Snoring

About a quarter of women and 40 percent of men snore on a regular basis, according to the American Academy of Sleep Medicine. Snoring can affect relationships, increase daytime fatigue, and can be a sign of-or a risk for-more serious health conditions. Fortunately there are treatments to ease snoring and relieve these associated conditions.

Causes
Snoring is a common problem that can affect people of any age. It occurs when the air entering the nose or mouth encounters a narrowing or blockage on its way into the airway. As the air moves through this narrowed tissue in the back of the throat, it causes the tissue to vibrate, creating a sound. The more narrow the airway, the louder the snoring becomes.

If the airway is very narrow, the flow of air can actually stop completely, causing you to stop breathing for several seconds at a time multiple times throughout the night. Your body must continually “wake you up” to restart your breathing. This condition is called obstructive sleep apnea, and it can both deprive you of sleep, and increase the risk for several serious health conditions, including heart attack and stroke. About half of people who snore loudly are believed to have obstructive sleep apnea.

In some cases, overly large tonsils and/or adenoids can be the cause of snoring. Their large size can prevent enough air from getting into the lungs. An overly long uvula (the thin, cone-shaped tissue that hangs down in the back of the throat) can also block the airway.

A sinus problem may trigger snoring. Sometimes the problem is long-term; in other cases snoring starts with a cold or sinus infection and tapers off when the infection clears.

Risk Factors
Risks for sleep apnea include:

• Male gender-men are more likely to snore and have sleep apnea than women, although the incidence of snoring in women increases after menopause.
• Obesity-having extra weight in the neck area reduces the size of the airway
• Nasal congestion
• Enlarged adenoids and tonsils
• Use of alcohol or sedatives

Many of these risks can be lowered by making positive lifestyle changes such as loosing weight and avoiding alcohol, especially before bed time.

Symptoms and Signs
Snoring is itself a symptom, and it can be an indicator of sleep apnea, especially if it is accompanied by pauses in breathing.

If your snoring is due to sleep apnea, you may experience other symptoms, including:

• Restless, continuously interrupted sleep
• Excessive daytime sleepiness
• Memory loss
• Impaired mental function
• Depression
• Morning headaches
• Impaired sexual function, impotence

When to Seek Medical Advice
If your snoring is loud or persistent, it’s time to get medical help. It’s especially important to get diagnosed if your partner notices that you stop breathing periodically during the night, you are especially tired during the day, or you have trouble concentrating. All of these symptoms could indicate sleep apnea.

Diagnosis
During the exam, the doctor will take a medical history, and will ask about your sleep patterns, any medications you take, and whether you drink alcohol. The doctor will also examine your nose and throat for any anatomical abnormalities that could be at the root of your snoring.

The doctor may recommend that you have a sleep study (polysomnography), during which you will stay overnight in a sleep clinic or hospital while technicians monitor your heart rate, breathing, brain activity, blood-oxygen levels, movement, and other vital body functions to determine whether the cause of the problem is sleep apnea or another condition.

Complications
Snoring can wreak havoc on relationships and excessive daytime sleepiness may lead to decreased productivity at work. If sleep apnea is the problem, it can lead to serious health complications, including:

• High blood pressure
• Heart attack
• Stroke
• Irregular heartbeat
• Impotence
• Decreased mental function
• Increased risk of vehicle accidents

Treatment
If your snoring persists, you will likely need to be seen and treated for an underlying medical condition. Which method the doctor recommends to treat your snoring will depend on the condition causing the problem.

Treatments for sinus problems include:

• Inhaled steroid medications
• Nasal strips to open up clogged breathing passages.
• Balloon sinuplasty-a non-surgical procedure that inserts a balloon into the sinus passages and inflates it to open up the airway.
• Repair and straightening of the nasal septum (the tissue that divides the right and left nostrils)
• A nasal valve procedure, in which the doctor makes two incisions-one under the eye and one in the nostril-and inserts a clip in the bone under the eye. A piece of floss attaches to the clip and loops around the sagging nasal tissue to pull it taut and open the nasal passages.

Non-surgical treatments for snoring and sleep apnea include:

• Continuous positive airway pressure-a machine that gently blows air into the lungs through a mask.
• Oral appliance-a device that moves the jaw down and brings the tongue forward while you sleep.
• Radiofrequency of the soft palate-a technique that uses radio waves to shrink tissues in the throat or tongue that are obstructing your breathing.
• Pillar implants-a minimally invasive technique in which the doctor places three tiny polyester implants into the palate. The implants create scar tissue, which stiffens the palate to keep it open at night.

If the snoring cannot be treated by non-surgical treatments or if a diagnosis of sleep apnea is made, surgical treatments include:

• Uvulopalatopharyngoplasty (UPPP)-a procedure that removes excess tissue from the uvula, palate and tonsils in the throat to widen the airway.
• Laser-assisted uvuloplasty-a surgical procedure to shorten remove the uvula and widen the airway.
• Tonsillectomy-surgery to remove the tonsils (and sometimes also the adenoids) if they are obstructing airflow.

Self-Care
Several lifestyle interventions can help reduce-or even eliminate-snoring. Here are a few:

• If you’re overweight, lose weight with diet and exercise.
• Avoid using alcohol, sleeping pills, and other sedatives-especially before bedtime. Also avoid caffeine and eating a heavy meal before bed, both of which can interfere with a good night’s sleep.
• Practice good “sleep hygiene.” Go to bed at the same time every night and wake up at the same time each morning. Keep your bedroom dark and at a comfortable temperature. Stick to relaxing activities (such as reading or taking a warm bath) before bedtime.
• Sleep on your side, rather than on your back where you’re more likely to snore. You can either buy a pillow that to keep you on your side, or sew a tennis ball into the back of your pajamas to prevent you from flipping over.
• Tilt the head of your bed up a few inches. The higher angle will help you breathe better.

Prognosis
Seeing your doctor and getting the right treatment can help reduce or even eliminate snoring. Both you-and your partner-will enjoy much more restful nights and more alert days. You may also reduce your risk of heart attack, stroke, and other conditions associated with snoring and sleep apnea.

Sources:
Knuiman M, James A, Divitini M, Bartholomew H. Longitudinal Study of Risk Factors for Habitual Snoring in a General Adult Population The Busselton Health Study. Chest. 2006;130.
Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: results from the National Sleep Foundation Sleep in America 2005 poll. Chest. 2006;130:780-786.
American Association of Oral and Maxillofacial Surgeons. “Snoring and Sleep Apnea.” http://www.aaoms.org/sleep_apnea.php.
Vilaseca I, et al. Usefulness of Uvulopalatopharyngoplasty With Genioglossus and Hyoid Advancement in the Treatment of Obstructive Sleep Apnea. Arch Otolaryngol Head Neck Surg. 2002;128:435-440.American Academy of Sleep Medicine. Snoring.http://www.sleepeducation.com/Disorder.aspx?id=26.