Snoring is defined as breathing during sleep with hoarse or harsh sounds as caused by the vibration of the soft palate through the open mouth and the nose when asleep.
Is Snoring Common?
It is recognized that snoring is common, occurring in about 40% of the adult population, but estimates of its prevalence in different populations vary widely. Snoring, being a perception of the listener, may be reported differently depending on who answers the question (the snorer or the bed partner), how the question is phrased, and whether the bed partner is present during the interview. People who snore can have any body type. In general, as people get older and as they gain weight the snoring will worsen.
Snoring is the most common complaint precipitating a referral to a sleep laboratory. Increased awareness of sleep apnea has resulted in a concern on the part of some snorers that they may have this disorder. Others simply wish to do something about the objectionable noise that disturbs bed partners and others in the sleep environment and to avoid the social embarrassment caused by snoring (e.g. during travel, while sharing a hotel room, during camping trips).
How Is Snoring Produced?
Snoring is a sound produced by the vibrating structures of the upper airway. When we are asleep, the area at the back of the throat sometimes narrows. The same amount of air passing through this smaller opening can cause the tissues surrounding the opening to vibrate, which in turn can cause the sounds of snoring. Different people who snore have different reasons for the narrowing. The narrowing can be in the nose, mouth or throat.
Health Effects Of Snoring
Snoring sometimes can be the only sign of a more serious problem. People who snore should be investigated to ensure that the snoring is not a sign of obstructive sleep apnea, upper airway resistance syndrome , insomnia or other sleep disorders.
How To Diagnose The Possibility Of Snoring Being Harmful?
Snoring is a symptom. The purposes of obtaining the history of and performing a physical examination on a snorer are to determine the likelihood of sleep apnea, identify the presence of risk factors associated with snoring, and identify anatomic or functional abnormalities whose correction may improve or abolish snoring, and give advice regarding treatment.
Studies of snoring have identified a number of risk factors (e.g., overweight, alcohol, allergies, nasal obstruction, muscle relaxants, smoking), but only overweight, alcohol, and perhaps nasal obstruction (e.g., during allergy season) have been shown to be causally related to snoring. If snoring has appeared recently or changed for the worse, it is important to determine whether there was a change in any of these risk factors.
The history is best obtained in the presence of the bed partner, because the snorer is not aware of snoring.
Does the snorer wake up feeling refreshed?
Is he or she tired or excessively sleepy during the day?
Is performance at work adequate?
Are there difficulties with memory, ability to concentrate, and the performance of routine tasks?
Several questionnaires that are employed in assessing patients with sleep apnea (e.g. the Epworth Scale) are also useful for determining daytime function in snorers.The Epworth Sleepiness Scale is a “test” based on a patient’s own report that establishes the severity of sleepiness. A person rates the likelihood of falling asleep during specific activities. Using the scale from 0-3 below, patients rank their risk of dozing in the chart below. (This chart can be printed out and taken to the doctor)
0 = Unlikely to fall asleep
1 = Slight risk of falling asleep
2 = Moderate risk of falling asleep
3 = High likelihood of falling asleep
|Sitting and reading|
|Sitting inactive in a public place|
|In a car, while stopped for a few minutes in traffic|
|As a passenger in a car riding for an hour, no breaks|
|Sitting and talking with someone|
|Sitting quietly after lunch, without alcohol|
|Lying down to rest in the afternoon|
A total score of 10 or more definitely needs to be investigated further for sleep disorders.
People who sleep (or lie awake not sleeping) near a snorer often report signs that may indicate a more serious problem. Witnessed apnea (stopping breathing) or gasping can suggest a breathing problem like sleep apnea (see below) or heart problems. Leg kicking or other jerking movements can indicate a problem such as restless leg syndrome or periodic limb movement disorder.
Which laboratory tests to perform is, to some extent, directed by the findings obtained. The two main investigations to be considered are assessment of the upper airway and sleep study (nocturnal polysomnography). Daytime sleepiness can be estimated with a sleepiness inventory, and a sleep study can be performed if a sleeping problem is suspected.
Treatment of snoring is generally similar to that of sleep apnea. The first decision is whether nonapneic snorers should be treated at all. This requires individual consideration in each case.Snorers with unrefreshing sleep (even in the absence of polysomnographically confirmed Upper Airway Resistance Syndrome, UARS), snorers with cardiovascular disease, and those whose snoring interferes with their bed partner’s sleep or causes embarrassment should all be provided with an appropriate therapeutic trial.
Treatment options for all sleep-related breathing disorders (sleep apnea, nonapneic asymptomatic snoring, and UARS) fall into four general categories-lifestyle modification, oral appliances, continuous positive airway pressure (CPAP) and surgery.
The best way to treat snoring is to modify the risk factors, including obesity and alcohol ingestion; body position training (if applicable in a particular case) is beneficial. Snorers should also be taught to practice good sleep hygiene.If these treatments are not possible or effective, oral appliances and continuous positive airway pressure are the noninvasive treatments of choice.
Surgeries are generally successful in reducing snoring. The success of a procedure depends on the problem area causing the snoring. For example, someone with nasal congestion will not have much improvement with a palate procedure and vice versa. The other factor that makes success hard to measure is the definition of success. The problem of snoring usually is a problem for the bed partner or roommate. Therefore, successful treatment should also include the goal of achieving a successful night’s sleep for the bed partner or roommate. This makes treatment of snoring a difficult challenge. However, when carried out by surgeons experienced in treating sleep disordered breathing, these procedures are effective in most individuals; consequently, surgical assessment of nonapneic snorers is certainly warranted.
Types of surgeries :
Nasal Surgeries –
- Radio Frequency reduction of Turbinates
- Correction of deviated nasal septum
- Removal of nasal polyps
Oral surgery options –
- Modified Cautery-Assisted Palatal Stiffening Operation CAPSO (Anterior palatoplasty)
- Radiofrequency stiffening of the soft palate
- Palatal implants
- Procedures to reduce the tongue bulk
Snoring is caused by vibration of tissues in the airways of the nose and mainly the throat. The vibrations that cause snoring are caused by turbulent airflow through narrowed airways. Snoring is affected by the stage of the sleep, posture during sleep and the use of medications and alcohol. Snoring may be a sign of underlying medical problems and thus must be investigated. The treatment modalities for snoring are non-surgical and surgical.
|Last reviewed||:||26 April 2012|
|Writer||:||Dr. Balwinder Singh a/l Saroop Singh|
|Reviewer||:||Dato’ Dr. Narizan Ariffin|