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Snoring - causes, treatment, surgery

Snoring is the sound made by air passing through narrowed airways, which causes parts of the throat or nose to vibrate. Surgery and non-surgical treatments, and lifestyle changes, aim to reduce or remove airway obstructions.

Approximately 50% of New Zealand adults will snore occasionally and approximately 25% will be habitual snorers. Snoring is more common in men than women and the severity of the snoring tends to worsen with age.

Snoring can be disruptive — both for the snorer and anyone within earshot - which means people may not get the quality, restorative sleep they require, leading to daytime sleepiness. Heavy snorers are also at greater risk of developing high blood pressure at a younger age than people who do not snore. 

What causes snoring?

When we breathe, air travels into the mouth and/or nostrils, down the throat, and into the lungs via the windpipe (trachea). On the way, the air passes the tongue, soft palate (the soft tissue at the back of the roof of the mouth), uvula (which hangs at the back of your throat), and the tonsils. 

When we sleep the normally firm muscles in the throat relax. In some people they relax so much that the airway becomes partially blocked. Then, as air is inhaled and exhaled during sleep, parts of the mouth and throat like the tongue, soft palate, uvula and tonsils can vibrate, producing distinctive snoring sounds.

The most exaggerated and potentially dangerous form of snoring is obstructive sleep apnoea (OSA). This is when snoring is interrupted by frequent episodes of totally obstructed breathing, semi-wakening, and a resumption of breathing. The effect is to reduce the quality and benefits of a good night’s sleep and has the potential to cause high blood pressure and heart rhythm abnormalities. 

There are many factors that make a person more likely to snore. These include:

  • Poor muscle tone in the tongue and throat — this can occur during stages of deep sleep. Alcohol and medications such as sleeping tablets can also cause the muscles to excessively relax
  • Nasal obstruction — this may be caused by conditions such as a cold or sinusitis, or by allergic conditions such as hay fever. Nasal obstruction may also be due to nasal polyps or a structural abnormality in the nasal passages, such as a deviated septum
  • Abnormalities of the soft palate —  which may be swollen, floppy, or excessively long
  • Being overweight — which can also make the throat bulkier and can exert extra pressure on the breathing passages
  • Smoking — which can cause the airways to become inflamed, contributing to narrowing of the airways. 

Diagnosis

A doctor should be consulted if OSA is suspected and/or if snoring is causing problems for you (such as excessive tiredness during the day) or your partner (such as keeping them awake at night or waking them up). 

A child who snores should be taken to see a doctor as their snoring may be caused by the underlying problem with their airways, such as enlarged tonsils. 

A referral to an ear, nose, and throat (ENT) specialist (otolaryngologist) may be recommended for tests and treatment. The specialist will take a full medical history and examine the nasal passages, mouth, and throat to see if the cause for the snoring can be identified. 

Tests may include:

Imaging tests — x-rays and computerised tomography (CT) or magnetic resonance imaging (MRI) scans may be done to check for structural problems in the airways, such as a deviated septum of the nose.

Nasendoscopy — a small telescope is inserted into the nasal passages allowing them to be viewed on a television monitor. This can be performed in the ENT specialist's office. The test may also be performed in an operating theatre under a light general anaesthetic in order for the specialist to assess what happens to the structures in the nasal passages and throat when the person is asleep. This is called 'sleep nasendoscopy'.

Sleep studies – an overnight assessment in a special sleep laboratory where the person is closely monitored to assess the extent of their snoring and how it affects their sleep. This test is primarily used to diagnose OSA. 

Non-surgical treatment

Treatment for snoring differs from treatment for OSA. It is therefore important to ensure that the person does not also have OSA before treatment for snoring is undertaken. 

The type of treatment or lifestyle change recommended will depend on the cause of the snoring. Treatment can be either non-surgical or surgical but surgery is usually not recommended until non-surgical treatments have been tried and proven unsuccessful. 

Lifestyle changes:

  • Maintain a healthy body weight (lose weight if overweight)
  • Exercise regularly (this can help strengthen neck muscles which reduces airway narrowing)
  • Reduce alcohol intake and avoid alcohol close to bedtime
  • Avoid taking sleeping tablets 
  • Sleep on your side rather than your back
  • Quit smoking.

Devices:

  • Nasal devices — strips or dilators designed to help open nasal passages.
  • Oral, neck, or chin devices — designed either to block airflow through the mouth to encourage nose breathing or to prevent obstruction of the airway.
  • Continuous positive airway pressure (CPAP) — a pressurised mask worn over the nose or mouth while sleeping (most often used to treat snoring caused by OSA). 

Medications

Sprays to unblock congested nasal passages may be helpful. These should be used in careful consultation with a doctor as some sprays should not be used on a long-term basis. 
Surgery options

Surgery

Various different types of surgery are used to reduce or eliminate snoring.  Some aim to remove obstructions or adjust structures in the nose, throat or jaw.  Other procedures use scarring (with a sclerosing liquid), heat (with a laser or cauterizer) or implants to firm-up or support the soft palate. 

An individual should discuss with their doctor what surgical options might be relevant to their specific situation. 

Further information and support

For further information and support about snoring or OSA, consult a doctor or contact: 

Sleep Apnoea Association of NZ Inc.
Phone: 021 344 253
Website: www.sleepapnoeanz.org.nz 

References

Joshi, A. S. (2018). Oral appliances for snoring and obstructive sleep apnea (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/869831-overview#a5 [Accessed: 12/06/2020] 
Mayo Clinic (2017). Snoring (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/snoring/symptoms-causes/syc-20377694 [Accessed: 12/06/20] 
Morgan, C. E. (2019). Surgical approach to snoring and sleep apnea (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/868770-overview [Accessed: 12/06/20] 
NHS (2017). Snoring (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/snoring/  [Accessed: 12/06/20] 


Reviewed – June 2020

 
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