Snoring is the sound of partially obstructed breathing caused by the vibration of the tissues as they collapse during the relaxing influence of sleep. Snoring is generally a danger sign that indicates a serious problem is present or that one may develop in the years to come.
Snoring occurs when the structures in the throat relax enough during sleep to cause the upper airway to narrow and partially obstruct the flow of air. As the air tries to pass through the partially collapsed airway, the throat structures vibrate causing the sound we know as snoring. Sometimes, large tonsils, a long soft palate and uvula, certain jaw formations and excess fat deposits contribute to the collapse ability of the airway.
Obstructive Sleep Apnea (OSA)
While snoring is the sound of a partially obstructed airway, Obstructive Sleep Apnea occurs when the airway completely collapses during sleep and airflow stops entirely. Since no air can be drawn into the lungs, the oxygen level in the blood drops which eventually signals the brain to partially awaken in order to stimulate the throat muscles to open and clear the obstruction. This usually happens with a loud gasp, snort or choking sensation. Once the airway is open again, breathing and sleep can resume. However, the relaxing influence of sleep affects the throat muscles as before and this process starts again and continues over and over all night. People with OSA experience disrupted sleep and periodic drops in oxygen levels each night. This is associated with cardiovascular disease and excessive daytime sleepiness. A condition known as Upper Airway Resistance Syndrome (UARS) lies midway between snoring and true OSA. People who suffer from UARS suffer many of the symptoms of OSA but don’t really have OSA.
At the very least, snoring is an obnoxious irritation! In addition, loud, continuous snoring can have significant health consequences for the bed partner.
Studies show that when snoring is treated, the bed partner’s sleep quality is improved leading to better health. Other studies demonstrate that the bed partner’s mood, daytime alertness, quality of life and personal relationship with the snoring is improved when the snoring is resolved. Research in 2003 showed that the bed partners of snorers may experience noise induced hearing loss over time.
Sleep-Disordered Breathing (snoring and obstructive sleep apnea) can be managed in several ways:
- 1. Behavior Modification
Modification of certain behaviors can help reduce the tendency of snoring and OSA but generally do not cure it in less it is very mild. These modifications include weight loss, sleeping on your side instead of your back, avoiding alcohol and sedatives later in the evening, and eliminating smoking
- 2. Positive Airway Pressure (CPAP or BiPAP)
Considered the “gold standard”, continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) work very well to manage snoring and OSA in the vast majority of people. It requires the use of an air compressor at bedside to deliver forced air into the nose via a nasal mask which keeps the breathing passages open with air pressure. However, the treatment is intrusive and cumbersome for many people and therefore rejected in a significant number of cases.
There are many surgical options to treat snoring and OSA ranging from relatively simple to very invasive and complex. Depending on the severity of the problem and the type of surgery done, the results can vary from person to person. In the hands of an experienced sleep surgeon, and with proper diagnosis, it can provide a good solution to the problem.
- 4. Oral Appliance Therapy
Oral appliances have been used since the mid-1980s to successfully manage snoring and OSA. They are very effective for many people but not everyone. Recent research and official medical practice guidelines indicate they are best utilized for mild to moderate conditions and whenever CPAP is not tolerated.
Now there is an effective way to control snoring and obstructive sleep apnea without resorting to cumbersome CPAP devices. A small device similar to an orthodontic appliance, can be an alternative to intrusive CPAP machines and, in some cases be the first choice for treatment of mild to moderate obstructive sleep apnea. In other cases, the CPAP mask can be attached to the oral appliance for enhanced comfort and stability.
Continuous Positive Airway Pressure (CPAP) is generally considered the mainstay of treatment for obstructive sleep apnea. However, in almost half of the cases where it is prescribed, it is poorly tolerated or simply rejected due to its cumbersome and intrusive nature.
Other objections may include:
- Mask leaks
- Nasal congestion
- Sinus problems
- Skin irritation