Snoring
Encyclopedia
Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleep
ing. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea
(OSA).
and soft palate
. The irregular airflow is caused by a passageway blockage and usually due to one of the following:
to snorers and those around them, as well as daytime drowsiness, irritability
, lack of focus
and decreased libido
. It has also been suggested that it can cause significant psychological and social damage to sufferers. Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about +67% chance).
Though snoring is often considered a minor affliction, snorers can sometimes suffer severe impairment of lifestyle. The between-subjects trial by Armstrong et al. discovered a statistically significant improvement in marital relations after snoring was surgically corrected. This was confirmed by evidence from Gall et al., Cartwright and Knight and Fitzpatrick et al.
New studies associate loud "snoring" with the development of carotid artery atherosclerosis, the risk of brain damage and of stroke
. Researchers hypothesize that loud snoring creates turbulence in carotid artery blood flow closest to the airway. Generally speaking, increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis
.
A U.S. study estimates that roughly one in every 15 Americans is affected by at least a moderate degree of sleep apnea.
can be consistent with the symptom of snoring. A sleep study
can identify such issues. Patients can also assess their own condition to determine the likelihood of such problems based on the severity of their sleeping difficulties.
(smoking weakens and clogs the throat) and sleep on their side (to prevent the tongue from blocking the throat). A number of other treatment options are also available, ranging from over-the-counter aids such as nasal sprays, nasal strips or nose clips, lubricating sprays, and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo
. However, snoring is a recognized medical problem and people who snore should always seek professional medical advice before relying on techniques that may mask symptoms (i.e. snoring) but not treat the underlying condition.
s, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. Typically, a dentist specializing in sleep apnea dentistry is consulted. Such appliances have been proven to be effective in reducing snoring and sleep apnea
in cases where the apnea
is mild to moderate . Mandibular advancement splints are often tolerated much better than CPAP
machines. Possible but rare side effects include gradual movement of the teeth, temporomandibular joint disorder
, excess salivation and gum irritation .
Over-the-counter mandibular advancement splints provide the same benefits if fitted correctly. They are usually made from an EVA polymer and are similar in appearance to protective mouth-guards worn for sports. One disadvantage of the cheaper devices compared to the professionally fitted devices is the difficulty in setting up the correct jaw position. An over-advanced jaw results in jaw joint pain, whilst an under-advanced jaw produces no therapeutic effect. The professionally fitted devices generally incorporate an adjustment mechanism so that jaw advancement can be easily increased or decreased after fitting. To adjust the "do it yourself" appliances it is necessary to reheat them and mold them again in the desired new position. Alternatively, given the low cost, a new splint can be used.
In the United States, mandibular advancement splints are currently considered class 2 medical devices and cannot be legally sold without a prescription. Americans are, however, allowed to purchase these devices outside the United States and import them for personal use. In Australia, manufacturers can obtain approval from the Therapeutic Goods Administration (TGA) allowing the devices to be sold via normal retail channels without the involvement of a doctor.
, attempt to widen the airway by removing tissues in the back of the throat, including the uvula
and pharynx
. These surgeries are quite invasive, however, and there are risks of adverse side effects. The most dangerous risk is that enough scar tissue could form within the throat as a result of the incisions to make the airway more narrow than it was prior to surgery, diminishing the airspace in the velopharynx. Scarring is an individual trait, so it is difficult for a surgeon to predict how much a person might be predisposed to scarring. Some patients have reported the development of severe sleep apnea as a result of damage to their airway caused by pharyngeal surgery. Currently, the American Medical Association
does not approve of the use of lasers to perform operations on the pharynx or uvula.
Radiofrequency ablation
(RFA) is a relatively new surgical treatment for snoring. This treatment applies radiofrequency energy and heat (between 77°C to 85°C) to the soft tissue at the back of the throat, such as the soft palate and uvula, causing scarring of the tissue beneath the skin. After healing, this results in stiffening of the treated area. The procedure takes less than one hour, is usually performed on an outpatient basis, and usually requires several treatment sessions. Radiofrequency ablation is frequently effective in reducing the severity of snoring, but, often does not completely eliminate snoring.
