Snoring refers to the rattly noise, noticeable by others, which people might make when they breathe whilst sleeping. It is very common - the chances are extremely high that the person reading this is either a snorer him/herself, or lives with someone who is! Read on to learn why snoring happens, how it might be impacting your health and that of your sleeping partner, and what can be done about it!
The degrees of snoring!
Most people snore occasionally, especially if they are suffering from a cold, or have had a bit too much to drink before going to bed – the snoring is not usually very loud (although can still be very annoying to the sleeping partner) and, as the snorer’s breathing is unaffected, it is not usually associated with any other health problems. This is so-called Grade 1 snoring, and affects up to 40% of the population (usually in the 40-60 age group, and apparently more commonly in men - although this may be due to inaccuracies in data collection, as women are often reluctant to report their snoring to a health care professional due to embarrassment). Grade 2 snoring refers to loud snoring three or four nights a week, and Grade 3 snoring refers to very loud (audible in the next room) snoring every night of the week. Grade 2 and 3 snoring affect up to 25% of the population, and are both associated with breathing difficulties during sleep and associated health problems. It is National Stop Snoring Week from 25th-29th April 2016, so if you would like to know more about how to tackle this common and annoying problem, read on! Further details of National Stop Snoring Week can be found at www.britishsnoring.co.uk.
What causes snoring?
Snoring occurs because of vibrating of the soft tissues of the nose, mouth or throat (the “upper airways”) as air moves in and out during sleeping breathing. Snoring only occurs during sleep because the muscles of the head and neck relax, and this makes the airways narrower, and the vibrating stronger. The muscles can be relaxed yet further by drinking alcohol; or taking some sedating medications; the airways can be narrowed yet further by excess body weight; by inflammation or congestion that results from smoking, allergies and respiratory tract infections; or by anatomical blockages in the airways such as enlarged tonsils, deviated nasal septum or nasal polyps, and so on. The type of noise that the snoring makes can give a clue as to where the most likely problem in the airways might be, and how best it might be tackles – the website www.britishsnoring.co.uk has a helpful quiz which you can click through, which lets you know more about the likely cause of your own or someone else’s snoring by answering a few simple questions. Broadly speaking, nose problems tend to cause a quieter, “pinched” sounding nasal snore, whereas problems in the mouth and throat tend to cause a louder, more “guttural” sounding snore – however, there is usually more than one area of the airways that is vibrating or blocked.
Snoring and relationships
Snoring is an issue in many relationships, with up to 90% of couples reporting arguments about it. Sleeping with a grade 2 or grade 3 snorer can cause the partner to lose 10 hours’ (or even more) of sleep per week, which can lead to great resentment within the partnership. Everyone has the right to a good night’s sleep, and a loud snore can reach 90 decibels (the same volume as a food blender) – not surprisingly, this is often totally incompatible with people continuing to sleep together, and couples can end up in separate rooms for years at a time (or avoiding taking breaks away from home which would mean that they would be sharing a bed) – neither of which is likely to enhance a loving relationship. Interestingly, women are far more likely to “put up with” the snoring of a male sleeping partner than the other way round; there can be a tendency for a snorer to display some “learned helplessness” behaviour and to say something like “just nudge me when I start to snore, and I’ll turn over” – not only does this only work for a matter of moments, but it unfairly puts the burden of solving the problem firmly at the feet of the non-snoring partner. Sleeping well is crucial for mental health and well-being, and the partners or snorers who are not able to, or choose not to, escape the noise often report low mood, irritability and depression as well as poorer cognitive functioning and decision-making. Sadly, many otherwise close and loving relationships have ended because of snoring. Ultimately, snoring which interferes significantly with a relationship is a good enough reason to bring it to your doctor’s attention.
The wider implications of snoring
People with grade 2 or grade 3 snoring will not only have relationship problems to worry about, as they will also inevitably suffer from breathing difficulties during their sleep. This not only leads to excessive daytime sleepiness (which can be extremely dangerous, especially if driving/operating machinery – for an assessment of your daytime sleepiness, visit the British Lung Foundation website and click on the Epworth Sleepiness Scale link) but also the mental health problems listed above. In addition, people with grade 3 snoring may often suffer from Obstructive Sleep Apnoea (OSA) whereby the narrowing of the airways becomes so pronounced that breathing actually stops for around 10 seconds or so. During this period of not breathing (apnoea), the snorer’s blood oxygen levels drop to a much lower level than normal. This causes the snorer to wake with a start, or a choking/snorting sound, only to fall asleep once more and for the cycle to start all over again. OSA sufferers are often unaware of their recurrent night-time waking, which can occur hundreds of times every night, but never really get a proper night’s sleep. This would be bad enough if daytime sleepiness and relationship problems were the only associated issues, but people with OSA are at higher risk of high blood pressure and associated strokes, heart attacks and abnormal heart rhythms than the rest of the population; they also suffer more with headaches. If you snore and have excessive daytime sleepiness, or you care about someone who seems to fit the above description, please see your GP.
