Snoring

What is snoring?

Snoring is a sound caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway. Snoring occurs when these structures strike each other and vibrate during breathing.

When one falls sleep, the muscles in the tongue, throat and roof of the mouth relax. This muscle relaxation causes throat tissues to sag and when one breathes, these sagged tissues narrow the airway and vibrate or flutter, creating the sound of snoring.

Snoring is usually very normal and more common amongst men. It is not an indication of an underlying disorder except in case of serious sleep disorders such as sleep apnoea, which means that the obstruction is severe enough to block air entry totally for that period of time, and the person stops breathing because of it. Thus the brain and the rest of the body do not get enough oxygen. People who have snoring periods lasting more than 10 seconds have some degree of sleep apnoea and are at risk for chronic hypoxia (a condition characterised by an insufficient blood oxygen levels).

What are the causes?

A variety of factors can lead to snoring, including:

• Alcohol consumption: consuming too much of alcohol before bedtime can lead to snoring. Alcohol acts as a sedative, relaxing throat muscles.
  
• Bulkiness of throat tissue: Children with large tonsils and adenoids may snore. Overweight people may also have bulky neck tissue and often suffer from this problem. Recent weight gain is especially important in evaluating for sleep apnoea. Bulkiness may also be present due to the presence of tumours or cysts, but they are rare.
  
• Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates a vacuum in the throat, which results in snoring.
  
• Deformities of the nose or nasal septum, such as deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.
  
• Age can also be a factor as when one gets older, the throat muscles become weaker causing the surrounding tissues to sag and vibrate.

What is the diagnosis?

A physical examination and recording the medical history is done. One may also need to visit the ENT surgeon or sleep specialist for additional studies and evaluation.

What is the treatment?

Treatment depends on the underlying cause for snoring. Dental plates are available that help prevent snoring. These bring the lower jaw and the tongue forward thus opening up the air passage behind.

Treat nasal congestion or obstruction - having a deviated septum or allergies can limit airflow through the nose. This forces one to breathe through the mouth, increasing the likelihood of snoring. Don't use an oral or spray decongestant for more than three days in a row for acute congestion unless directed to do so by the doctor.

Limit or avoid alcohol and sedatives - avoid drinking alcohol at least four hours before bedtime, and let the doctor know about your snoring before taking sedatives or hypnotics. Sedatives and hypnotics (sleeping pills) and alcohol depress the central nervous system, causing excessive relaxation of muscles, including the tissues in your throat.

Continuous positive airway pressure (CPAP) - this approach involves wearing a pressurised mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway, which keeps it open. CPAP eliminates snoring and prevents sleep apnoea.

Surgery may be suggested if there is a specific nasal deformity, or if there is excessive soft tissue at the back of the throat, when an operation called Uvulopalatopharyngoplasty may be advised to open the airway.

• Laser surgery: in laser-assisted uvulopalatoplasty (LAUP), your doctor uses a small hand-held laser beam to shorten the soft palate and remove your uvula. Removing excess tissue enlarges your airway and reduces vibration.
  
• Somnoplasty: in this type of surgery, doctors use a low-intensity radio frequency signal to remove part of the soft palate to reduce snoring. It's an outpatient procedure performed using local anesthesia.

How can it be prevented?

Snoring may not get cured completely but can be prevented by following these guidelines:

• Adopt a healthy lifestyle, as people with good muscle tone are less likely to snore.
  
• Lose extra weight, if any.
  
• Avoid sleeping pills, tranquillisers and antihistamines before bedtime.
  
• Avoid alcohol for at least two to three hours before going to sleep.
  
• Establish regular sleeping patterns.
  
• Sleep on the side rather than the back.
  
• Raise the head of the bed by about four inches by stacking pillows.
  
• Treat nasal congestion and obstruction.

What are the complications?

Habitual snoring may be more than just a nuisance and a cause of daytime sleepiness. Untreated, persistent snoring caused by obstructive sleep apnoea may raise the risk of developing health problems like high blood pressure, heart failure and stroke. In children, obstructive sleep apnoea may increase the risk of attention-deficit hyperactivity disorder (ADHD).