Bipolar radiofrequency ablation, a technique used for coblation tonsillectomy, is also used for the treatment of snoring.
and domperidone
shows excellent results (about 95%) in the treatment of severe snoring. The preparation is sold over the counter in some countries.
.
Change of bed position – There are occasions wherein snoring is the result of wrong sleeping position. Sometimes, sleeping with too many pillows can stretch and narrow the air passage. Use one pillow to avoid it. Also, lying on the back can cause snoring. So, a change in sleeping position can be a good help.
All natural anti snoring sprays are also available. These can come in over-the-counter products available at pharmacies.
Also amongst the 'natural' remedies are exercises to increase the muscle tone of the upper airway, with some evidence indicating this, and one medical practitioner noting anecdotally that professional singers seldom snore, although sufficient study of this area remains to be undertaken.
Earplugs may facilitate good sleep for people sharing the same bedroom with someone who snores. External earmuffs
are not designed to sleep with. Other alternatives include white noise
generators.
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...
ing. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea
Obstructive sleep apnea
Obstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...
(OSA).
Causes
Generally speaking the structures involved are the uvulaUvula
The palatine uvula, usually referred to as simply the uvula , is the conic projection from the posterior edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers .-Function in language:The uvula plays a role in the...
and soft palate
Soft palate
The soft palate is the soft tissue constituting the back of the roof of the mouth. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone....
. The irregular airflow is caused by a passageway blockage and usually due to one of the following:
- Throat weakness, causing the throat to close during sleep
- Mispositioned jaw, often caused by tension in the muscles
- Fat gathering in and around the throat
- Obstruction in the nasal passageway.
- Obstructive sleep apneaObstructive sleep apneaObstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...
- The tissues at the top of airways touching each other causing vibrations
- Relaxants such as alcohol or drugs relaxing throat muscles
- Sleeping on one's back, which may result in the tongue dropping to the back of the mouth.
Impact
Snoring is known to cause sleep deprivationSleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
to snorers and those around them, as well as daytime drowsiness, irritability
Irritability
Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration....
, lack of focus
Focusing
In psychotherapy-related disciples, the term focusing is used to refer to the simple matter of holding a kind of open, non-judging attention to something which is directly experienced but is not yet in words. Focusing can be used to become clear on what one feels or wants...
and decreased libido
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
. It has also been suggested that it can cause significant psychological and social damage to sufferers. Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about +67% chance).
Though snoring is often considered a minor affliction, snorers can sometimes suffer severe impairment of lifestyle. The between-subjects trial by Armstrong et al. discovered a statistically significant improvement in marital relations after snoring was surgically corrected. This was confirmed by evidence from Gall et al., Cartwright and Knight and Fitzpatrick et al.
New studies associate loud "snoring" with the development of carotid artery atherosclerosis, the risk of brain damage and of stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
. Researchers hypothesize that loud snoring creates turbulence in carotid artery blood flow closest to the airway. Generally speaking, increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
.
A U.S. study estimates that roughly one in every 15 Americans is affected by at least a moderate degree of sleep apnea.
Prevalence
Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore. One survey of 5,713 Italian residents identified habitual snoring in 24% of men and 13.8% of women, rising to 60% of men and 40% of women aged 60 to 65 years; this suggests an increased susceptibility to snoring as age increases.Diagnosis
Besides the "noise" of snoring, more complex conditions such as sleep apneaSleep apnea
Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
can be consistent with the symptom of snoring. A sleep study
Polysomnography
Polysomnography , also known as a sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG...
can identify such issues. Patients can also assess their own condition to determine the likelihood of such problems based on the severity of their sleeping difficulties.
