Some 45% of adults snore at least occasionally and 25% are thought to be habitual snorers. Problem snoring is more common in males and overweight individuals, and it usually grows worse with age. More than 300 devices are registered with the US Patent and Trademark Office as cures for snoring – this suggests that there is no single solution to this difficult and common problem.
The noise of snoring occurs when there is partial obstruction to the free flow of air through the passages at the back of the mouth and nose. This is the collapsible part of the airway where the tongue and throat meet the soft palate and uvula (the fleshy structure that dangles from the palate). When these structures vibrate during breathing, the noise of snoring occurs. Therefore, people who snore have one of the following problems:
Poor muscle tone in the muscles of the tongue and throat, which allows the soft tissues to be drawn into the airway. This poor muscle tone can occur in the deep sleep stages, or if the person is too relaxed from alcohol or other drugs which cause sleepiness.
Excessive bulkiness of the tissues in the throat e.g. a large tongue in overweight individuals, elongated or bulky soft palate and uvula. Large tonsils and adenoids may cause snoring in children. Cysts or tumours can occur, but are rare.
Nasal airway obstruction – when an individual has a stuffy or blocked nose, it causes the person to mouth-breathe, which may cause the floppy tissues in the throat to collapse and narrow the airway. Causes of nasal obstruction include viral upper respiratory tract infections, sinusitis, deformities of the nose or deviations of the nasal septum (the wall that separates the 2 sides of the nose).
Snoring may be disruptive to family life. It may cause other family members sleepless nights. Snorers become unwelcome on vacations and on business trips.
Snoring may disturb sleeping patterns of the snorer himself, so that he may not sleep restfully.
Snoring may be associated with obstruction sleep apnoea (OSA) when loud snoring is interrupted by frequent episodes of totally obstructed breathing and the oxygen level falls in the bloodstream. If these episodes last over 10 seconds and occur frequently, sleep is very severely disturbed and daytime sleepiness may occur. This may occur while driving a motor vehicle, or at work. OSA is also associated with high blood pressure and an irregular heartbeat.
If OSA is suspected, you may need a referral to a sleep laboratory for a sleep study for further information.
Sleep disordered breathing is less severe than OSA as there is no apnoeaic spells but there is a degree of obstruction to the breathing and disturbed sleep.
Most snorers can be helped. In overweight adults, who are mild snorers, the following simple measures may help:
Exercise regularly – this helps to develop good muscle tone
Avoid tranquilisers, sleeping pills and antihistamines
Avoid alcoholic beverages within 3 hours of retiring for the night
Avoid heavy meals within 3 hours of retiring for the night
Establish regular sleeping patterns
Sleep on your side rather than on your back – try sewing a pocket on the pyjama back to hold a tennis ball – this may help to avoid sleeping on your back.
When snoring becomes disruptive to the snorer and/or the people around him, or if OSA is suspected, medical advice should be sought.
An examination of the nose, mouth, throat, palate and neck should be performed. Referral to a sleep laboratory may be arranged.
Treatment will depend on the diagnosis. It may be as simple as managing nasal allergies or infection, surgically correcting a nasal deformity, or removing the tonsils and adenoids. The snoring may respond best to an operation to tighten the tissues of the palate and the back of the throat e.g. excision of the uvula, or an operation called a uvulo-palato-pharyngoplasty (UPPP).
Some patients, especially those with OSA, may respond best to sleeping with a CPAP (continuous positive airway pressure) mask, which prevents the tissues in the throat from collapsing inwards. Oral splinting devices may be useful in some patients.
Every child who snores should be thoroughly examined. Most children will improve following a tonsillectomy and adenoidectomy.
Snoring is due to obstructed breathing and can sometimes indicate a serious problem.