Snoring – Complications, Risk Factors and Lifestyle Changes

Overview

Snoring is a common sleep-related issue that occurs when the airflow through the nose and throat is obstructed during sleep. This obstruction causes the surrounding tissues to vibrate, producing a harsh and often loud sound. The most common cause is the relaxation of muscles in the throat, tongue, and soft palate, which can narrow the airway. Factors like obesity, alcohol consumption, certain medications, and sleep position can contribute to the likelihood and severity of snoring. It not only disrupts the quality of sleep for the person affected but can also disturb their partner or others sharing the same sleeping space.

In some cases, it may be a symptom of a more serious sleep disorder called obstructive sleep apnea (OSA). OSA occurs when the airway becomes completely blocked, leading to brief pauses in breathing during sleep. This condition can have significant health implications, as it disrupts normal sleep patterns and reduces oxygen intake, potentially increasing the risk of cardiovascular problems and daytime fatigue. Treatment ranges from lifestyle changes like weight management and altering sleep positions to medical interventions such as continuous positive airway pressure (CPAP) machines, which help keep the airway open during sleep, particularly in cases of OSA.

Types of Snoring

It can be categorized into different types based on the characteristics and underlying causes. Here are some common types:

1. Nasal Snoring: This type occurs when there is a blockage or narrowing in the nasal passages. It may be caused by issues like allergies, sinus congestion, nasal polyps, or a deviated septum.
2. Mouth Snoring: Mouth snoring is characterized by the vibration of the soft tissues in the back of the mouth, including the soft palate and uvula. It often happens when the mouth falls open during sleep and can be exacerbated by factors like sleeping position and muscle relaxation.
3. Tongue Snoring: When the base of the tongue collapses backward and obstructs the airway, it can lead to tongue snoring. This type is more likely to occur in individuals with poor tongue muscle tone or certain anatomical factors.
4. Palatal Flutter: Palatal flutter snoring is a high-pitched and rhythmic snoring sound caused by the vibration of the soft palate. It is often associated with relaxation of the throat muscles during sleep.
5. Positional Snoring: Positional snoring occurs when snoring is primarily linked to a specific sleep position, such as sleeping on one’s back. In these cases, snoring may improve or worsen depending on the sleep position.
6. Mixed Snoring: Some individuals may experience a combination of the above types of snoring. For example, a person may have both nasal and mouth snoring contributing to their overall snoring problem.

It’s essential to identify the type of snoring to determine the underlying causes and appropriate treatment options. If it is severe or accompanied by other symptoms like daytime fatigue or gasping for breath during sleep, it’s essential to seek medical evaluation to rule out obstructive sleep apnea or other sleep-related disorders.

Pathophysiology

It results from the soft tissues, like the uvula, soft palate, and pharynx, vibrating in the airway while sleeping. Reduced muscle tone during sleep makes the tissues more flexible, and turbulent airflow causes complex vibratory patterns that produce the characteristic snoring sound. Though it is mainly happens during inhalation, some individuals also snore during exhalation. It can occur during oral, nasal, or both types of breathing and is often more troublesome when sleeping on the back. In children, snoring should never be overlooked as it could indicate enlarged tonsils or other airway issues. The social consequences of snoring are evident, causing embarrassment and disturbance to nearby individuals. Additionally, it can lead to relationship problems, as it may result in partners sleeping separately and feeling resentment and reduced closeness.

Prevalence of snoring

It is a prevalent sleep-related issue that affects a significant portion of the population worldwide. Its prevalence varies across different age groups and demographics. According to various studies, the overall prevalence of habitual snoring, defined as snoring occurring on most nights, ranges from 30% to 45% in adults. The incidence tends to be higher in men than women, with the prevalence in men ranging from 34% to 50%, and in women from 17% to 33%.

The prevalence tends to increase with age. It is relatively uncommon in young adults but becomes more prevalent in middle-aged and older individuals. Factors such as obesity and lifestyle habits, such as smoking and alcohol consumption, can contribute to a higher prevalence of snoring. Additionally, certain anatomical factors like nasal congestion, enlarged tonsils, and a deviated septum can also increase the likelihood of snoring in specific populations. Furthermore, it can be an important symptom of obstructive sleep apnea (OSA), a more severe sleep disorder, which affects about 2% to 9% of the adult population. Overall, it is a widespread condition that can significantly impact sleep quality and may warrant medical evaluation and intervention, particularly in cases of loud and disruptive snoring or when associated with other health issues.

