Snoring is mainly considered to be normal. It occurs in about 40% of the adult population. While it might be a poor predictive value of OSA due to a high prevalence in the general population, it has its principal clinical significance. It can be a marker of obstructive sleep apnea syndrome and upper airway resistance. Snoring may occur nightly or sporadically. Habitual snoring (loud snoring consistent for at least three nights per week) is often associated with some form of sleep apnea.
What Causes Snoring?
Restricted breathing puts you at risk of snoring when you sleep. It occurs when your throat relaxes and becomes narrow. This then causes the soft palate and uvula to knock against the back of your throat, causing vibration and snoring. This constant tissue vibration interferes with normal breathing function and may likely cause you to develop sleep apnea.
Snoring hinders airflow through the lungs and decreases your oxygen levels. Other conditions that cause snoring are:
Bodyweight
People who are overweight often have excess tissue around the neck and throat that blocks their breathing passages, leading to snoring. Children with enlarged tonsils or adenoids can also be more prone to snoring because these obstructions restrict regular airflow.
Alcohol and drug use
The use of alcohol, muscle relaxers, or sedatives before bedtime causes your airway and tongue to relax too much. This decreases your natural defense against airway obstruction and causes sleep apnea.
Formation of your head and neck
Snoring may be a result of the shape of structures surrounding your airway. These narrow the opening from your nose or mouth to your airway. They include enlarged tonsils, deviated nasal septum, small or recessed jaw, a large tongue, soft palate, or nasal polyps. Snoring may also be caused by an allergy or sinus infection.
Sleep position
Sleeping on your back causes more restricted airflow than when you sleep on your side or stomach. This is attributed mainly to the effect of gravity on the throat, which narrows your airway. Using a pillow that's too soft or too large may affect your sleep position and result in snoring.
Pregnancy
Pregnant women experience hormonal changes in the last few months of pregnancy. One side effect is swelling, which may cause some discomfort and make breathing more difficult when it occurs around the throat or airway. This condition can also lead to snoring due to an obstructed air passage during sleep time.
Sleep deprivation
When you don't get enough sleep your throat becomes more relaxed, swallowing becomes difficult at times, and the throat opening to it shrinks. When this happens it's harder for air to move through eventually causing snoring.
Endocrine disorders
Some hormones produced by the endocrine system interfere with breathing during sleep and cause sleep apnea. These hormones include hypothyroidism characterized by low thyroid hormone levels; acromegaly, which causes a high level of growth hormones; and hypogonadism, where testosterone is low in men.
*Other factors that contribute to snoring are age and sex. People above 50, mostly men, are more likely to snore in their sleep.
Snoring and Obstructive Sleep Apnea
Snoring is often associated with obstructive sleep apnea (OSA), but not everyone that snores has it. Therefore, it is essential to differentiate between the two and understand how they can be treated to help stop snoring.
If you suffer from sleep apnea, it means that there are periods during sleep where you stop breathing for at least 10 seconds. Hypoapneas refer to episodes of shallow breathing where the air inhaled is insufficient to meet the requirements of your body.
Sleep apnea is a sleep disorder that has two categories. These are obstructive sleep apnea and central sleep apnea. People who snore due to OSA wake up choking or gasping for air because of a physical blockage that restricts breathing.
Central sleep apnea (CSA) is characterized by pauses in breathing due to a lack of respiratory effort during sleep. Your respiratory muscles fail to activate due to poor coordination with your brain. In other words, the brain fails to send a signal to the diaphragm and muscles of your rib cage to contract and cause inhalation.
To know the severity of your sleep apnea, doctors use the Apnea-Hypopnea Index (AHI). This helps them evaluate the number of sleep apnea episodes you have every hour. People with mild symptoms of OSA experience five to 15 episodes per hour, while severe cases can experience up to 30 hourly episodes.
OSA and CSA are different but may occur at the same time during sleep. This is known as mixed sleep apnea. OSA causes significant sleep disruptions for you and your bed partner. The result of this is excessive daytime sleepiness that may affect your daily routine and quality of life.
Read more about OSA & CSA here.
When Should You See a Doctor About Snoring?
If your snoring and sleep apnea are accompanied by health-related symptoms like high blood pressure, mood disturbances, morning headaches, overweight, or daytime sleepiness, it is time to visit your doctor for a comprehensive evaluation. During the visit, your doctor will review your medical history, conduct a physical exam and discuss symptoms related to your sleep and health.
