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'''Snoring''' is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during [[breath]]ing while [[sleep]]ing. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of [[obstructive sleep apnea]] (OSA).
'''Snoring''' is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during [[breath]]ing while [[sleep]]ing. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of [[obstructive sleep apnea]] (OSA).
Stuart Powell is one of the U.Ks worst offenders keeping his long suffering girlfriend awake all night. He also uses this as an excuse for his bad memory and constant tiredness.

==Causes==
==Causes==
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:
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:

Revision as of 10:35, 25 April 2012

"Snore" redirects here. For other uses, see Snore (disambiguation).
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 loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Stuart Powell is one of the U.Ks worst offenders keeping his long suffering girlfriend awake all night. He also uses this as an excuse for his bad memory and constant tiredness.

Causes

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 drugs relaxing throat muscles.
  • Sleeping on one's back, which may result in the tongue dropping to the back of the mouth.

Impact

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.[1] It has also been suggested that it can cause significant psychological and social damage to sufferers.[2] Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about +67% chance).[3]

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.,[4] Cartwright and Knight[5] and Fitzpatrick et al.[6]

New studies associate loud "snoring" with the development of carotid artery atherosclerosis,[7] the risk of brain damage[8] and 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.

A U.S. study estimates that roughly one in every 15 Americans is affected by at least a moderate degree of sleep apnea.

Prevalence

Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore.[9] One survey of 5,713 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.[10]

Diagnosis

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).[11] 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, and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo.[12] 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 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 [13]. Mandibular advancement splints are often tolerated much better than CPAP machines.[14] Possible but rare side effects include gradual movement of the teeth, temporomandibular joint disorder, excess salivation and gum irritation [citation needed].

Over-the-counter mandibular advancement splints provide approximately the same benefits if fitted correctly.[citation needed] They are usually made from an EVA polymer and most 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 most "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.

Previously in the United States, mandibular advancement splints were considered to be class 2 medical devices and could not be legally sold without a prescription. Americans were, however, allowed to purchase these devices outside the United States and import them for personal use. In Australia, manufacturers can obtain approval from the Therapeutic Goods Administration (TGA) 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 device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.[15]

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 pharyngeal 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.[16][17]

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.[citation needed] 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.

Turbinate Coblation

Turbinate Coblation is a minimally invasive treatment for nasal obstruction caused by enlarged inferior turbinates. Inferior turbinates are normal structures of the nose. When enlarged, they can cause nasal congestion, which can contribute to snoring. Turbinate Coblation is performed in the office, using local anesthesia, and is often a component of minimally invasive snoring treatment.

Pharmacological treatment

A combination of pseudoephedrine and domperidone shows excellent results (about 95%) in the treatment of severe snoring. The preparation is sold over the counter in some countries.[18] [dead link]

Natural remedies

There are various natural methods alleged to alleviate snoring. These can be in the form of herbal pills, acupressure devices or specialized acupuncture.

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.

All-natural anti-snoring sprays are also available, as over-the-counter products available at pharmacies.

Among the 'natural' remedies are exercises to increase the muscle tone of the upper airway, [19] and one medical practitioner noting anecdotally that professional singers seldom snore,[20] but sufficient study of this area remains to be undertaken.[21]

Coping as partner

The bed partner of a snorer loses, on average, an hour of sleep per night[citation needed]. This can cause significant relationship issues, as well as health effects of sleep deficit for the 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. ^ 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)
  2. ^ "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.
  3. ^ "Snoring 'linked to heart disease'". BBC News. 2008-03-01. Retrieved 2010-05-23.
  4. ^ "Quality of life in mild obstructive sleep apnea". Gall, R., Isaac, L., Kryger, M. (1993) Sleep, 16, S59 S61. 1993.
  5. ^ "Silent partners: the wives of sleep apneic patients". Cartwright, R.D. & Knight, S. (1987) Sleep, 10, 244 248. 1987.
  6. ^ "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.
  7. ^ Lee, SA (September 2008). "Heavy snoring as a cause of carotid artery atherosclerosis". Sleep. 31 (9). Asoociated Professional Sleep Societies: 1207–1213. ISSN 0161-8105. PMC 2542975. PMID 18788645. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ "Snoring linked to brain damage". Sydney Morning Herald. 22 October 2010. Retrieved 22 October 2010.
  9. ^ "New Vaccine Could Cure Snoring (statistics insert)". BBC News. 2001-09-19.
  10. ^ "Some epidemiological data on snoring and cardiocirculatory disturbances". Lugaresi E., Cirignotta F., Coccoagna G. et al. (1980), Sleep 3, 221–224.
  11. ^ "BBC Health website: snoring".
  12. ^ "Didgeridoo playing as alternative treatment for obstructive sleep apnea syndrome" (PDF). British Medical Journal. 2005-12-23.
  13. ^ [1], Henke,Frantz AM J RESPIR CRIT CARE MED 2000;161:420–425.
  14. ^ "Comparative Study of Oral Devices for Snoring" [2], Journal of the California Assoc. Aug. 1998
  15. ^ "Continuous Positive Airway Pressure (CPAP)". American Academy of Otolaryngology−Head and Neck Surgery. Retrieved 2007-07-02.
  16. ^ Snoring subdued with new treatment: 5/20/98
  17. ^ Radiofrequency ablation of the soft palate for snoring
  18. ^ Faronkal.pd.cl
  19. ^ Pai, Irumee; Lo, Stephen; Wolf, Dennis; ajieker, Azgher (2008). "The effect of singing on snoring and daytime somnolence". Sleep and Breathing. 12 (3): 265–268. doi:10.1007/s11325-007-0159-1. PMID 18183444. Retrieved 9 January 2011Template:Inconsistent citations{{cite journal}}: CS1 maint: postscript (link)
  20. ^ Scott, Elizabeth (1995). The Natural Way to Stop Snoring. London: Orion Books. ISBN 0-7528-0067-1Template:Inconsistent citations{{cite book}}: CS1 maint: postscript (link)
  21. ^ Valbuza, J.S; de Oliveira, M.M; Conti, C.F; Prado, L.B.F; de Carvalho, L.B.C; do Prado, G.F (2008). "Methods to increase muscle tonus of upper airway to treat snoring: Systematic review" (PDF). Arq Neuropsiquiatr. 66 (3-B): 773–776. Retrieved 9 January 2011Template:Inconsistent citations{{cite journal}}: CS1 maint: postscript (link)



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