Introduction

Snoring is a common sleep disorder that is experienced by up to 50% of the general population. It is a noise that is caused by the partial obstruction of the upper airways leading to the vibration of tissue in the airways. Snoring is commonly associated with obstructive sleep apnea, which is a disorder that causes interrupted breathing when one is asleep. It can also be an indicator of other underlying health conditions, such as nocturnal gastroesophageal reflux, respiratory complications, cardiovascular disease, and immunological disorders. Snoring reduces people’s sleep quality as it can cause sleep disturbances to the snorer and the people around him or her. Due to sleep interruptions, snoring increases the risk of other health conditions, such as insomnia and excessive daytime sleepiness. However, there are effective treatment options that can resolve the condition either temporarily or permanently.

Symptoms of snoring

The main symptom of snoring is a harsh and loud noise made through the nose and the mouth. This noise occurs due to the difficulty in breathing caused by a partial obstruction of one’s air passageway. A snorer also experiences other unpleasant symptoms when asleep, including:

  • Gasping and choking when asleep
  • Labored breathing
  • Restless sleep
  • Elevated blood pressure
  • Nocturnal acid reflux

Individuals who experience snoring are not usually aware of the breathing difficulties that they experience in their sleep. When they wake up, they experience complications, such as a sore throat, dry mouth, and headaches.

Causes of snoring

Snoring is often caused by other underlying complications, including:

1. Obstructive sleep apnea

Snoring occurs in many people who have obstructive sleep apnea. This condition causes interruptions in breathing when asleep. The person experiences partial or complete obstruction of breathing several times during the night. The obstruction can last for up to ten seconds after which breathing resumes. However, breathing is obstructed a short while later. As a result, the individual will continually struggle to breathe and snores deeply and heavily due to the obstruction of the airways.

2. Respiratory problems

Complications in the respiratory system can cause one’s breathing to be frequently disrupted and also become heavily labored. Snoring will occur as one struggles to take breaths when asleep. Other symptoms that might accompany snoring in respiratory illnesses include wheezing and coughing. Common respiratory problems that cause snoring include asthma, bronchitis, pneumonia, sinus infections, and inflamed tonsils.

3.      Abnormal anatomical predispositions

Abnormalities in the nose and throat affect a person’s breathing when asleep. Common abnormalities that lead to snoring include:

  • Nasal polyps
  • A protruding tongue
  • Enlarged tonsils
  • A deviated nasal septum
  • Abnormal facial bones

Abnormalities can also occur due to other health complications leading to snoring. For example, respiratory infections and allergies cause the inflammation of the nose and throat, thus leading to snoring.

4. Nocturnal Gastroesophageal reflux (NGER)

This condition causes severe chest pains, due to heartburns, that are caused by the stomach acids irritating the esophagus. Individuals who have NGER have many symptoms of respiratory problems, such as labored breathing, and wheezing, that can lead to snoring.

Risk Factors of snoring

1. Age

The normal aging process increases the risk of snoring when asleep. As one ages, the throat muscles lose their integrity and traction capacity and become relaxed. The relaxed muscles can block the air passage, and this leads to snoring. In children, snoring occurs because of excess or obstructive tissues causing blockages in the throat. Some studies also show that the early gut microbiota found in children may be linked to snoring although this relationship is still under study.

2. Smoking

Smoking is associated with many respiratory complications. It irritates the delicate linings of the nose and throat causing inflammation. The inflamed membranes block air movement and this can cause snoring. Frequent smoking increases the risk and frequency of snoring. Passive smokers are also at risk of snoring. Maternal smoking has also been found to increase the risk of snoring in infants aged between 3 and 8 months.

3. Alcohol consumption

Alcohol has sedative effects on the body, thus it causes the muscles to relax. Relaxed muscles might cause a partial collapse of the airways and obstruct the passage of air. The affected individual will struggle to breathe due to the blockage and this might lead to snoring. Hence, taking alcohol before going to be bed increases the risk of snoring and worsens the condition.

