Snoring - Breathing Disorders In Sleep: Sleep Disorders

Content provided by the Faculty of the Harvard Medical School

Snoring

With the onset of sleep, muscles in the airway relax and the airway narrows. Snoring occurs when the airway narrows excessively, causing turbulent airflow. This, in turn, causes the surrounding tissue to vibrate, producing noise. More than one-third of adults in one survey said they snored at least a few nights a week in the previous year.

The source of snoring depends on where in the upper airway the narrowing is. When a person's nasal passages are swollen by a cold, allergies, or a reaction to smoking, temporary snoring may occur. For someone with a deviated septum, the problem is ongoing. A particularly large uvula; enlarged tonsils, adenoids, or tongue; an elongated soft palate; or a very small jaw may also contribute to snoring.

In yet other people, the culprit may be poor muscle tone in the tissues around the upper airway. Excess fat in the neck area may reduce the width of the air passage and promote snoring. The hormones progesterone and estrogen may play a protective role; prior to menopause, women snore less than men, but snoring increases among women later in life. Many women snore late in their pregnancies, a phenomenon attributed to hormone-related swelling of airway tissues.

Although snoring is rarely life-threatening, sleep specialists take even simple snoring seriously. A person who snores heavily deserves a thorough examination of the throat, mouth, palate, tongue, and neck and may need to undergo sleep studies.

Treatments for snoring

Hundreds of devices are marketed as aids for people who wish to stop snoring or improve their nighttime breathing. Some encourage you to sleep on your side; others are dental appliances that try to keep your airway open by preventing your tongue from falling back or by moving your jaw forward. Check with your physician before investing in such a breathing device. He or she may be able to recommend simple, inexpensive ways to prevent snoring.

For example, some people snore only when lying on their backs and can be encouraged to lie on their sides by having a tennis or golf ball sewn into the back of their pajamas (which makes it uncomfortable to sleep on their backs). Others keep air passages open by raising their heads with an extra pillow or by propping up the head of the bed a few inches.

Doctors usually encourage an overweight snorer to lose weight.

It may also help to quit smoking, forgo alcohol in the evening, and avoid sleeping pills or tranquilizers, which slow breathing and decrease muscle tone.

If swollen nasal tissues are the problem, a humidifier or medication may reduce swelling. An operation may be necessary to correct a deviated septum or remove large tonsils and adenoids. In extreme cases, physicians may recommend more extensive surgery, similar to that used to treat sleep apnea.

Laser surgery. In 1990, a French physician reported successfully using a type of laser surgery, called laser-assisted uvulopalatoplasty (LAUP), to treat snoring. Some ear, nose, and throat specialists in the United States now use the procedure, which is done on an outpatient basis. In this surgery, the physician uses a carbon dioxide laser to shorten the uvula and to make small cuts in the soft palate on either side of the uvula. As these nicks heal, the surrounding tissue pulls tighter and stiffens. Because snoring results from the flapping of loose tissue at the back of the soft palate, it is less likely to occur when the tissue is smaller and stiffer. The procedure, which can be done under local anesthetic, causes little bleeding. Patients usually have a sore throat for about a week. After five weeks of healing, the treatment may be repeated if snoring persists. Three or four procedures may be needed.

LAUP is not considered an essential therapy and may not be covered by insurance. Also, while LAUP can be quite effective in stopping snoring, it has not been shown to ease apnea. In fact, undergoing this procedure can be dangerous for people with apnea because it removes the warning signal of this breathing disorder. Therefore, it's important to have sleep apnea ruled out by a physician before undergoing LAUP.

Somnoplasty. Another option for the treatment of snoring is somnoplasty, or radiofrequency tissue volume reduction, which was developed by ear, nose, and throat specialists at Stanford University. In the mid-1990s, the FDA approved this therapy as a treatment for snoring; more recently, it's become a treatment option for obstructive sleep apnea. Somnoplasty is performed on an outpatient basis using a local anesthetic. The doctor delivers 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 to achieve results. There is typically some swelling immediately following the procedure, but post-treatment pain is usually minimal and can be managed with over-the-counter painkillers.

Palatal implants. Placement of small Dacron stents in the soft palate has recently been approved for the treatment of snoring. The stents stiffen the airway wall, preventing snoring. This is done in the doctor's office under local anesthesia.

Last updated:	January 23, 2007