Snoring and Sleep
Snoring is noisy breathing during sleep. It is a common problem among all ages and both genders, and it affects approximately 90 million American adults — 37 million on a regular basis. Snoring may occur nightly or intermittently. Persons most at risk are males and those who are overweight, but snoring is a problem of both genders, although it is possible that women do not present with this complaint as frequently as men. Snoring usually becomes more serious as people age. It can cause disruptions to your own sleep and your bed-partner's sleep. It can lead to fragmented and un-refreshing sleep which translates into poor daytime function (tiredness and sleepiness). The two most common adverse health effects that are believed to be casually linked to snoring are daytime dysfunction and cardiovascular disease. About one-half of people who snore loudly have obstructive sleep apnea.
While you sleep, the muscles of your throat relax, your tongue falls backward, and your throat becomes narrow and "floppy." As you breathe, the walls of the throat begin to vibrate - generally when you breathe in, but also, to a lesser extent, when you breathe out. These vibrations lead to the characteristic sound of snoring. The narrower your airway becomes, the greater the vibration and the louder your snoring. Sometimes the walls of the throat collapse completely so that it is completely occluded, creating a condition called apnea (cessation of breathing). This is a serious condition which requires medical attention.
There are several factors which facilitate snoring. First, the normal aging process leads to the relaxation of the throat muscles, thus resulting in snoring. Anatomical abnormalities of the nose and throat, such as enlarged tonsils or adenoids, nasal polyps, or deviated nasal septum cause exaggerated narrowing of the throat during sleep and thus lead to snoring. Functional abnormalities (e.g. inflammation of the nose and/or throat as may occur during respiratory infection or during allergy season) will result in snoring. Sleep position, such as sleeping on your back, may lead to snoring in some people. Alcohol is a potent muscle relaxant and its ingestion in the evening will cause snoring. Muscle relaxants taken in the evening may lead to or worsen snoring in some individuals. One of the most important risk factors is obesity, and in particular having a lot of fatty tissue around the neck.
People who snore make a vibrating, rattling, noisy sound while breathing during sleep. It may be a symptom of sleep apnea. Consult your doctor if you snore and have any of the following symptoms or signs:
- Excessive daytime sleepiness
- Morning headaches
- Recent weight gain
- Awakening in the morning not feeling rested
- Awaking at night feeling confused
- Change in your level of attention, concentration, or memory
- Observed pauses in breathing during sleep
Snorers are generally unaware of their snoring, and must rely on the observations of their bed-partners. Some snorers may wake up at night choking and gasping for breath, but this occurs relatively infrequently. If you have been told that your snoring is disturbing to others, or you have some of the symptoms and signs listed above, consult your doctor. He or she will take your history, perform a physical exam and will determine whether you require a consultation with a sleep specialist and a sleep test to determine if you have sleep apnea and to see how your snoring affects your sleep quality.
Depending on the results of the sleep study, you will be presented with a series of options to treat snoring. These will generally include:
- lifestyle modification (i.e. avoidance of risk factors mentioned above, sleep position training if applicable, treatment of allergies if applicable, etc…);
- surgery (generally on the back of the throat and roof of the mouth, or the nose if applicable, using a variety of instruments including scalpel, laser, or microwaves);
- appliances (mainly oral appliances constructed by a dentist experienced in treatment of snoring and sleep apnea, but also other appliances such as nasal dilators);
- and sometimes CPAP (a continuous positive airway pressure appliance which blows room air into the back of the throat thus preventing it from collapse).
The latter method is the treatment of choice for sleep apnea. If you are diagnosed with this condition, it is imperative that you pursue treatment aggressively; untreated sleep apnea will lead to daytime dysfunction and puts you at a higher risk for vascular disease.
Your own doctor, or sleep specialist, will talk to you in detail about each of the above treatment approaches, their chances of success, possible complications, and costs. They will be able to advise you which of the above treatment approaches is the correct one for you.
People who suffer mild or occasional snoring, who wake up feeling refreshed, and function well during the day may first try the following behavioral remedies, before consulting their doctor:
- Lose weight
- Avoid tranquilizers, sleeping pills, and antihistamines before bedtime
- Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring
- Establish regular sleeping patterns
- Sleep on your side rather than your back
The National Sleep Foundation's 2002 Sleep in America Poll revealed that 37% of adults report they had snored at least a few nights a week during the previous year. In fact, 27% said that they snore every night or almost every night. Males were more likely than females to report snoring at least a few nights a week (42% vs. 31%).
NSF's 2003 poll, which focused on older adults between the ages of 55-84, reveals that about one-third of older adults overall (32%) report they had snored at least a few nights a week in the past year, with about four in ten 55-64 year olds (41%) most likely to have said they snore compared to about one-fourth of 65-74 year olds (28%) and 75-84 year olds (22%). Men were significantly more likely than women to report snoring at least a few nights a week (40% vs. 26%).
Reviewed by Victor Hoffstein, M.D.
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