Snoring is the one prevalent health condition that no one likes to talk about. Not infrequently, when the issue is brought up to a doctor, the first thought is to see if the person is suffering with sleep apnea, a dangerous health condition. Snoring can be caused by other issues as well. And in reality, snoring is a big deal because it affects relationships -- a spouse or a significant other is often the one who suffers and loses sleep the most.
During sleep, there is a natural relaxation of the muscles of the body. When this relaxation involves the muscles around the throat and behind the tongue, it creates a narrowing of the area and impedes the passage of air when one breathes. This causes a reverberation in the soft palate which can be quite noisy. And so the snoring begins.
The situation does get more complicated if airway phenomena affect the breathing and, specifically, the level of oxygen in the blood. This is often found in obese individuals, who are carrying excess weight that they need to “push” and breathe against.
What are the first general measures to take if you snore?
Avoid the conditions that lead to snoring
Lose weight to minimize the obstructions directly resulting from obesity
If you smoke, quit. Narrowing of the bronchi (which occurs in smokers) will only add to the resistance of the airways, causing noise (snoring) during the passage of air
If those measures are not enough, consider the following:** Change your sleep position.** Lying on your back makes it more likely that the tongue will move back and collapse into the soft palate, causing reverberations and snoring. Place an object in the back of your night shirt, like a tennis ball, or something else that will make it unpleasant to lie on your back. There are commercially available clothing items that have a solid object sewn into the back.
Open nasal passages. Nasal strips can be effective for some people (you’ve probably seen athletes using them). A hot shower before going to bed can help to clear your nasal passages, and using saltwater preparations to rinse the nose can also help to open the nasal passages.
Try using a humidifier in the bedroom, especially at night. Dry air can worsen nasal congestion or allergy symptoms.
Change pillowcases frequently. We sweat at night and sweat that accumulates at night may promote dust mites, which are small insects that cause allergies and asthma and associated breathing issues.
If you need to go beyond those recommendations, you may need to consider surgery. Procedures include:
- The Pillar Procedure: This is the placement of woven implants into the soft palate to avoid the reverberation movement.
- Radiofrequency ablation: The injection of a sclerosing-substance into the soft palate, hardening it and making it less likely to reverberate. This is done in a doctor’s office and is quite painless. The problem is that the effect typically wears off after one or two years.
- Uvulopalatopharyngoplasty (UPPP): This procedure, done in a doctor’s office, uses local anesthesia. The doctor will cut part of the soft palate and the entire uvula to make the space behind wider. Pain post-surgery usually lasts for about two weeks, and then it remits. In some instances, a change in the patient's voice has been reported.
A number of oral devices specially fitted by dentists are also available. Their purpose is to advance the mandible to promote and expand the opening behind the tongue. One such device is called the ZQuiet.
The latest option to treat snoring is a machine called the Cloud 9. Promising data on the device was presented at the American Academy of Sleep Medicine. It is a small CPAP machine that’s compact and easy to carry. It is also quiet and relatively inexpensive compared to the traditional CPAP machine, but right now, most insurance companies are not covering the cost. It provides small pressure only, which would not be sufficient to treat sleep apnea, but those levels of pressure are enough to maintain the patency (openness) of the back of the throat for a person whose snoring is not associated with sleep apnea.
When you decide to face your snoring issue, it’s usually best to start with the simplest measures and work your way through the levels of treatment, saving the more radical therapies as last options. Do remember, though, that treating your snoring will help you -- and might save a very special relationship that you treasure.
Eli Hendel, M.D. is a board-certified Internist and pulmonary specialist with board certification in Sleep Medicine. He is an Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations. His areas of expertise in private practice include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases.