24 April 2019
During National Stop Snoring Week, Consultant ENT surgeon Mr F J Uddin explains the reasons why people snore and offers some advice about different treatment options that might help.
"Snoring and sleep disorders are a common problem but underdiagnosed in adults in the UK. Snoring is more common with increasing age and in men. Up to 10% of men under 30 years snore and 60% over 60 years.
Snoring has traditionally been regarded as no more than a social nuisance, and although appearing to be harmless to the snorer, is known to contribute to relationship disharmony. Snoring may progress to sleep apnoea which unlike snoring has adverse health consequences.
What causes snoring?
Snoring is due to partial obstruction of the upper airway behind the tongue whilst asleep.
A number of factors that restrict airflow through the nose or mouth can contribute to snoring - such as nasal blockage due to rhinitis, a deviated septum, nasal polyps, large adenoids; or large tonsils, a long floppy palate, a large tongue or jaw problems.
Being overweight however, is the most common and important risk factor and a neck collar size of 17 inches or more is a recognised risk factor. Recent weight gain is a common finding in ‘new snorers’.
Having alcohol in the evenings/bedtime relaxes the muscles in the throat and leads to floppiness of the upper airways.
Some medical conditions such as an underactive thyroid gland can lead to snoring.
Effects of snoring
Simple snoring is generally not harmful to the snorer themselves but can lead to embarrassment and anxiety about sleeping with friends or going on holiday. It can cause disturbance to partners and family members with resultant relationship problems.
Sleep apnoea is more serious as there are medical consequences of frequent episodes of low oxygen and gasping for breath at night, such as high blood pressure, strokes, heart disease and diabetes - and these individuals generally feel unrefreshed and excessively tired throughout the day.
Self-help for snoring
Here are my recommendations on simple lifestyle changes that should be tried first:
- Weight loss – this is vital if your BMI is above the recommended range.
- Reducing alcohol and smoking intake, particularly in the evenings. Alcohol also contributes to weight gain due its hidden calories. Smoking affects lung function and hence is indirectly associated with lower levels of oxygen in the blood.
- Lying on your side – this prevents the tongue relaxing backwards, causing partial airway blockage whilst asleep.
- Nasal breathing strips - can be of limited help if nasal blockage is the predominant issue.
When to see a doctor
If you have tried the self-help recommendations above and they have not worked, then it would be worth seeing your GP. They can refer you to an ENT surgeon who will perform a detailed examination with a telescopic camera of the inside of your nose and throat to identify the cause(s) of snoring. If it is felt that there may be sleep apnoea, a referral to a sleep clinic may be suggested to measure your oxygen levels whilst asleep.
Treatment for snoring
When the above measures have been tried and failed then other options to consider are:
- Mandibular advancement devices – these are like a gum shield and may be useful if you have a small jaw. They work by bringing the lower jaw forward and therefore open up the space behind the tongue. They can be customised through your dentist or available in various sizes over the internet.
- Surgery - This may be required to deal with nasal blockage, large tonsils or a floppy palate at the back of the throat. It is worth bearing in mind that research has shown that surgery works best in well-motivated patients who are not overweight and have tried the above self-help measures and have snoring or mild sleep apnoea only.
- Face mask at night (CPAP) - this may be required if you have moderate to severe sleep apnoea.
Don’t forget the partner
Simple measures like earplugs should not be overlooked as they may prevent your partner moving into the spare bedroom!
Is snoring different in children?
Yes, in children who are otherwise well and without underlying medical problems, the most common cause of snoring or sleep apnoea is due to large adenoids and tonsils. The most effective treatment for this is surgery to remove the large adenoids and tonsils."