4. Obesity

Obesity is a major risk factor in snoring and is associated with a large number of cases. Excess fat in the neck area obstructs the movement of air in and out of the windpipe. Additionally, layers of fat around the neck and chest may also compress the ribcage and the airway. Further, belly fat often pushes the diaphragm up. Consequently, obesity leads to labored breathing which is accompanied by snoring.

5. Sleeping position

Some sleep positions increase the possibility of snoring in some people. Sleeping on the back, for example, is known to increase snoring as it causes the base of the tongue to collapse to the throat.

6. Pregnancy

Snoring is reported in many pregnant women who did not have the problem before they were pregnant. The condition mainly occurs in the last trimester. At this stage, the uterus pushes the diaphragm up and the weight gained during the maturation of the pregnancy contribute to difficulties in breathing. Further, the pregnancy hormones can also cause inflammations in the nose. Therefore, pregnant women may experience snoring due to several conditions resulting from pregnancy.

7.      Gender

Snoring is more common in men than in women. It is hypothesized that snoring occurs more in men because they have larger upper airways than women. The muscles in the pharynx relax when a person is asleep. The gap left by the muscles is filled by the base of the tongue which might cause an obstruction and thereby lead to snoring.

Diagnosis

Snoring can be a long-lasting condition, especially if the underlying cause of the problem is not identified and treated. It is, therefore, important to identify the symptoms of the condition early on and find the right treatment. The common methods used in diagnosis include:

1. Analysis of the sleep medical history

The doctor obtains information from the individual about their sleep patterns and any sleep disorders that may have been experienced in the past. Most of the information on snoring is taken from people who live with the patient ( guardian, siblings, parents or spouse) since the affected individual is not usually aware of their snoring in most cases. Questionnaires can be used to assess a person’s sleep medical history and the responses provided will help doctors confirm the disorder.

2. Clinical examination

The doctor examines the different structures that are related to breathing. Many areas are evaluated including:

  • The tongue
  • Larynx
  • Oropharynx
  • Hypopharynx
  • Facial bones
  • Dental status
  • Mucosa

Nasal endoscopy is commonly carried out to examine the nose and sinuses. A thin flexible tube with a camera, known as an endoscope, is used to identify any problems in the nasal and sinus passages.

3. Sleep test

Individuals who make choking and gasping sounds when snoring might undergo an overnight sleep study. The sleep test is used to identify underlying sleep disorders that may be causing the snoring. A common sleep disorder that can be identified in a sleep study is obstructive sleep apnea. The sleep study can be carried out at home or in a sleep center.

Treatment

Snoring does not require treatment in most cases. However, when it affects one’s sleep quality or those around them, several treatment methods can be used including:

1.      Continuous positive airway pressure (CPAP)

CPAP is a form of a ventilator that uses air pressure to prevent the blockage of the airway. This method of treatment is used to treat obstructive sleep apnea and is also effective for treating snoring. A CPAP device, commonly in the form of a mask, delivers a constant flow of pressure into the airway through the nose and mouth as the person sleeps. The pressure keeps the airways open throughout the night, thus preventing obstructions in breathing.

2. Nasal decongestants

Congestion in the nose occurs when the blood vessels swell causing the nose to be “stuffy”.  Several medications are prescribed and can be found over the counter to reduce this congestion. They work by causing the blood vessels to vasoconstrict, thus allowing the passage of air. These medications are available in the form of sprays, inhalers, and nasal drops. The effect of nasal decongestants is usually temporary; thus they are used frequently. The common nasal decongestants include:

  • Pseudoephedrine
  • Naphazoline
  • Ephedrine
  • Propylhexdrine
  • Oxymetazoline
  • Xylometazoline

