Snoring

Definition

Considerations

Snoring is common in adults and usually is not an indication of an underlying disorder.

Sometimes, however, snoring can be a sign of a serious sleep disorder called sleep apnea. This means you have periods when you are not breathing for more than 10 seconds while you sleep. These periods of "apnea" are indicated by a long period of silence just after you have been snoring. They are followed by a sudden snort or gasp when breathing resumes. Then, snoring starts all over again. If you have sleep apnea, this cycle generally happens several times a night.

The major risk from this condition is stroke due to episodes when your brain is not getting enough oxygen. If sleep apnea is suspected, your doctor (or a sleep specialist) can test you for it by doing a sleep study either at home or in a hospital setting.

Common Causes

In most people, the reason for snoring is not known. The following are potential causes other than sleep apnea:

• Sleeping pills, antihistamines, or alcohol at bedtime
• Nasal congestion from colds or allergies, especially if it lasts a long time
• Enlarged adenoids and tonsils that block the airway
• Being overweight, which leads to excessive neck tissue that puts pressure on the airway
• Last month of pregnancy

Home Care

The following can reduce snoring:

• Lose weight if you are overweight.
• Cut down or eliminate alcohol and other sedatives at bedtime.
• Avoid sleeping flat on your back. Sleep on your side if possible. Some doctors even suggest sewing a golf or tennis ball into the back of your night clothes. Then, if you roll over onto your back, you are reminded to stay on your side because of the discomfort. Eventually, sleeping on your side is a habit and you don't need to be reminded.

Call your health care provider if

Call your doctor right away if you awaken at night confused. Also call your doctor if you have:

• Excessive daytime drowsiness, morning headaches, recent weight gain, awakening in the morning not feeling rested, or change in your level of attention, concentration, or memory
• Episodes of no breathing (apnea) -- your partner may need to tell you if this is happening

Children with chronic snoring should also be evaluated for apnea. Sleep apnea in children has been linked to growth problems, ADHD, poor school performance, learning difficulties, bedwetting, and high blood pressure. Most children who snore do NOT have apnea, but a sleep study is the only reliable way to tell for sure.

What to expect at your health care provider's office

Your doctor will ask questions to evaluate your snoring and perform a physical exam, paying careful attention to your throat, mouth, and neck.

Questions may include the following (some of which your partner might have to answer):

• Is your snoring loud?
• Does it occur no matter what position you are lying in or only in certain positions?
• Doesyour own snoring ever wake you up?
• How often do you snore? Every night?
• Is your snoring persistent during the night?
• Are there episodes when you are not breathing?
• Do you have other symptoms like daytime drowsiness, morning headaches, insomnia, or memory loss?

Referral to a sleep specialist for sleep studies may be needed.

Treatment options include:

• Weight loss
• Avoiding alcohol
• Use of nasal dilator strips (e.g., Breathe-rite strips)
• Dental appliances to prevent tongue from falling back
• Surgery (e.g., correction of a deviated septum)
• Palatoplasty -- stiffening of the palate using surgery or injection
• Use CPAP mask (a device you wear on the nose while sleeping to decrease snoring and sleep apnea)

References

Tung A. The Biology and Genetics of Obesity and Obstructive Sleep Apnea. Anesthesiol Clin North America. 2005; 23(3): 445-461.

Goh YH. The physiologic impact of sleep apnea on wakefulness. Otolaryngol Clin North Am. 2003; 36(3): 423-435, v.

Illustrations

Throat anatomy