Treatment
Almost all treatments for snoring revolve around clearing the blockage in the breathing passage. This is the reason snorers are advised to lose weight (to stop fat from pressing on the throat), stop smokingSmoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
(smoking weakens and clogs the throat) and sleep on their side (to prevent the tongue from blocking the throat). A number of other treatment options are also available, ranging from over-the-counter aids such as nasal sprays, nasal strips or nose clips, lubricating sprays, and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo
Didgeridoo
The didgeridoo is a wind instrument developed by Indigenous Australians of northern Australia around 1,500 years ago and still in widespread usage today both in Australia and around the world. It is sometimes described as a natural wooden trumpet or "drone pipe"...
. However, snoring is a recognized medical problem and people who snore should always seek professional medical advice before relying on techniques that may mask symptoms (i.e. snoring) but not treat the underlying condition.
Dental appliances
Specially made dental appliances called mandibular advancement splintMandibular advancement splint
A mandibular splint or mandibular advancement splint is a device worn in the mouth that is used to treat obstructive sleep apnea and snoring...
s, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. Typically, a dentist specializing in sleep apnea dentistry is consulted. Such appliances have been proven to be effective in reducing snoring and sleep apnea
Sleep apnea
Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
in cases where the apnea
Apnea
Apnea, apnoea, or apnœa is a term for suspension of external breathing. During apnea there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged...
is mild to moderate . Mandibular advancement splints are often tolerated much better than CPAP
CPAP
CPAP may stand for:* Continuous positive airway pressure, a particular type of ventilation therapy* The Center for Public Administration and Policy, an academic department at Virginia Tech...
machines. Possible but rare side effects include gradual movement of the teeth, temporomandibular joint disorder
Temporomandibular joint disorder
Temporomandibular joint disorder , or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment...
, excess salivation and gum irritation .
Over-the-counter mandibular advancement splints provide the same benefits if fitted correctly. They are usually made from an EVA polymer and are similar in appearance to protective mouth-guards worn for sports. One disadvantage of the cheaper devices compared to the professionally fitted devices is the difficulty in setting up the correct jaw position. An over-advanced jaw results in jaw joint pain, whilst an under-advanced jaw produces no therapeutic effect. The professionally fitted devices generally incorporate an adjustment mechanism so that jaw advancement can be easily increased or decreased after fitting. To adjust the "do it yourself" appliances it is necessary to reheat them and mold them again in the desired new position. Alternatively, given the low cost, a new splint can be used.
In the United States, mandibular advancement splints are currently considered class 2 medical devices and cannot be legally sold without a prescription. Americans are, however, allowed to purchase these devices outside the United States and import them for personal use. In Australia, manufacturers can obtain approval from the Therapeutic Goods Administration (TGA) allowing the devices to be sold via normal retail channels without the involvement of a doctor.
Positive airway pressure
A continuous positive airway pressure (CPAP) machine is often used to control sleep apnea and the snoring associated with it. To keep the airway open, a device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.Surgery
Surgery is also available as a method of correcting social snoring. Some procedures, such as uvulopalatopharyngoplastyUvulopalatopharyngoplasty
Uvulopalatopharyngoplasty is a surgical procedure used to remove tissue in the throat...
, attempt to widen the airway by removing tissues in the back of the throat, including the uvula
Uvula
The palatine uvula, usually referred to as simply the uvula , is the conic projection from the posterior edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers .-Function in language:The uvula plays a role in the...
and pharynx
Pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
. These surgeries are quite invasive, however, and there are risks of adverse side effects. The most dangerous risk is that enough scar tissue could form within the throat as a result of the incisions to make the airway more narrow than it was prior to surgery, diminishing the airspace in the velopharynx. Scarring is an individual trait, so it is difficult for a surgeon to predict how much a person might be predisposed to scarring. Some patients have reported the development of severe sleep apnea as a result of damage to their airway caused by pharyngeal surgery. Currently, the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
does not approve of the use of lasers to perform operations on the pharynx or uvula.