3. Surgery

In some extreme cases surgery can be carried out to modify physical attributes or abnormalities of respiratory system that cause snoring. Snoring occurs when the person has difficulty breathing through the nose due to obstructions and, therefore, opens the mouth to facilitate air passage. Hence, eliminating the obstructions can resolve snoring permanently. Several surgical procedures are used to clear obstructions in the airway, including:

Septoplasty and turbinate reduction

Abnormalities in the nose can lead to difficulty in breathing and create obstructions. Septoplasty is a surgical procedure that is used to straighten the tissues and bones in the nose to eliminate obstructions. In turbinate reduction, the size of the tissues in the nose is reduced to prevent them from blocking air movement. These two surgeries open up the airway by creating more space for air to pass. They are commonly done at the same time for maximum effectiveness in eliminating breathing obstructions.

Uvulopalatopharyngoplasty (UPPP)

This surgical procedure is carried out to open the airway and make breathing easier. It involves removing the soft tissues around the throat that may be causing obstructions. Some of the tissues that are commonly removed are the uvula, throat walls, and palate. UPPP is effective in treating snoring but it can lead to complications such as voice changes and difficulties in swallowing.

Maxillomandibular advancement (MMA)

Abnormalities in the shape and position of the jaw can lead to snoring. When the jaw occupies a large area at the back of the mouth, it blocks airways leading to difficulties in breathing and airflow, which leads to snoring. These abnormalities are fixed using the MMA surgical procedure where the upper and lower jaws are realigned and moved to create space for the airways. When the airways are open, the snoring problems becomes resolved permanently. The only downside of this method is that it can lead to facial deformities because of the change in the position of the jaws.

4. Nasal strips

Nasal strips are adhesive, plastic strips that are used to open the airways by reducing nasal airflow resistance. They are used when the size of the nostril restricts the flow of air. The skin on the nose is cleaned and dried to help with the adhesion of the strips. A nasal strip is then placed on the nose from the bridge to the end of the nose and is rubbed gently to stick to the skin. The strip adheres to the nasal valve and gradually opens the airways. It keeps the walls of the nose from collapsing when breathing. The size of the air passage increases, and the nasal walls become rigid. One is, therefore, able to breathe without struggling hence snoring is resolved. It is important to ensure that there is no wound, irritation, or sunburn on the skin before using nasal strips. Nasal strips are also non-invasive and have less complications compared to other surgical procedures.

5. Weight loss

Individuals who are overweight have an increased risk of snoring. Losing weight can reduce snoring by eliminating the fat layers around the neck that causes pressure on the airway. A person can lose weight by:

  • Exercising regularly
  • Reducing the intake of refined carbohydrates (fast foods, refined foods, junk foods, etc)
  • Eating more whole foods
  • Intermittent fasting
  • Limiting caloric intake

6. Positional therapy

The sleep position of an individual can lead to snoring. Sleeping on the back aggravates snoring in many people and, therefore, it is recommended to sleep on the side (side sleeper). Through positional therapy, a person can learn to sleep on the side, hence preventing snoring. Special types of pillows are commonly used to train one to sleep on their side. Alternatively, elevating the head using wedge pillows also helps in alleviating snoring, especially in overweight people.

Conclusion

Snoring is a common condition experienced by a large number of people. It occurs due to alterations in the airways that obstruct the movement of air. A loud noise is made through the nose and mouth, accompanied by other symptoms such as gasping, choking, labored breathing, and restless sleep. Snoring is commonly caused by blockages in the nasal and sinus passages that restrict the movement of air to and from the lungs. Underlying health conditions, such as obstructive sleep apnea and respiratory problems, can also lead to snoring. Many risk factors are linked to snoring including obesity, smoking, pregnancy, and alcohol consumption. Snoring does not require any treatment in most cases. It however, can be resolved temporarily or permanently if it disrupts one’s quality of sleep or life. Visiting the doctor for a clinical examination can help identify the underlying health condition and find the right treatment.

 

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