Signs of Snoring

Snoring itself is often considered a symptom of an underlying issue, such as airway obstruction during sleep. However, snoring can also be associated with various symptoms and complications. Here are some common symptoms include:

• Loud and bothersome noises during sleep.
• Daytime fatigue and feeling excessively sleepy.
• Waking up with morning headaches.
• Having a dry mouth and a sore throat in the morning.
• Gasping or choking during sleep (in some cases).
• Restless sleep with frequent awakenings.
• Feeling irritable, moody, and having difficulty concentrating during the day.

Remember, snoring can be a symptom of an underlying issue like sleep apnea. If you or someone you know experiences severe or persistent snoring with these symptoms, it’s essential to consult a healthcare professional for proper evaluation and potential treatment.

Causes

It’s often hard to tell why one person snores and another one doesn’t. These are common causes are as follows:

• Later stages of pregnancy.
• Irregularly shaped bones in the face.
• Swelling of the tonsils and adenoids.
• Alcohol consumption.
• Antihistamine or sleeping pill use.
• Large base of the tongue or unusually large tongue and small mouth.
• Congestion from allergies or a cold.
• Overweight.
• Swollen areas inside the mouth (including the uvula and soft palate).

Snoring by itself when it’s not a symptom of a medical problem like sleep apnea may not pose any physical risk. But it can cause problems when sleeping in a room with your spouse or bed partner. It can affect your partner’s sleep and trigger a number of problems caused by sleep deficiency.

Complications

Frequent snoring increases your chances of experiencing:

• Drowsiness during the day
• Difficulty concentrating
• Vehicle accidents because of drowsiness
• Hypertension or high blood pressure
• Heart disease
• Stroke
• Relationship conflict
• Serious medical conditions are more likely to occur with OSA than with snoring alone

What are the risk factors?

The risk factors include:

• Older age (over 50)
• Obesity, particularly fat distributed around the neck or midriff
• Use of alcohol (a very common cause of snoring) or other sedatives
• Long-term (chronic) nasal congestion
• A small jaw or a jaw that is farther back than normal
• Menopause
• Male sex
• Pregnancy
• Abnormalities that can block airflow, such as large tonsils, a large tongue, a large soft palate, a deviated nasal septum, and nasal polyps

Snoring frequently occurs in families.

How to diagnosis snoring?

Diagnosing snoring involves a combination of medical history, physical examination, and, in some cases, sleep studies. Here’s an outline of the process:

Medical History

The healthcare provider will begin by taking a detailed medical history, including questions about the frequency and intensity of snoring, sleep patterns, daytime sleepiness, and any other symptoms that may be present. They will also inquire about lifestyle factors such as alcohol consumption, smoking, and sleeping position, as these can contribute to snoring.

Physical Examination

A physical examination of the nose, throat, and mouth may be conducted to identify any anatomical issues that could be causing or contributing to snoring. Enlarged tonsils, nasal polyps, deviated septum, or other structural abnormalities can obstruct airflow and lead to snoring.

Sleep Diary

The healthcare provider may ask the individual or their partner to keep a sleep diary for a certain period. This diary will track sleep patterns, including bedtime, wake time, and any instances of snoring or disrupted sleep.

Sleep Study (Polysomnography)

In more complex cases or when obstructive sleep apnea is suspected, a sleep study may be recommended. Polysomnography involves spending a night in a sleep clinic where various physiological parameters are monitored, such as brain activity, eye movements, muscle activity, heart rate, respiratory effort, and blood oxygen levels. This data helps to assess the severity of snoring and detect any potential underlying sleep disorders.

Once the diagnosis is confirmed, the healthcare provider can develop an appropriate treatment plan tailored to the individual’s specific needs. Treatment options may range from lifestyle modifications to medical interventions, depending on the severity and underlying causes of snoring.

How to treat snoring?

The treatment depends on the underlying cause and the severity of the condition. Here are some common treatments for snoring:

Nasal Strips and Devices

• Nasal Dilators: These small devices are inserted into the nostrils to help keep the nasal passages open during sleep, reducing nasal snoring.
• Nasal Sprays: Saline or nasal decongestant sprays can help alleviate nasal congestion and promote better airflow.

