Snoring: Not Funny, Not Hopeless
Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.
More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a sock that holds a tennis ball on the pajama back to force the snorer to sleep on his side. (Snoring is often worse when a person sleeps on his back). Some devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. But, if you snore, the truth is that it is not under your control whatsoever. If anti-snoring devices work, it is probably because they keep you awake.
What Causes Snoring?
The noisy sounds of snoring occur 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 (see illustration) where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.
People who snore may suffer from:
• Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep.
• Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare.
• Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse.
• Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection.
Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can aggravate the above areas of obstruction.
Is Snoring Serious?
Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness.
Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.
Obstructive Sleep Apnea
When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.
Can Heavy Snoring be Cured?
Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer's health.
Treatment
Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids. If you are found not to have significant obstructive sleep apnea, then there are a variety of options depending on your situation. All the following palatal procedures are performed in the office under local anesthesia, and are successful in 70-90% of patients. Because there are so many causes for snoring, the office examination is crucial in determining where the area of narrow occurs.
Laser Assisted Uvulo-Palatoplasty: A laser is used to vaporize the uvula and portions of the soft palate. This must be performed 2-3 times, about 4-6 weeks apart.
Injection Snoreplasty: The soft palate mucous membrane is injected with a stiffening agent. Most people need 1-3 treatments, 4-6 weeks apart.
Radiofreqeuncy Thermal Ablation (Somnoplasty): An needle electrode is placed in the muscles of the soft palate and the tissues heated gently, causing scarring and tightening. Most people need 2-3 treatments, 4-6 weeks apart.
Pillar Implants: Three thin braided polyesters rods are inserted into the soft palate. This causes an inflammatory response, eventually causing stiffening. Most people need 1 treatment. This procedure was recently FDA approved for mild obstructive sleep apnea.
For people with significant tongue collapse, a mandibular advancement device may also be a good option.
For anyone with nasal congestion, treatment is directed to the cause (allergies, deviated septum, etc.).
Children and Snoring
A chronically snoring child should be examined for problems with his or her tonsils and adenoids. Snoring children are more likely to suffer from attention deficit hyperactivity disorder, poor school performance and other behavioral issues. A tonsillectomy and adenoidectomy may be required to return the child to full health.
Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and not hopeless.
Adapted from an American Academy of Otolaryngology - Head & Neck Surgery Brochure
Steven Y. Park, M.D.
Otolaryngology – Head & Neck Surgery
(212) 315-9058
