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Shared by : – Dr. B. Bala Krishna MBBS, DNB, FCCP (CONSULTANT PULMONOLOGIST)
Snoring is the often loud or harsh sound that can occur as you sleep. You snore when the flow of air as you breathe makes the tissues in the back of your throat vibrate.
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- Snoring, at some point in their lives, is more common in men, though many women snore.
- It appears to run in families and becomes more common as you get older.
- Men become less likely to snore after the age of 70. Sleeping on your back may make you more likely to snore.
- It may also occur as your throat muscles relax from use of alcohol or other depressants.
- Congestion from a cold or allergies can also cause you to snore.
In many cases people do not realize that they snore.
A clearer understanding: Snoring vs. Sleep Apnea
Obstructive sleep apnea is a serious sleep disorder that causes you to temporarily stop breathing when you are asleep. If you are regularly tired during the day even though you have had sufficient sleep or if your snoring is paired with choking or gasping sound, you may have sleep apnea. Not everyone who snores has the sleep disorder. A sleep medicine physician is trained to detect a sleep apnea using an in-lab sleep study or home sleep testing. Sleep apnea is manageable using several approaches including CPAP (continuous positive airway pressure), oral appliance therapy and surgery.
Figure 1 – Cross-section of the back of the pharyngeal area, showing the mechanism of obstruction of the upper airway during sleep. Snoring Snoring – Causes and Symptoms Causes and Symptoms Causes and Symptoms Causes and Symptoms
Causes
Obesity, Pregnancy and Genetic Factors Extra tissue in the throat can vibrate as you breathe in air in your sleep, causing you to snore. People who are overweight or pregnant often have extra bulky throat tissue. Genetic factors that can cause snoring include extra throat tissue.
Allergies, Congestion and Certain Nasal Structures Anything that prevents you from breathing through your nose can cause you to snore. You may snore when your throat or tongue muscles are relaxed. Substances like, alcohol, muscle relaxants and other medications may cause you to snore. Normal aging and the prolonged effects of smoking can also relax your throat and tongue muscles.
The symptoms:
The symptoms of snoring may include waking up with a sore throat or dry mouth.
Clinical features of obstructive sleep apnea syndrome.
BMI: body mass index.
Obstructive Sleep Apnoea Syndrome (OSAS) is not generally recognised as a specific cause of death and therefore is not routinely reported on death certificates. The association with cardiovascular, cardiovascular and metabolic disorders implies that OSAS contributes to increased morbidity and mortality in the general population. Obesity (particularly central, BMI >30 kg•m-2) Large neck circumference (>40 cm) Small mandible, small maxilla Retrognathia (back-set jaw) Dental malocclusion, overbite Reduced nasal patency High and narrow hard palate Elongated and low-lying uvula Enlarged tonsils and adenoids Macroglossia (large tongue)
Untreated OSAS increases the rate of road traffic accidents and work-related and domestic accidents. A recent meta-analysis has shown that most medical conditions confer an increased risk of a driving accident. By contrast, OSAS was associated with a large increase in risk of a motor vehicle accident. Undiagnosed OSAS results in higher medical costs. The more severe the disease, the greater the medical cost. Prevention.
Prevention:
Targets for primary prevention are the campaigns focused on obesity, smoking and excessive alcohol consumption. Prior to diagnosis, OSAS is associated with a large number of medical complaints and with annual healthcare costs per person of 50–100% more than those for the general population. In adults, these excess costs are attributable to cardiovascular disease, digestive problems and metabolic disease. Secondary prevention includes screening patients with the above conditions for symptoms potentially related to OSAS.
Does your partner complain that you snore regularly?
Have you recently gained weight or stopped exercising?
Do you have family members that snore?
If you answered ‘yes’ to any of the above questions you either snore or are at risk for snoring. You may want to see a sleep medicine physician if you snore regularly or loudly. If you also make choking or gasping sounds as you snore, you will need to be tested for obstructive sleep apnea. In addition to a complete medical history, the physician will need to know how long you have been snoring, whether you recently gained weight or stopped exercising, any past or present drug and medication use.
A sleep medicine physician will recommend a home sleep apnea test, or in some cases an in-lab sleep study. A board-certified sleep physician is specially trained to diagnose sleep apnea. In-lab overnight sleep study This type of sleep study requires you to stay overnight at a sleep center, in a bed that may resemble a hotel room, or in some cases an actual hotel room. You will sleep with sensors hooked up to various parts of your body. These record your brain waves, heartbeat, and breathing among other things. Physicians usually recommend this test for more complicated or difficult to diagnose cases, as it is more expensive and requires you to stay overnight.
Home sleep apnea test
This type of sleep study lets you sleep in the comfort of your own home while a machine collects information. The testing equipment differs in that it is less complicated than what is used in an overnight sleep study. Sleep center staff will show you how to hook up the testing equipment yourself. After your home sleep apnea test, you can take the device back to the sleep center or send it by mail.
Management
Once OSAS is diagnosed, its treatment is relatively straightforward. Lifestyle measures, such as weight loss, alcohol consumption and smoking should be addressed. However, the commonest and most rapidly effective treatment for moderate-to-severe OSAS is with nocturnal continuous positive airway pressure (CPAP)
This is usually delivered through the upper airway using a mask over the nose, or the nose and mouth, attached by a hose to an air compressor that generates a flow of air at positive pressure throughout the breathing cycle, of sufficient magnitude to keep the upper airway open and prevent it from collapsing.
Other potential treatments include: tonsillectomy, where appropriate and especially in children; upper airway surgery in exceptional cases where significant craniofacial abnormalities are present; and bariatric surgery for those in whom severe obesity is the primary contributor to OSAS. Stimulation of the hypoglossal nerve through implanted electrodes is increasingly being trialled in patients with OSAS who fail to respond to more conventional modes of therapy, though this treatment remains very much under development. No effective pharmacological therapies are currently available. As with other forms of long-term treatment, adherence requires application of the specific treatment by trained personnel and long-term follow-up. In few other chronic medical conditions is a simple treatment so rapidly effective and cost-efficient as CPAP Lifestyle changes are effective ways of mitigating symptoms of sleep apnea.
We have enlisted some tips that may help reduce apnea severity:
- Lose weight. If you are overweight, this is the most important action you can take to cure your sleep apnea (CPAP only treats it; weight loss can cure it in the overweight person).
- Avoid alcohol; it causes frequent nighttime awakenings, and makes the upper airway breathing muscles relax.
- Quit smoking. Cigarette smoking worsens swelling in the upper airway, making apnea (and snoring) worse.
- Some patients with mild sleep apnea or heavy snoring have fewer breathing problems when they are lying on their sides instead of their backs.
