Snoring

Definition

Snoring is the sound produced by obstructed breathing during sleep. People who snore have an increased risk of high blood pressure , heart disease , and stroke . More study is needed to determine whether those snorers at risk for more serious problems are people who have actual pauses in breathing while snoring, called sleep apnea .

Blocked Airway

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Causes

Snoring results when air cannot move freely through the air passages at the back of the mouth and nose. This causes vibration of the roof of the mouth and uvula (part of the soft palate), which creates the snoring sound. The smaller the airway, the more obstruction, and the louder the snoring. This airway obstruction can be caused by:

  • Decreased muscle tone in the tongue and throat
  • Enlarged tonsils, adenoids, or other obstructions (ie, tumors or cysts)
  • Excessive tissue around the throat due to obesity
  • Structural factors
    • A long soft palate (roof of the mouth)
    • A long uvula
    • Deformities of the nose or nasal septum
    • Small chin, overbite, or high palate (in women)
  • Congested nasal passages from a cold , flu , sinus infection , or allergies

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

  • Sex: male
  • Being overweight
  • Age: Over 50
  • Family history
  • Use of drugs (central nervous system depressants) or alcohol that act as respiratory depressants
  • Lying on back while sleeping
  • Nasal obstruction (due to a cold, sinus infection, allergy, enlarged adenoids, or injury that has displaced the nasal cartilage or bones)

Symptoms

The main symptom of snoring is noisy breathing during sleep.

The following symptoms may indicate that obstructive sleep apnea is causing the snoring:

While sleeping:

  • Gasping
  • Choking
  • Long pauses in breathing
  • Sudden awakening

While awake:

  • Sleepiness and fatigue during the day
  • Slowness in mental functioning
  • Headaches

Diagnosis

If your snoring is severe, the doctor will want to make sure you do not have obstructive sleep apnea. Diagnosis may involve:

  • Physical exam of the throat, neck, mouth, and nose
  • A sleep study in a laboratory to determine how the snoring disrupts your sleep

Treatment

In cases of snoring without sleep apnea, lifestyle changes may alleviate symptoms. More severe cases may require surgery or devices.

Lifestyle Changes

Changes that may help stop snoring include:

  • If you are overweight, lose weight.
  • Exercise to improve muscle tone
  • Avoid drinking alcohol or taking sedatives.
  • Sleep on your side rather than on your back. Try taping a marble or tennis ball to your back before going to bed to prevent rolling onto your back.
  • Treat causes of nasal congestion (eg, allergies or colds).
  • Raise the head of the bed up about four inches. Use extra pillows or put something under the mattress.

Surgery

During surgery, a laser or scalpel can be used to remove excess tissue that is blocking the airway. This type of surgery is called uvulopalatopharyngoplasty (UPPP). Treatment by laser surgery requires a series of surgeries and is usually reserved for severe and disruptive cases of snoring. In case of life threatening obstructive sleep apnea that has failed other treatments, a tracheostomy may need to be done. In this type of surgery, an opening is made in your neck and a small tube is inserted. More studies are needed to evaluate the effectiveness of the surgical approaches.

Devices

Devices that can open airways during sleep include:

  • Continuous positive airway pressure (CPAP) involves wearing a mask-like nasal device during sleep that maintains continuous air pressure in the nose and upper throat to keep it open. It is more commonly used for people with obstructive sleep apnea.
  • Dental devices are put into the mouth during sleep to position the soft palate for better breathing.
  • Nasal strips help widen nasal passages.

Medications

Modafinil (Provigil) may be used in patients who have some residual sleepiness during the day and are treated with CPAP at night.

Prevention

You can take the following steps to help prevent snoring:

  • Maintain a healthy body weight.
  • Treat cold and allergy symptoms.
  • Avoid drinking alcohol, or taking sedatives for several hours before bedtime.
  • Sleep on your side.

RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

National Center on Sleep Disorders Research
http://www.nhlbi.nih.gov/about/ncsdr

CANADIAN RESOURCES:

Better Sleep Council Canada
http://www.bettersleep.ca/

The Canadian Lung Association
http://www.lung.ca

References:

American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/ . Accessed October 7, 2005.

American Medical Association website. Available at: http://www.ama-assn.org/ . Accessed October 7, 2005.

Beers MH. The Merck Manual of Medical Information . 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.

Health Topics: Snoring. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/snoring.html . Accessed October 7, 2005.

Lindman JP. Snoring and obstructive sleep apnea, surgery. eMedicine website. Accessed September 27, 2006.

Mayo Clinic website. Available at: http://www.mayoclinic.com/health/obstructive-sleep-apnea/DS00968/DSECTION=1 . Accessed November 9, 2007.

McDonald JP. A review of surgical treatment for obstructive sleep apnoea/hypopnoea syndrome. Surgeon. 2003;1:259-264. Review.

Obstructive sleep apnea. Dynamed website. Available at: http://dynamed101.ebscohost.com/Detail.aspx?id=115600 .

Sher AE. Upper airway surgery for obstructive sleep apnea. Sleep Med Rev. 2002;6:195-212. Review.

Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death NEJM. 2005;353:2034-2041.



Last reviewed November 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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