Snoring is the sound made when breathing is blocked while asleep. The sound is caused by tissue at the top of the airway that strike each other and vibrate. Snoring is very common, especially among older people and people who are overweight and is more frequent in males. Forty-five percent of normal adults snore at least occasionally and 25 percent are habitual snorers.
When the snore becomes severe, it can cause frequent awakenings through the night and cause daytime sleepiness. It can disrupt a bed partner’s sleep. Snoring can also be a sign of a serious sleep disorder called SLEEP APNEA. The physicians at Oklahoma Otolaryngology Associates can help if you are often tired during the day, don’t feel that you sleep well, or wake up gasping. Snoring may be an indication of obstructed breathing and should not be taken lightly.
Snoring occurs when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate while breathing.
Snoring children may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by the physicians at Oklahoma Otolaryngology Associates, who may, after a thorough examination, recommend a tonsillectomy and adenoidectomy to return the child to full health.
- Poor muscle tone in the tongue and throat: When muscles are too relaxed, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. Some relaxation is natural during deep sleep, but may become a problem if exacerbated by alcohol or drugs that cause sleepiness
- Excessive bulkiness of throat tissue: Children with large tonsils and adenoids often snore. Overweight people may have excess soft tissue in the neck that can lead to airway narrowing. Cysts or tumors are rare causes of airway narrowing.
- Long soft palate and/or uvula: A long palate narrows the opening from the nose into the throat. The excessive length of the soft palate and/or uvula acts as a noisy flutter valve during relaxed breathing.
- Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, and snoring results. So snoring may only occur during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.
Heavy snorers should seek medical advice to ensure that sleep apnea is not a problem. Heavy snorers include people who snore constantly in any position or who negatively impact a bed partner’s sleep. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, often using a fiberoptic scope. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction, or enlargement of tonsils and adenoids. A sleep study in a laboratory or at home may be necessary to determine if snoring is due to OSA.
All snorers with any of the following symptoms should be evaluated for possible obstructive sleep apnea:
- Witnessed episodes of breath pauses or apnea during sleep
- Daytime sleepiness or fatigue
- High blood pressure
- Heart disease
- History of a stroke
Treatment depends on the diagnosis and level(s) of upper airway narrowing. In some cases, more than one area may be involved.Snoring or OSA may respond to various treatments offered by the highly trained surgeons at Oklahoma Otolaryngology Associates.
Obstructive sleep apnea is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is called CPAP; it is currently the initial treatment of choice for patients with OSA.
Uvulopalatopharyngoplasty (UPPP) is surgery for treating snoring and obstructive sleep apnea. It removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration. The size of the air passage may be further enlarged when a tonsillectomy is added to the procedure.
Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base, and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser, and radiofrequency.
Methods to increase the stiffness of the soft palate without removing tissue include injecting an irritating substance that causes stiffness in the injected area near the uvula. Another method is inserting stiffening rods (Pillar implants) into the soft palate.
Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring.In some patients, significant weight loss can also improve snoring and OSA.
Sources: www.entnet.org; National Institute on Aging