Radiofrequency ablation
Radiofrequency ablation
Radio frequency ablation is a medical procedure where part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from the high frequency alternating current to treat a medical disorder...
(RFA) is a relatively new surgical treatment for snoring. This treatment applies radiofrequency energy and heat (between 77°C to 85°C) to the soft tissue at the back of the throat, such as the soft palate and uvula, causing scarring of the tissue beneath the skin. After healing, this results in stiffening of the treated area. The procedure takes less than one hour, is usually performed on an outpatient basis, and usually requires several treatment sessions. Radiofrequency ablation is frequently effective in reducing the severity of snoring, but, often does not completely eliminate snoring.
Bipolar radiofrequency ablation, a technique used for coblation tonsillectomy, is also used for the treatment of snoring.
The Pillar Procedure
The Pillar Procedure is a minimally invasive treatment for snoring and obstructive sleep apnea. This procedure was FDA indicated in 2004. During this procedure, three to six+ dacron (the material used in permanent sutures) strips are inserted into the soft palate, using a modified syringe and local anesthetic. While the procedure was initially approved for the insertion of three "pillars" into the soft palate, it was found that there was a significant dosage response to more pillars, with appropriate candidates. As a result of this outpatient operation, which typically lasts no more than 30 minutes, the soft palate is more rigid and snoring, possibly reducing instances of sleep apnea. This procedure addresses one of the most common causes of snoring and sleep apnea - vibration or collapse of the soft palate (the soft part of the roof of the mouth). If there are other factors contributing to snoring or sleep apnea, such as the nasal airway or an enlarged tongue, it will likely need to be combined with other treatments to be more effective.Turbinate Coblation
Turbinate Coblation is a minimally invasive treatment for nasal obstruction caused by enlarged inferior turbinates. Inferior turbinates are normal structures of the nose. When enlarged, they can cause nasal congestion, which can contribute to snoring. Turbinate Coblation is performed in the office, using local anesthesia, and is often a component of minimally invasive snoring treatment.Pharmacological treatment
A combination of pseudoephedrinePseudoephedrine
Pseudoephedrine is a sympathomimetic drug of the phenethylamine and amphetamine chemical classes. It is used as a nasal/sinus decongestant and stimulant, or as a wakefulness-promoting agent....
and domperidone
Domperidone
Domperidone is an antidopaminergic drug, developed by Janssen Pharmaceutica, and used orally, rectally or intravenously, generally to suppress nausea and vomiting, or as a prokinetic agent...
shows excellent results (about 95%) in the treatment of severe snoring. The preparation is sold over the counter in some countries.
Natural remedies
There are various natural methods alleged to alleviate snoring. These can be in the form of herbal pills, acupressure devices or specialized acupunctureAcupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
.
Change of bed position – There are occasions wherein snoring is the result of wrong sleeping position. Sometimes, sleeping with too many pillows can stretch and narrow the air passage. Use one pillow to avoid it. Also, lying on the back can cause snoring. So, a change in sleeping position can be a good help.
All natural anti snoring sprays are also available. These can come in over-the-counter products available at pharmacies.
Also amongst the 'natural' remedies are exercises to increase the muscle tone of the upper airway, with some evidence indicating this, and one medical practitioner noting anecdotally that professional singers seldom snore, although sufficient study of this area remains to be undertaken.
Coping as partner
The bed partner of a snorer loses, on average, an hour of sleep per night. This can cause significant relationship issues, as well as health effects of sleep deficit for the partner.Earplugs may facilitate good sleep for people sharing the same bedroom with someone who snores. External earmuffs
Earmuffs
Earmuffs are objects designed to cover a person's ears for protection. They consist of a thermoplastic or metal head-band, that fits over the top of the head, and a pad at each end, to cover the external ears....
are not designed to sleep with. Other alternatives include white noise
White noise
White noise is a random signal with a flat power spectral density. In other words, the signal contains equal power within a fixed bandwidth at any center frequency...
generators.