Snoring: Not Funny, Not Hopeless

06 April 2019

By Dr Gan Tong Nee, Consultant Ear, Nose & Throat – Head & Neck Surgery

 

50% of normal adults snore occasionally, and 25% are habitual snorers.  Problem snoring is more frequent in males and overweight persons, and it usually becomes worse with age.

What Causes Snoring?

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.  This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate uvula.  Snoring occurs when these structures strike each other and vibrate during breathing.

People who snore may suffer from:

  • Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway.  This can also happen during deep sleep.
  • Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore.  Overweight people have bulky neck tissue, too.  Cysts or tumours can also cause bulk, but they are rare.
  • Long soft palate and / or uvula. A long palate narrows the opening from the nose into the throat.  As it dangles, it acts as a noisy flutter valve during relaxed breathing.  A long uvula makes matters even worse.
  • Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it.  This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results.  So, snoring is common in people who suffer from rhinitis, sinusitis or deviated nasal septum.  Also, in adult Chinese who experiences increasing snoring with nasal blockage should be checked for nose cancer (Nasopharyngeal Carcinoma).

Is Snoring Serious?

Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness.

Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest.  When snoring is severe, it can cause serious, long-term health problems including obstructive sleep apnoea.

Obstructive Sleep Apnoea (OSA)

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as OSA. Serious episodes last more than 10 seconds each and occur more than 7 times per hour. OSA patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.

The immediate effect of OSA is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.

Treatment

Treatment depends on the diagnosis. Snoring or OSA may respond to various treatments now offered by many ENT surgeons:

  • Nasal and / or sinus surgery to clear the nasal airways will markedly reduces snoring in patients with nasal obstruction.
  • Tonsillectomy and adenoidectomy must be considered first especially in a snoring child.
  • Uvulopalatopharyngoplasty ( UPPP ) is surgery for treating OSA.  It removes excessive flabby tissues in the throat and palate, and expands air passages.
  • Laser Assisted Uvula Palatoplasty ( LAUP ) treats snoring and mild OSA by vapourizing the uvula and a specified portion of the soft palate to reduce airway obstruction.
  • Radiofrequency ablation utilizes a needle electrode to emit energy to shrink excess tissue to the upper airway including the soft palate and uvula ( for snoring ), base of tongue ( for OSA ) and nasal turbinates ( for chronic nasal obstruction ).
  • Genioglossus and hyoid advancement is a surgical procedure for the treatment of OSA.  It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
  • Pillar Procedure is the latest treatment option for patient with mild to moderate snoring. (see adjacent information sheet).

If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure (CPAP).

Self-Help for the Light Snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  • Avoid tranquilizers, sleeping pills and antihistamines before bedtime.
  • Avoid alcohol for at least 4 hours and heavy meals or snacks for 3 hours before bedtime.
  • Establish regular sleeping patterns.
  • Sleep on your side rather than your back.
  • Tilt the head of your bed upwards 4 inches or sleep on 2 or 3 pillows.

Remember, snoring means obstructed breathing, and obstruction can be serious.  It’s not funny, and not hopeless.

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