intended. Dental visits may be necessary at least once every six months during the first year, and then at least annually after that, to have the fit checked and to assess your oral health.

  Excessive salivation, dry mouth, jaw pain and facial discomfort are possible side effects from wearing these devices.

• Continuous positive airway pressure (CPAP). This approach involves wearing a mask over your nose or mouth while you sleep. The mask directs pressurized air from a small bedside pump to your airway to keep it open during sleep.

  CPAP (SEE-pap) eliminates snoring and is most often used to treating snoring when associated with OSA.

  Although CPAP is the most reliable and effective method of treating OSA, some people find it uncomfortable or have trouble adjusting to the noise or feel of the machine.

• Upper airway surgery. There are a number of procedures that seek to open the upper airway and prevent significant narrowing during sleep through a variety of techniques.

  For example, in a procedure called uvulopalatopharyngoplasty (UPPP), you're given general anesthetics and your surgeon tightens and trims excess tissues from your throat — a type of face-lift for your throat. Another procedure called maxillomandibular advancement (MMA) involves moving the upper and lower jaws forward, which helps open the airway. Radiofrequency tissue ablation employs a low-intensity radiofrequency signal to shrink tissue in the soft palate, tongue or nose.

  A newer surgical technique called hypoglossal nerve stimulation employs a stimulus applied to the nerve that controls forward movement of the tongue so the tongue does not block the airway when you take a breath.

  The effectiveness of these surgeries varies and the response can be challenging to predict.

Lifestyle and home remedies

To prevent or quiet snoring, try these tips:

• If you're overweight, lose weight. People who are overweight may have extra tissues in the throat that contribute to snoring. Losing weight can help reduce snoring.
• Sleep on your side. Lying on your back allows your tongue to fall backward into your throat, narrowing your airway and partially obstructing airflow. Try sleeping on your side. If you find that you always end up on your back in the middle of the night, try sewing a tennis ball in the back of your pajama top.
• Raise the head of your bed. Raising the head of your bed by about 4 inches may help.
• Nasal strips or an external nasal dilator. Adhesive strips applied to the bridge of the nose help many people increase the area of their nasal passage, enhancing their breathing. A nasal dilator is a stiffened adhesive strip applied externally across the nostrils that may help decrease airflow resistance so you breathe easier. Nasal strips and external nasal dilators aren't effective for people with OSA, however.

• Treat nasal congestion or obstruction. Having allergies or a deviated septum can limit airflow through your nose. This forces you to breathe through your mouth, increasing the likelihood of snoring.

  Ask your doctor about a prescription steroid spray if you have chronic congestion. To correct a structural defect in your airway, such as a deviated septum, you may need surgery.

• Limit or avoid alcohol and sedatives. Avoid drinking alcoholic beverages at least two hours before bedtime, and let your doctor know about your snoring before taking sedatives. Sedatives and alcohol depress your central nervous system, causing excessive relaxation of muscles, including the tissues in your throat.
• Quit smoking. Smoking cessation may reduce snoring, in addition to having numerous other health benefits.
• Get enough sleep. Adults should aim for at least seven hours of sleep per night. The recommended hours of sleep for children vary by age. Preschool-aged children should get 10 to 13 hours a day. School-age children need nine to 12 hours a day, and teens should have eight to 10 hours a day.

Alternative medicine

Because snoring is such a common problem, there are numerous products available, such as nasal sprays or homeopathic therapies. However, most of the products haven't been proved effective in clinical trials.

Coping and support

If your partner is the one who's snoring, you may sometimes feel frustrated as well as fatigued. Suggest some of the home remedies mentioned, and if those don't help quiet your partner's nocturnal noisemaking, have your partner make a doctor's appointment.

In the meantime, ear plugs or background noise, such as a white noise machine or a fan near the bed, may help mask snoring noise so you get more sleep.

Preparing for an appointment

You're likely to first see your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in treating sleep disorders.

Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to arrive well-prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Ask your partner to describe what he or she hears or notices at night while you're sleeping.

  Or, better yet, ask your sleep partner to go with you to your appointment so that he or she can talk with your doctor about your symptoms.

• Make a list of all medications, as well as any vitamins or supplements that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. For snoring, some basic questions to ask your doctor include:

• What makes me snore when I sleep?
• Is my snoring a sign of something more serious, such as OSA?
• What kinds of tests do I need?
• What happens during a sleep test?
• What treatments are available for snoring, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• Are there any steps I can take on my own that will help my snoring?
• I have other health conditions. How can I best manage these conditions together?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin snoring?
• Do you snore every night or only once in a while?
• Do you often wake up during the night?
• Does anything you do seem to improve your snoring?
• What, if anything, appears to worsen your snoring?
• Does your snoring depend on specific positions of sleep?
• How loud is your snoring? Does it bother your bed partner? Can it be heard outside the bedroom?
• Does your bed partner ever tell you that you have pauses or irregularities in your breathing during sleep?
• Do you snort, choke or gasp yourself awake from sleep?
• What daytime symptoms are you experiencing, such as sleepiness?

What you can do in the meantime

While you're waiting to see your doctor, here are some tips you can try:

• Don't drink alcohol or take sedatives before bed.
• Try over-the-counter nasal strips.
• Sleep on your side, instead of your back.
• If nasal congestion is an issue, try an over-the-counter decongestant for a day or two.