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Snoring

Definition

Considerations

Snoring is common in adults and is not necessarily a sign of an underlying disorder.

Sometimes, however, snoring can be a sign of a sleep disorder called sleep apnea. This means you have periods when you completely or partly stop breathing for more than 10 seconds while you sleep. The episode is followed by a sudden snort or gasp when breathing resumes. Then, snoring starts all over again. If you have sleep apnea, this cycle generally happens multiple times a night. Sleep apnea is not as common as snoring.

A doctor (or a sleep specialist) can tell if you have sleep apnea by doing a sleep study either at home or in a hospital setting.

Snoring is an important social problem. Persons who share a bed with a someone who snores can develop sleep difficulties.

Causes

In most people, the reason for snoring is not known. Some potential causes (other than sleep apnea) include:

• Being overweight, which leads to excessive neck tissue that puts pressure on the airways
• Last month of pregnancy
• Nasal congestion from colds or allergies, especially if it lasts a long time
• Swelling of the muscular part of the roof of the mouth (soft palate) or uvula, the piece of tissue that hangs down in the back of the mouth
• Swollen adenoids and tonsils that block the airways
• Use of sleeping pills, antihistamines, or alcohol at bedtime
• Prominence of the area at the base of the tongue
• Large tongue size compared to the mouth
• Abnormalities in the bones of the face

See obstructive sleep apnea for more causes.

Home Care

The following tips can help reduce snoring:

• Avoid alcohol and other sedatives at bedtime.
• Don't sleep flat on your back. Sleep on your side, if possible. Some doctors even suggest sewing a golf or tennis ball into the back of your night clothes. This causes discomfort if you roll over and helps reminds you to stay on your side. Eventually, sleeping on your side becomes a habit and you don't need to be reminded.
• Lose weight, if you are overweight.
• Try over-the-counter, drug-free nasal strips that help widen the nostrils. (These are not intended as treatments for sleep apnea.)

When to Contact a Medical Professional

Talk to your doctor if you have:

• Excessive daytime drowsiness, morning headaches, recent weight gain, awakening in the morning not feeling rested, or change in your level of attention, concentration, or memory
• Episodes of no breathing (apnea) -- your partner may need to tell you if this is happening

Children with chronic snoring should also be evaluated for apnea. Sleep apnea in children has been linked to growth problems, ADHD, poor school performance, learning difficulties, bedwetting, and high blood pressure. Most children who snore do NOT have apnea, but a sleep study is the only reliable way to tell for sure.

What to Expect at Your Office Visit

Your doctor will ask questions to evaluate your snoring and perform a physical exam, paying careful attention to your throat, mouth, and neck.

Questions may include the following (some of which your partner might have to answer):

• Is your snoring loud?
• Does it occur no matter what position you are lying in or only in certain positions?
• Does your own snoring ever wake you up?
• How often do you snore? Every night?
• Is your snoring persistent during the night?
• Are there episodes when you are not breathing?
• Do you have other symptoms like daytime drowsiness, morning headaches, insomnia, or memory loss?

Referral to a sleep specialist for sleep studies may be needed.

Treatment options include:

• Dental appliances to prevent tongue from falling back
• Weight loss
• If you have sleep apnea, use of a CPAP mask (a device you wear on the nose while sleeping to decrease snoring and sleep apnea)
• Surgical procedures on your palate
• Surgery to correct a deviated septum or remove tonsils (tonsillectomy)
• Other types of surgery involving the airway

References

Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P, Myhre KI, et al. Effects and side-effects of surgery for snoring and obstructive sleep apnea--a systematic review. Sleep. 2009;32:27-36.

Friedman M, Schalch P. Surgery of the palate and oropharynx. Otolaryngol Clin North Am. 2007 Aug;40(4):829-43.

Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007 Jul;132(1):325-37.

Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med. 2007 Apr 26;356(17):1751-8.

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