Have you ever thought about what
happens when your breathing is on ‘autopilot’ as you
Breathing slows, your muscles relax, and your airway narrows. Snoring occurs when the narrowing is a little too small but it may also be a sign that something more dangerous is lurking – Obstructive Sleep Apnoea (OSA). OSA is where the airway narrows so much that breathing may cease altogether, forcing you to gasp for air and temporarily wake up. It is a serious disorder with potentially grave effects on your health and quality of life. The only reliable way of distinguishing ‘simple’ snoring from OSA is with a sleep study and specialist advice. Call us on 1300 484 707 and we can assist you.
“ So Why Do I Snore ? ”
While you sleep, the muscles of your throat relax becoming narrower and floppy. If the airway narrows too much, airflow becomes turbulent instead of smooth and steady. This makes the walls of the throat begin to vibrate, generally as you breathe in, crating the characteristic sound. The narrower your airway becomes, the greater the vibration, the louder the snoring and the risk of the dangerous disorder OSA.
“ What’s Causing Me To Snore?”
Usually, it is a combination of:
Decreased muscle tone. Muscle tone decreases as we age, allowing the sides of the throat to close more easily.
Obesity. This is the biggest risk factor, since excess fat in the neck area reduces the width of the air passage.
Congestion. Nasal congestion makes you inhale harder to breathe and more difficult for air to enter the lungs. Sinus problems or allergies often are the culprits. Talk to your doctor to discuss treatment options.
Anatomical abnormalities. Anything that causes airway narrowing can lead to snoring. A deviated nasal septum, large tonsils, tongue, etc may narrow the airway. A very small or narrow jaw also may contribute to snoring. SleepMed has the facility to easily and quickly make assessment of your upper airways with nasendoscopy and nasal rhinomanometry which are often done free of charge as a part of our comprehensive workup of snoring and OSA.
Alcohol and drugs. Sedatives (often given for insomnia and anxiety) and muscle relaxants cause the throat muscles to relax more than usual, resulting in a narrow airway worsening snoring or turning simple snoring into sleep apnoea.
“ What Are The Nonsurgical Options?”
Lifestyle changes. If you are ‘big boned’, losing weight can reduces the amount of fatty tissue in the neck and throat and lead to significant improvements. Quit smoking, avoid alcohol in the evening, as well as sleeping pills.
Home solutions. If you snore only when lying on your back, sewing a tennis or golf ball into the back of your pajamas will prod you to sleep on your side. Another simple solution that helps some snorers is to elevate your head by propping up one end of the bed a few inches. You will need more than just a couple of extra pillows.
Store products. Nasal strips, which you've probably seen worn by professional athletes, consist of two flat parallel band of plastic embedded in a special adhesive pad. When placed across the nose, the bands lift the skin upward and outward, pulling open the flexible cartilage walls and widening the nasal valve. There is some evidence that they may be of marginal benefit. Mechanical dilators, usually made of plastic, are inserted just inside the nostril and push outward. Patients whose snoring originates from the mouth and throat won't benefit from these devices.
Medication. Nasal congestion can often be helped by a combination of nasal steroid spray (eg. Nasonex or Rhinocort) – use these only in consultation with your doctor. Avoid over-the-counter spray decongestants; their effect diminishes after a few days, excessive use can damage the lining of the nose, and it's easy to become dependent on them. Sometimes, humidification of the air (especially in dry areas) can help.
Dental devices. These are very effective if fitted by
an experienced, trained practitioner and quite well
tolerated by most patients. Broadly, there are 2 types: mandibular (lower jaw) advancing devices (MAS) or tongue
retaining devices (TRDs). The former are used most
often. They are like mouth guards, bringing the lower
jaw forward, thereby pulling the base of the tongue with
it and opening up the airway.
“What About Surgery?”
This option is usually reserved for when other remedies prove ineffective and severe snoring persists.
Uvulopalatopharyngoplasty (UPPP). Developed in the 1960s, UPPP was the first surgical procedure for snoring. A surgeon removes the uvula, the tonsils, and a rim of loose tissue at the edge of the soft palate. Recovery is similar to that following a tonsillectomy and you will need to stay in hospital for a few days. You usually have a very painful sore throat for a couple of weeks.
Laser-assisted uvulopalatoplasty (LAUP). This is a
more recent development and usually done on an
outpatient basis. A laser is used to shorten the uvula
and make small cuts in the soft palate. As these cuts
heal, the surrounding tissue pulls tighter and stiffens,
preventing loose tissue from flapping while you sleep.
The procedure causes little bleeding. Patients usually have a sore throat for about a week. Three or four procedures may be needed.
One important note about LAUP: it can be effective in stopping snoring, but it has not been shown to ease sleep apnea. In fact, undergoing this procedure can be dangerous for people with apnea because it removes the warning signal of this breathing disorder. So it's important to have sleep apnea ruled out by a physician before undergoing LAUP.
Somnoplasty. Developed in the mid-1990s, this FDA approved therapy for snoring involves radiofrequency waves through the tips of tiny needles inserted into the obstructive tissue to shrink it. Somnoplasty only takes a few minutes to perform and doesn't cause bleeding, but it may have to be repeated (outpatient basis) to achieve results. Although there is typically some swelling immediately following the procedure, post-treatment pain is usually minimal and can be managed with over-the-counter painkillers.
Palatal implants. (also known as the Pillar procedure). This is also FDA approved for snoring in the USA but experience is only fairly recent. Up to three matchstick-sized stiffening rods made of polyester material are implanted in the soft palate. The rods help prevent collapse of the palate, limiting obstruction of the back of the throat when a person falls asleep. It is done under local anesthesia in an office and is reversible. Sometimes the rods come out on their own, but this does not seem to cause significant discomfort. If palatal collapse is the main reason for a patient's snoring, then the procedure may improve symptoms; it has limited benefit when other anatomical problems are involved.
Other corrective surgeries. Remove large tonsils and correcting any obvioius anatomical abnormalities can help also.
If there are obvious predispositions, these should be addressed first eg. Nasal decongestion, removal of tonsils, predisposing medications. You must make sure that your snoring is not hiding a more sinister diagnosis – that of sleep apnoea so seek advice from your doctor or contact us <link> to find out more. Most over-the-counter therapies simply do not work or only work to a limited extent. Having rules out sleep apnoea, a dental device is a very well tolerated and effective treatment to consider. Surgical avenues are usually reserved for many as a last option. The major problem with surgery, is the poor long term outcomes. Most follow-up studies have found long-term success to be around 50%. Thus, whilst many have a good success initially, their snoring returns after a year or so. Palatal implants are fairly new and reliable longer term success rates not firmly established.
If you're considering surgery for snoring, a sleep specialist can review the options in greater detail and help you determine which procedure, if any, is most likely to help you. If you decide on surgery, ask your ENT specialist about their success rates, the potential risks, recovery, and the likelihood that you'll need repeat surgery later. Above all, it is essential that an evaluation is done to rule out potentially dangerous sleep apnoea before deciding on any invasive treatment for snoring.