You may also be required to take your bed partner along for the appointment so that they can share their observations. If your doctor finds any evidence of OSA, they might refer you to to a sleep medicine specialist for polysomnography. This is an overnight test conducted in a laboratory to monitor your breathing during sleep.
Health Risks Associated With Snoring
When sleep is disturbed, it affects your mental, physical, emotional, and physiological health. You can no longer go about your day comfortably, and keeping up your performance becomes extremely difficult. As a result, you are often frustrated, disappointed, and under immense pressure. Daytime sleepiness and feeling tired become the order of your day. Your interpersonal relationships are affected as you become irritable and anxious, unable to work well with others.
Additionally, OSA can cause oxygen deprivation to your brain. Long-term OSA raises your blood pressure, may make your heart bigger, and cause health complications. This leads to serious health problems like increased risks of stroke, cardiovascular disease, arrhythmias, heart attack, dementia, Parkinson's disease, and other forms of neurocognitive impairment. Often, sleep apnea is accompanied by a high risk of hypertension.
According to doctors at the American Academy of Otolaryngology head and neck surgery, breathing through your mouth puts you at a health risk of bacterial growth, having a dry mouth, and burning mouth syndrome. As such, habitual snorers have higher chances of developing periodontal disease and dental cavities.
How to Reduce Snoring
A bed partner who snores at night will often keep you from a good night's sleep. The risk factors associated with this can have detrimental effects on your health. With snoring and sleep apnea, you risk relationship strain on different levels. However, a qualified medical doctor can help remedy the condition to make your night restful as it should be. For the best results, consult one who specializes in Otolaryngology.
One such remedy is Continuous positive airway pressure (CPAP) which has proven to be a highly effective treatment for people with OSA. CPAP involves the use of a machine that draws in outside air and pressurizes it. The air is channeled to your nose and mouth using a special mask to ensure proper delivery. Such therapy is only offered under the direction of an Otolaryngologist who oversees head and neck surgery.
Other ways to reduce snoring include:
Losing weight
If you started snoring after gaining weight, losing it is a great way to reduce snoring at night and regain your health. Weight gain around your neck minimizes the diameter of your throat, making it more likely to collapse and cause a vibration of tissues in your throat.
Practice good sleep hygiene
Working for long hours decreases your chances of getting quality sleep. If you're too tired and overworked, you run the risk of making audible sounds when you sleep. Research suggests that being mindful of your sleep habits can help reduce your snore and improve the quality of your rest.
Changing your sleeping position
For people who snore, changing their sleeping position helps solve the condition. Measures like keeping your head elevated and sleeping on your side go a long way in your treatment.
Avoiding alcohol and drug abuse
Avoid taking alcoholic drinks close to your bedtime. Muscle relaxants have a similar effect to alcohol, making muscles lose and obstructing the airways. Sleeping pills can also bring about deep sleep, which makes it more difficult to awaken from an apnea event.
Anti-snoring mouthpieces
Mandibular advancement and tongue-retaining devices are also practical solutions for someone who snores. Mandibular advancement devices (MADs) are prescription aids that help move your tongue and jaw forward to increase airflow and improve overall health. On the other hand, tongue-retaining devices (TRDs) keep your tongue in place to prevent it from falling back into your throat. They use suction and create a seal to prevent blocking in your airway and solve your sleep apnea.
References
Levartovsky, A., Dafna, E., Zigel, Y., & Tarasiuk, A. (2016). Breathing and snoring sound characteristics during sleep in adults. Journal of Clinical Sleep Medicine, 12(3), 375-384.
Ben-Israel, N., Tarasiuk, A., & Zigel, Y. (2012). Obstructive apnea hypopnea index estimation by analysis of nocturnal snoring signals in adults. Sleep, 35(9), 1299-1305.
Wolkove, N., Elkholy, O., Baltzan, M., & Palayew, M. (2007). Sleep and aging: 1. Sleep disorders commonly found in older people. Cmaj, 176(9), 1299-1304.
Smith, D.L., Gozal, D., Hunter, S.J. and Kheirandish-Gozal, L., 2017. Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children. Sleep medicine, 34, pp.170-178.
Izci, B., Martin, S. E., Dundas, K. C., Liston, W. A., Calder, A. A., & Douglas, N. J. (2005). Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep medicine, 6(2), 163-169.
