Causes of Snoring:
Snoring is due to an obstruction to the flow of air through the passages at the back of the mouth and nose. Snoring occurs when throat structures (where the tongue and upper throat meet the soft palate and uvula) strike each other and vibrate during breathing, typically in supine position.
More likely in children, snoring may be due to enlarged tonsils and adenoids. Otolaryngology specialists would evaluate and may recommend a tonsillectomy and adenoidectomy to improve the airway.
Problems with Snoring:
- Social – Snoring can be socially disruptive, especially with a bed partner, leading to sleepless nights and general fatigue.
- Medical – Snoring can also lead to inadequate rest. This may be part of the spectrum of obstructive sleep apnea (OSA; see below), leading to more serious long-term health problems.
What is Obstructive Sleep Apnea?
Snoring may be a sign of a more serious condition known as obstructive sleep apnea (OSA). OSA is characterized by multiple episodes of breathing pauses greater than 10 seconds at a time, due to upper airway narrowing or collapse. This results in lower amounts of oxygen in the blood, which causes the heart to work harder. It also causes disruption of the natural sleep cycle, which makes people feel poorly rested despite adequate time in bed. Apnea patients may experience 30 to 300 such events per night.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep the throat muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he or she may be sleepy during the day, which impairs job performance and makes him or her a hazardous driver or equipment operator. Untreated obstructive sleep apnea increases the risk of developing heart attacks, strokes, diabetes, and many other medical problems.
Factors in Snoring and Obstructive Sleep Apnea:
- Nasal congestion/blocked nasal passages – Inhaling in through an obstructed nasal passage can lead to a vacuum pulls together the soft tissues of the throat, leading to blockage and snoring. In addition, deformities of the nose or nasal septal deviation can cause such an obstruction.
- Poor muscle tone in the tongue and throat leading to the tongue falling backwards into the airway blocking the airflow. It is well known that alcohol or drugs can lead to relaxation of these muscles.
- Obstructive throat tissue – This would include large obstructive tonsils/adenoids, or excess soft tissue in the neck from obesity, leading to airway narrowing. Other intrinsic masses or tumors can cause airway narrowing, though rare.
- Long redundant soft palate and/or uvula – The excessive length of the soft palate can flutter noisily during relaxed breathing and sleep.
Snoring and Sleep Apnea Workup:
Patients with heavy snoring leading into those with questionable obstructive sleep apnea may undergo a thorough examination with their Otolaryngologist with evaluation of the nose, mouth, throat, palate, and neck, often using a fiberoptic nasal endoscopy. Diagnoses may range from nasal allergy, infection, nasal obstruction, throat obstruction, or enlargement of tonsils and adenoids. Traditionally a sleep study is ordered to evaluate for severity of obstructive sleep apnea if present.
Medical Issues associated with snoring or possible obstructive sleep apnea:
- Witnessed episodes of breath pauses or apnea during sleep
- Daytime sleepiness or fatigue
- High blood pressure
- Heart disease
Snoring and Obstructive Sleep Apnea Treatments:
Treatment is typically broken down into nonsurgical and surgical:
- Life Style Modification – Significant weight loss can improve snoring and OSA. This is always first line therapy.
- CPAP (continuous positive airway pressure) – This is a machine that opens the airway with a small amount of positive pressure either through the nose or both the nose and mouth (mask), worn during sleep. This treatment is the gold standard for sleep apnea.
- A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA. This should be fitted by an otolaryngologist, dentist, or oral surgeon with expertise in sleep dentistry.
- Uvulopalatopharyngoplasty (UPPP) is surgery that removes excess soft palate tissue and opens the airway. This increases airflow and minimizing tissue vibration. A tonsillectomy is typically added to the procedure if they exist.
- Septoplasty/Turbinate Reduction – This is a procedure that increases the air flow capacity of the nose.
- Genioglossus and hyoid advancement – This is encompasses surgical procedures that prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.