Snoring is noisy breathing during sleep, it is the hoarse or harsh sound that occurs when your breathing is partially obstructed in some way while you’re sleeping. Some people snore infrequently and the sound they make is not particularly loud, while others may snore every night, loud enough to be heard in the next room. Snoring is affected by the stage of sleep, sleeping position, and the use of medications and alcohol, it also may be a problem for family members and sleeping partners of the snorer. Snoring also may be a sign of an underlying medical problem.
Snoring vs. Sleep Apnea
Snoring can be a symptom of obstructive sleep apnea but not everyone who snores has the sleep disorder. Obstructive sleep apnea is a serious sleep disorder that causes you to temporarily stop breathing when you are asleep. If you are regularly tired during the day even though you have had sufficient sleep or if your snoring is paired with choking or gasping sound, you may have sleep apnea. A sleep medicine physician is trained to detect and diagnose sleep apnea using an in-lab sleep study or home sleep testing. Sleep apnea is manageable using several approaches including CPAP (continuous positive airway pressure), oral appliance therapy and surgery.
Generally speaking the structures involved are the uvula and soft palate. The irregular airflow is caused by a passageway blockage and is 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 apnea.
- The tissues at the top of airways touching each other, causing vibrations.
- Relaxants such as alcohol or other drugs relaxing throat muscles.
- Sleeping on one’s back, which may result in the tongue dropping to the back of the mouth.
Depending on the cause of your snoring, your symptoms may include:
- Noise during sleep
- Excessive daytime sleepiness
- Difficulty concentrating
- Sore throat
- Restless sleep
- Gasping or choking at night
- High blood pressure
- Chest pain at night
Call your doctor if:
- Your snoring is so loud it’s disrupting your partner’s sleep
- You wake up choking or gasping
These may indicate your snoring is caused by a more serious condition, such as obstructive sleep apnea.
If your child snores, ask your pediatrician about it. Children can have obstructive sleep apnea too. Nose and throat problems such as enlarged tonsils and obesity often can narrow a child’s airway, which can lead to your child developing sleep apnea. Treating these conditions may help your child in many ways.
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 smoking because 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, oral appliances and “anti-snore” clothing and pillows, to such unusual activities as playing the didgeridoo. Specially designed laser treatments can also be utilized to reduce the inflammation and elevate the soft palate and uvula.
One style of mandibular advancement splint.
Specially made dental appliances called mandibular advancement splints, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. 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.
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 is also available as a method of correcting social snoring. Some procedures, such as uvulopalatopharyngoplasty, 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. 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 and 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, possibly reducing instances of sleep apnea and snoring. 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 conditions of the nasal airway or an enlarged tongue, it will likely need to be combined with other treatments to be more effective.
An open label non-randomized study in 30 patients found benefit from pseudoephedrine, domperidone, and the combination in the treatment of severe snoring.
There are occasions wherein snoring is the result of a wrong sleeping position. 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 help.