Oral Appliances

• Mandibular Advancement Devices (MAD): These are dental devices worn in the mouth during sleep to push the lower jaw and tongue slightly forward, opening the airway and reducing mouth snoring.

Continuous positive airway pressure (CPAP)

Continuous positive airway pressure (CPAP) is a treatment in which a mask is worn over the nose and/or mouth while you sleep. The mask is hooked up to a machine that delivers a continuous flow of air into the nostrils. The pressure from air flowing into the nostrils helps keep the airways open so that breathing is not impaired. Other PAP machines are also available, including the BiPAP, which has two levels of air pressure, and the VPAP for varying levels of air pressure.

Treatment for Allergies and Nasal Conditions

Treating underlying allergies, sinusitis, or nasal polyps can improve nasal airflow and alleviate snoring.

Surgery

Surgery may be needed to correct a physical problem that is causing you to snore. Surgical options include:

• Somnoplasty: A minimally invasive procedure to reduce the soft tissue in the upper airway or back of the throat
• Tonsillectomy and adenoidectomy: Removing the tonsils and/or adenoids may be needed to prevent snoring.
• Palate surgery: Your doctor may recommend removing certain tissues of the soft palate that may be obstructing your breathing.
• Upper airway stimulator: This device, called Inspire, is a treatment for people who have sleep apnea. It consists of a small pulse generator placed under the skin in the upper chest. A breathing sensor electrode that is surgically implanted on the side of the chest by the ribs detects the person’s natural breathing pattern. Another wire, leading up to the jaw, delivers mild stimulation to nerves that control airway muscles, keeping them open. A doctor can program the device from an external remote. Also, the user has a remote to turn it on before bed and turn off upon waking in the morning.

How to prevent snoring?

Mild cases may be improved with a few lifestyle changes. Maintaining a healthy weight can help your body immensely and can even help you snore less at night. Other potentially effective changes include:

• Going to sleep at the same time every night
• Sleeping on your side
• Applying nasal strips to the bridge of your nose before bed
• Treating ongoing nasal congestion
• Avoiding alcohol before bedtime
• Not eating before bedtime
• Elevating your head by 4 inches with an extra pillow

Although you can do many things to prevent mild snoring, be sure to see your doctor if you snore frequently. Controlling snoring will help you sleep better and will improve your quality of life.

Making lifestyle changes can aid in reducing snoring

Changes to your lifestyle can also remedy:

Lose weight. Losing even a little bit of weight can reduce fatty tissue in the back of the throat and decrease, or even stop, snoring.

Quit smoking. If you smoke, your chances of snoring are high. Smoking irritates the membranes in the nose and throat which can block the airways and cause snoring. While quitting is easier said than done, it can bring quick snoring relief.

Avoid alcohol, sleeping pills, and sedatives because they relax the muscles in the throat and interfere with breathing. Also talk to your doctor about any prescription medications you’re taking, as some encourage a deeper level of sleep which can make snoring worse.

Be careful what you eat before bed. Research shows that eating large meals or consuming certain foods such as dairy or soymilk right before bedtime can make snoring worse.

Exercise in general can reduce snoring, even if it doesn’t lead to weight loss. That’s because when you tone various muscles in your body, such as your arms, legs, and abs, this leads to toning the muscles in your throat, which in turn can lead to less snoring. There are also specific exercises you can do to strengthen the muscles in your throat.

Anti-snoring throat exercises

Studies show that by pronouncing certain vowel sounds and curling the tongue in specific ways, muscles in the upper respiratory tract are strengthened and therefore reduce snoring. The following exercises can help:

1. Repeat each vowel (a-e-i-o-u) out loud for three minutes a few times a day.
2. Place the tip of your tongue behind your top front teeth. Slide your tongue backwards for three minutes a day.
3. Close your mouth and purse your lips. Hold for 30 seconds.
4. With your mouth open, move your jaw to the right and hold for 30 seconds. Repeat on the left side.
5. With your mouth open, contract the muscle at the back of your throat repeatedly for 30 seconds. Tip: Look in the mirror to see the uvula (“the hanging ball”) move up and down.
6. For a more fun exercise, simply spend time singing. Singing can increase muscle control in the throat and soft palate, reducing snoring caused by slack muscles.