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Snoring

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Snoring

Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be rather loud and quite unpleasant. The structures are usually the uvula and soft palate. The irregular airflow is caused by a 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
  • Caused by the tissues at the top of airways touching each other causing vibrations.

Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore.[1] One survey of 5713 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.[2]

Impacts

Snoring is known to cause sleep deprivation to snorers and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido.[3] It has also been suggested that it can cause significant psychological and social damage to sufferers.[4] Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about +67% chance).[5]

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.[6], Cartwright and Knight[7] and Fitzpatrick et al.[8]

New studies associate loud "snoring" with the development of carotid artery atherosclerosis[9] and the risk 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.

Diagnosis

Usually, snoring is recognized by a friend or partner who observes the patient sleeping. Besides the 'noise' of snoring, more complex conditions such as 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.

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 smoking (smoking weakens and clogs the throat) and sleep on their side (to prevent the tongue from blocking the throat).[10] A number of other treatment options are also available, ranging from over-the-counter aids like nose clips, lubricating sprays and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo[11]. 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 splints, 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.[citation needed] 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 TGA (Therapeutic Goods Administration) allowing the devices to be sold via normal retail channels without the involvement of a doctor.

Positive airway pressure

Main article: 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 shoebox-sized device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.[12]

Surgery

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. Some patients have reported the development of severe sleep apnea as a result of damage to their airway caused by pharnygeal surgery.[citation needed] 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.[13][14]

Bipolar radiofrequency ablation, a technique used for coblation tonsillectomy, is also used for the treatment of snoring.

The Pillar Procedure is a relatively new treatment for obstructive sleep apnea and snoring. In the procedure, three small fibrous stips are inserted into the soft palate. After this brief and painless outpatient operation, which usually lasts no more than an hour, the soft palate is more rigid and snoring and apnea are reduced.

Alternative approaches

Acupressure Devices

[dubious – discuss]

An acupressure device can use acupressure points along a meridean line that reaches to the little finger which the manufacturers claim allows the user to experience better breathing and sleeping conditions within 30 minutes of application.[15]

Coping as partner

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.

See also

References

  1. ^ "New Vaccine Could Cure Snoring (statistics insert)". BBC News. 2001-09-19. {{cite news}}: Check date values in: |date= (help)
  2. ^ "Some epidemiological data on snoring and cardiocirculatory disturbances". Lugaresi E., Cirignotta F., Coccoagna G. et al. (1980), Sleep 3, 221–224.
  3. ^ Luboshitzky, Rafael (March 23, 2002). "Decreased Pituitary-Gonadal Secreti". Journal of Clinical Endocrinology & Metabolism. 87 (7): 3394–3398. doi:10.1210/jc.87.7.3394. PMID 12107256. Retrieved 2007-07-03. Decreased libido is frequently reported in male patients with obstructive sleep apnea (OSA). {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ "The effect of surgery upon the quality of life in snoring patients and their partners: a between-subjects case-controlled trial". M. W. J. Armstrong, C. L. Wallace & J. Marais, Clinical Otolaryngology & Allied Sciences 24 6 Page 510. 1999-01-12]]. {{cite news}}: Check date values in: |date= (help)
  5. ^ BBC NEWS | Health | Snoring 'linked to heart disease'
  6. ^ "Quality of life in mild obstructive sleep apnea". Gall, R., Isaac, L., Kryger, M. (1993) Sleep, 16, S59 S61. 1993]]. {{cite news}}: Check date values in: |date= (help)
  7. ^ "Silent partners: the wives of sleep apneic patients". Cartwright, R.D. & Knight, S. (1987) Sleep, 10, 244 248. 1987]]. {{cite news}}: Check date values in: |date= (help)
  8. ^ "Snoring, asthma and sleep disturbance in Britain: a community-based survey". Fitzpatrick, M.F., Martin, K., Fossey, E et al. (1993) Eur. Respir. J. 69, 531 535. 1993]]. {{cite news}}: Check date values in: |date= (help)
  9. ^ Lee, SA (September 2008). "Heavy snoring as a cause of carotid artery atherosclerosis". Sleep. 31. Asoociated Professional Sleep Societies: 1207–1213. ISSN 0161-8105. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  10. ^ "BBC Health website: snoring".
  11. ^ "Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome" (PDF). British Medical Journal. 2005-12-23. {{cite news}}: Check date values in: |date= (help)
  12. ^ "Continuous Positive Airway Pressure (CPAP)". American Academy of Otolaryngology−Head and Neck Surgery. Retrieved 2007-07-02.
  13. ^ Snoring subdued with new treatment: 5/20/98
  14. ^ Radiofrequency ablation of the soft palate for snoring
  15. ^ "The Antisnor Ring - How It Works". TNZ Group. Retrieved 2009-23-03. {{cite web}}: Check date values in: |accessdate= (help)

But there is only one way to snoore, through your nose. :)

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