Snoring

Snoring

ICD-10	R06.5
ICD-9	786.09
DiseasesDB	12260
MeSH	D012913

Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be rather loud and quite unpleasant. Generally speaking, the structures involved are the uvula and soft palate. The irregular airflow is caused by a passageway blockage and usually due to one of the following:

• Throat weakness, causing the throat to close during sleep
• Mispositioned jaw, often caused by tension in the muscles
• Fat gathering in and around the throat
• Obstruction in the nasal passageway
• The tissues at the top of airways touching each other causing vibrations
• Relaxants such as alcohol or drugs relaxing throat muscles
• Sleeping on one's back, which may result in the tongue dropping to the back of the mouth.

Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore. One survey of 5,713 Italian residents identified habitual snoring in 24% of men and 13.8% of women, rising to 60% of men and 40% of women aged 60 to 65 years; this suggests an increased susceptibility to snoring as age increases.

Impacts

Snoring is known to cause sleep deprivation to snorers and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido. It has also been suggested that it can cause significant psychological and social damage to sufferers. Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about +67% chance).

Though snoring is often considered a minor affliction, snorers can sometimes suffer severe impairment of lifestyle. The between-subjects trial by Armstrong et al. discovered a statistically significant improvement in marital relations after snoring was surgically corrected. This was confirmed by evidence from Gall et al., Cartwright and Knight and Fitzpatrick et al.

New studies associate loud "snoring" with the development of carotid artery atherosclerosis and the risk of stroke. Researchers hypothesize that loud snoring creates turbulence in carotid artery blood flow closest to the airway. Generally speaking, increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis.

Diagnosis

File:Schnarchen-abf-.ogg

Snoring...

Usually, snoring is recognized by a friend or partner who observes the patient sleeping. Besides the "noise" of snoring, more complex conditions such as sleep apnea can be consistent with the symptom of snoring. A sleep study can identify such issues. Patients can also assess their own condition to determine the likelihood of such problems based on the severity of their sleeping difficulties.

Treatment

Almost all treatments for snoring revolve around clearing the blockage in the breathing passage. This is the reason snorers are advised to lose weight (to stop fat from pressing on the throat), stop smoking (smoking weakens and clogs the throat) and sleep on their side (to prevent the tongue from blocking the throat). A number of other treatment options are also available, ranging from over-the-counter aids such as nasal strips or nose clips, lubricating sprays, and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo. However, snoring is a recognized medical problem and people who snore should always seek professional medical advice before relying on techniques that may mask symptoms (i.e. snoring) but not treat the underlying condition.

Dental appliances

Specially made dental appliances called mandibular advancement splints, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. Typically, a dentist specializing in sleep apnea dentistry is consulted. Such appliances have been proven to be effective in reducing snoring and sleep apnea in cases where the apnea is mild to moderate.Mandibular advancement splints are often tolerated much better than CPAP machines. Possible but rare side effects include gradual movement of the teeth, temporomandibular joint disorder, excess salivation and gum irritation.

Over-the-counter mandibular advancement splints provide the same benefits if fitted correctly. They are usually made from an EVA polymer and are similar in appearance to protective mouth-guards worn for sports. One disadvantage of the cheaper devices compared to the professionally fitted devices is the difficulty in setting up the correct jaw position. An over-advanced jaw results in jaw joint pain, whilst an under-advanced jaw produces no therapeutic effect. The professionally fitted devices generally incorporate an adjustment mechanism so that jaw advancement can be easily increased or decreased after fitting. To adjust the "do it yourself" appliances it is necessary to reheat them and mold them again in the desired new position. Alternatively, given the low cost, a new splint can be used.

In the United States, mandibular advancement splints are currently considered class 2 medical devices and cannot be legally sold without a prescription. Americans are, however, allowed to purchase these devices outside the United States and import them for personal use. In Australia, manufacturers can obtain approval from the TGA (Therapeutic Goods Administration) allowing the devices to be sold via normal retail channels without the involvement of a doctor.

Positive airway pressure

Main article: Positive airway pressure

A continuous positive airway pressure (CPAP) machine is often used to control sleep apnea and the snoring associated with it. To keep the airway open, a shoebox-sized device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.

Surgery

Surgery is also available as a method of correcting social snoring. Some procedures, such as uvulopalatopharyngoplasty, attempt to widen the airway by removing tissues in the back of the throat, including the uvula and pharynx. These surgeries are quite invasive, however, and there are risks of adverse side effects. The most dangerous risk is that enough scar tissue could form within the throat as a result of the incisions to make the airway more narrow than it was prior to surgery, diminishing the airspace in the velopharynx. Scarring is an individual trait, so it is difficult for a surgeon to predict how much a person might be predisposed to scarring. Some patients have reported the development of severe sleep apnea as a result of damage to their airway caused by pharnygeal surgery. Currently, the American Medical Association does not approve of the use of lasers to perform operations on the pharynx or uvula.

Radiofrequency ablation (RFA) is a relatively new surgical treatment for snoring. This treatment applies radiofrequency energy and heat (between 77°C to 85°C) to the soft tissue at the back of the throat, such as the soft palate and uvula, causing scarring of the tissue beneath the skin. After healing, this results in stiffening of the treated area. The procedure takes less than one hour, is usually performed on an outpatient basis, and usually requires several treatment sessions. Radiofrequency ablation is frequently effective in reducing the severity of snoring, but, often does not completely eliminate snoring.

Bipolar radiofrequency ablation, a technique used for coblation tonsillectomy, is also used for the treatment of snoring.

The Pillar Procedure is a relatively new treatment for obstructive sleep apnea and snoring. In the procedure, three small fibrous strips are inserted into the soft palate. After this brief and painless outpatient operation, which usually lasts no more than an hour, the soft palate is more rigid and snoring and apnea are reduced.

Pharmacological treatment

A combination of pseudoephedrine and domperidone shows excellent results (about 95%) in the treatment of severe snoring. The preparation is sold over the counter in some countries.

Natural remedies

There are various natural methods alleged to alleviate snoring. These can be in the form of herbal pills, acupressure devices or specialized acupuncture.

Change of bed position – There are occasions wherein snoring is the result of wrong sleeping position. Sometimes, sleeping with too many pillows can stretch and narrow the air passage. Use one pillow to avoid it. Also, lying on the back can cause snoring. So, a change in sleeping position can be a good help.

All natural anti snoring spray are also available. These can come in over-the-counter products available at pharmacies.

Coping as partner

Earplugs may facilitate good sleep for people sharing the same bedroom with someone who snores. External earmuffs are not designed to sleep with. Other alternatives include white noise generators.

See also

• Sleep apnea
• Somniplasty

External links

• American Academy of Sleep Medicine information on snoring
• American Sleep Apnea Association
• Snoring treatment slashes heart-attack rates
• Snoring from EntNet.org
• "An escape from snoring hell", Irish Independent, August 9, 2007
• Snoring from MedlinePlus
• WebMD snoring overview
• British Snoring & Sleep Apnoea Association

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