Let’s say stop to snoring

Hearing a humming sound that prevents you from sleeping?

Nope, it is not a colony of bees swarming into your bedroom … it is actually your spouse or partner. Sleep is supposed to be a time of quiet and rest. But for some of us, it can be a noisy experience. As you may have surmised, snoring is the cause of the drone of bees or even the automobile horn that you hear regularly.

And if you think I am exaggerating, well … you should know that the noise can reach 111 decibels [2]. That is the equivalent to that of a steel mill or indeed that of an automobile horn (1 metre away) [3]!

Although snoring may remind you of funny, silly cartoons, you now understand why it can be a real issue for both the snorer and the victim.

For the latter, it implies sleepless nights or retreating to a spare room.

As for the culprit, it could be a sign of sleep apnea [4], a much more serious disease where your upper airways get temporarily blocked, and you gasp for oxygen in the middle of the night.

But let’s briefly look at the causes of snoring.

Mechanism

The noise comes from soft nasopharyngeal tissues relaxing and flapping during sleep, just like sails in the wind. It is typically the vibration of the uvula, soft palate, tonsils, cheeks, and the tongue that gives rise to snoring.

The air passage, at the back of your tongue, is somewhat narrow. Air needs to circulate between your tongue, your soft palate, your uvula, and the pharyngeal wall.

As your muscles relax, this airway passage becomes even narrower and may result in snoring. Think of it as a valve.

And if it shuts down completely, the results are seismic: no more oxygen. Air can no longer enter the lungs. That is when obstructive sleep apnea (OSA) kicks in. You will be making choking sounds and gasping for air in your sleep. Now, let me hazard a guess … by now, you are probably wondering why snoring only affects some of us and not others (?)

Next.

Risk factors

Some factors increase the likelihood of a noisy sleep:

  • Your lower mandible is very posterior, and your tongue tends to occlude the airway passage.
  • You suffer from an abnormally long soft palate and/or an enlarged uvula. This can be genetic or acquired (smoking, alcohol).
  • You sleep on your back.
  • You have an especially tight airway passage due to:
    • Thickness of the base of your tongue.
    • Short neck
    • An underdeveloped lower jaw
    • Nasal obstruction due to rhinitis or a deviated nasal septum.
    • Large tonsils (especially in the case of pediatric patients).

But how often do people snore in their sleep?

Frequency

Gender matters quite a lot. And if you’re female, there is good news. Your chances of snoring are 13.8% versus 24.1% if you are a male.[5]

The bad news is that it gets worse with age, and you are worse off if you are male.

Up to 30 years of age, your chances of being a habitual snorer are 10% if you are a male versus 5% if you are a female.

But beyond 30, things change. And adult man’s likelihood of becoming a habitual snorer increases more rapidly than that of a female

So, it is no surprise that between 60 and 65 years of age, more than 60% of males and about 40% of females are habitual snorers.

However, you should take the above with a grain of salt because another study showed that women tended to underreport snoring because it is unfeminine [6].

Now, let me ask you a question … how seriously should you take your nightly “wood sawing” activity?

If you are unsure about what to say, think about this simple fact: 70-95% [7] of people with obstructive sleep apnea (OSA) snore regularly.

And OSA is no laughing matter for it is associated with numerous health effects such as:

  • Hypertension
  • Cardiac arrest
  • Depression
  • Loss of libido
  • Alzheimer’s
  • Etc.

So, if your spouse complains about your rowdy nights, consider calling your doctor.

And even more so if you are frequently tired during the day and your snoring is interrupted by intervals of no breathing and no sound.

Since you are still with us, by now, you are probably curious to know what treatments are available.

I mean, is it a problem for life, or do some solutions exist?

Treatments

If your nightly sonorous activity is not too loud, then your doctor will usually initially advise some lifestyle changes such as:

  • Losing weight. Weight loss can decrease your tongue’s thickness and improve the (partial) obstruction of the airway passage.
  • Sleeping on your side instead of your back. This prevents your tongue from sliding backward, narrowing your upper airways.
  • Avoiding alcohol, antihistamines, and tranquilizers before you doze off. These tend to relax your throat’s muscles and lead to the same effects described above.
  • Quitting smoking because it clogs and weakens your throat.

If you are hoping for a medication that could do away with your problem …

… unfortunately, there is none.

Though, pharmaceuticals can be beneficial to resolve an underlying cause such as nasal congestion or an allergic reaction.

Now, if your snoring is heavy, then lifestyle changes will not be enough.  Also, you should seek medical advice, even more so than in the case of light snoring.

Why?

Because heavy snoring may be a sign of OSA.

Your doctor will carry out a thorough examination to understand the cause(s) and see whether you suffer from OSA.

They may even require a sleep study to assess the impact on your health. Now, the good news: depending on the results, different treatment possibilities exist.

But before we talk about the approved treatments, a brief word of caution about the unofficial ones is necessary.

Treatments such as nasal sprays, nasal strips, nose clips, lubricating sprays, “anti-snore” clothing and pillows abound. But one should be wary that no scientific proof exists to support their claims.

Okay, now on to the approved treatments.

Continuous positive airway pressure (CPAP)

Continuous … what?

It is a complicated name for a simple concept. An external pump blows air down your throat via a face or a nasal mask. As you may be guessing already, this ensures that your airways stay open.

It can both reduce your snoring as well as your sleep apnea.

Mouthpieces or dental devices

A mouthpiece will protrude your lower jaw forward, thus freeing your airways. The efficacy is lower than CPAP, but the result will be the same.

How is that possible?

Nope, it is not witchcraft, it is simply that a mouthpiece is easier to use. So, your better compliance will offset its lower efficacy.

Surgery

Your doctor will consider this more invasive technique after CPAP or dental appliances.

That is unless they identify abnormal anatomical structures that prevent you from using a device and that surgery can correct.

Children are the exception. Only one out of ten children snore. But those who do often have excess tissues like tonsils and adenoids to thank. And surgery can easily put an end to this.

Though, surgery may not be needed since tonsils tend to shrink as children grow.

So, if your child:

  • Is hyperactive;
  • snores frequently and noisily;
  • gasps for air during sleep making choking sounds
  • sleeps with an open mouth

he or she may indeed be suffering from OSA.

And although a rare occurrence, OSA in children is usually treated by surgical removal of the adenoids and tonsils.

 

[1] https://www.suttonpda.com/

[2] https://www.dailymail.co.uk/news/article-1220595/Meet-grandmother-snores-111-decibels–louder-JET-plane.html

[3] https://www.industrialnoisecontrol.com/comparative-noise-examples.htm

[4] https://www.suttonpda.com/definitive-guide-sleep-apnea/

[5] http://sleepeducation.org/essentials-in-sleep/snoring/overview-and-facts

[6] http://jcsm.aasm.org/ViewAbstract.aspx?pid=31532

[7] Some epidemiological data on snoring and cardiocirculatory disturbances”. Lugaresi E., Cirignotta F., Coccoagna G. et al. (1980), Sleep 3, 221–224


Dr Joseph Salim

About Dr Joseph Salim

I work in general and cosmetic dentistry at Sutton Place Dental Associates. Always believing that all patients deserve an unsurpassed level of care, I regularly attend seminars, conferences and workshops to remain up-to-date with the latest advancements in my field, including the rapidly growing field of cosmetic dentistry. I am an active member of the American Dental Association, the Academy of General Dentistry, the American Academy of Cosmetic Dentistry, and the American College of Forensic Examiners. I have also completed several training workshops and courses in the diagnosis and treatment of sleep apnea.