What causes snoring?
Snoring is caused by vibration of the soft tissues in the throat including the soft palate / uvula, enlarged tonsils, tongue, walls of the throat, and the vocal cords.
Snoring is a sign of resistance to the passage of air into the lungs and may be a sign of breathing trouble, but there can be significant obstruction without snoring, Apnea is the most dangerous consequence of the spectrum of what is called “sleep disordered breathing.”
With apnea, breathing totally stops for at least 10 seconds. With hypopnea there is significant drop in the oxygen level in the blood for 10 seconds though breathing does not stop completely. Many years of inhaling against constant resistance can progress to the more severe levels of obstruction. So while children can have apnea, even just loud breathing when asleep can eventually become very serious.
Snoring can be annoying and bothersome, but, it can also be potentially dangerous.
Even mild snoring without observed apneas maybe a sign of a problem that can be dangerous or even life threatening. It is often an indication that the person is not getting enough refreshing sleep.
We know that the average adult requires about 8 hours of quality sleep. If there is significant upper airway resistance they may not be getting enough time in REM or dream-stage sleep and even deeper stages. Without this, there is daytime sleepiness with memory loss and poor performance in school or at work. This is in addition to potentially causing serious medical problems such as heart attacks and heart failure, stroke, and high blood pressure.
How do you evaluate if someone has sleep disordered breathing?
First we take a complete history, often including a sleep questionnaire. Then we do an examination of the mouth, nose, neck, and throat to see if they have any of the medical or anatomic problems mentioned.
Often we use fiberoptic periscopes to look at the air passages for blockage and how they function when breathing. We may order a sleep study, which measures how loudly they snore, the oxygen level in the blood, heart rate, how hard they have to work to breathe, and their brainwaves to see if they are getting quality sleep.
What treatments are available?
Treatment depends on the cause and severity of the problem. For some it may be as simple as sleeping on their side rather than their back, elevating their head or using a different pillow. Eliminating sedatives or alcohol several hours before bed, stop smoking, or treating a medical condition such as allergy may be all that is necessary. If they are overweight just losing 10 to 20 pounds may make a significant difference.
If the obstruction is severe we may recommend a breathing device at night called CPAP – for continuous positive airway pressure – that blows air into the nose when they start to inhale. There are also dental devices to hold the tongue or mandible forward. Surgical options again depend on the location and severity of the problem. A tracheostomy may be literally life saving. In less severe instances we may do procedures that shorten the palate or pull the tongue forward or make the back of the tongue smaller.
However, most often for simple snoring all we need to do is to open the nasal passages and / or perform a simple office procedure to stiffen the soft palate so that it no longer vibrates against the back of the throat.
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Dr. Finerman is a member of the International Surgical Sleep Society. Founded in 2006, the society is dedicated to the education and study of sleep medicine.