How to reduce or stop snoring
There are many strategies which may be employed to help even grade 1 snorers (and their partners). The first things to tackle are those obvious lifestyle issues which can make all the difference, but which require effort on the part of the snorer. Losing weight, stopping smoking and cutting right back on alcohol may sound like kill-joy pieces of advice, but can sort most of the problem out for many snorers, and must be addressed. Exercise to strengthen the neck muscles can also help to prevent airway collapse, and singing may also help (many opera singers have the sort of body shape which would normally be associated with snoring, and yet don’t snore, raising the possibility that a highly toned upper airway may help to prevent it). It is definitely worth checking with your GP that none of your prescribed medications is responsible for sedation at night, and your GP can likewise prescribe nasal sprays/decongestants/antihistamines which may help those with allergies or other causes of reversible congestion. The old wives’ tales of gargling with garlic, or pinching a snorer’s big toes at night, are unlikely to help; however, sewing a tennis ball into a pocket on the back of the pyjamas, so the sleeping person is forced to sleep on his/her back or side, might work – also, many a relationship has been salvaged by the purchase of high quality earplugs (try beeswax ones) or white noise machines so that the partner is unaware of the noise of snoring (beware that you are still able to hear children crying, or smoke alarms, however!).
Grade 2 and grade 3 snorers may need more help than this. Mechanical devices such as nasal strips/dilators can be applied to the nose at night, which pull/push the nostrils open respectively – this can be helpful for people whose snoring is predominantly nasal. Conversely, chin strips or vestibular shields can be used to force nose breathing at night by holding the mouth shut or blocking the mouth, for those people whose snoring predominantly comes from the mouth. Mandibular advancement devices (MADs) push the jaw and tongue forward to reduce narrowing of this part of the airway; these can be bought for about £50, but for grade 3 snorers it is recommended that a bespoke device be made to the unique shape of the mouth and jaw using impressions taken by a specialist orthodontist (these can cost thousands of pounds).
Surgery for snoring
Ultimately, and as a last resort, if all the above have been tried and have not worked, surgical treatment of snoring is a possibility. It must be noted, however, that surgery will only be carried out on the NHS if snoring has been proven to be having a detrimental effect on the patient’s life, and that the snoring is of a sort that can be helped by anatomical correction - not all snoring will be helped by surgery. Snoring surgery is performed to open up the airways and/or to prevent collapse; sometimes, this is as comparatively simple as removing an enlarged set of tonsils (particularly in children, who may also need their adenoids removed). There are also specific snoring surgical operations which can be done to help – these are not to be taken lightly, as they are often uncomfortable to recover from. One such operation, UPPP (uvulopalatopharyngoplasty) involves the removal, under general anaesthetic, of the uvula, part of the soft palate, tonsils and adenoids, as well as some extra tissue. A less radical solution is UP (uvuloplasty) which involves the removal of the uvula alone. (Interestingly, some languages – but not English – require uvular consonant sounds, which need the uvula to be present – so UPPP and UP might impair your ability to speak foreign languages with a convincing accent!) Palatal implants may be put into the soft palate to stiffen it, and likewise radiofrequency ablation can be used to stiffen the soft palate by deliberately scarring it. Although these treatments are all approved by NICE (the National Institute for Clinical Excellence) they are not always available on the NHS – ask for an appointment with your GP to discuss what you might be entitled to on the NHS, or which private providers exist locally.
Further investigations and treatment options
If you and your GP are worried that your snoring is a real health risk, you may need some further tests. Blood tests such as thyroid function can help to rule out other causes of being very tired all the time. Your doctor may go through the Epworth Sleepiness Scale with you to determine the extent of any daytime sleepiness. Sleep studies at home, whereby the snorer wears sensors which measure their breathing, oxygen levels and heart rate, can be helpful in assessing snoring – some patients may need a more involved form of sleep study, called polysomnography, whereby the patient sleeps in a lab in the hospital and, in addition to the sensors used in the home sleep studies, measurements are taken of heart activity, brain waves and muscle tone using machines called ECGs, EEGs and EMGs respectively. These investigations can help to diagnose OSA, and sufferers can then be prescribed Continuous Positive Airways Pressure (CPAP) – this is a small pump which delivers compressed air, via a humidifier and mask, to stop the airway closing. CPAP is a little bit noisy (but a lot less noisy than grade 3 snoring) and is certainly not a desperately sexy bedtime look, but is very effective at treating OSA (and therefore preventing healtjh complications), especially in combination with a MAD. It takes a bit of getting used to, but many patients with OSA say that CPAP has changed their life.
When in doubt- see your GP!
Remember – snoring is common, and has been thought of for centuries as comical and endearing (snoring characters feature heavily in many of Dickens’ books, for example). For many people, however, it is a daily menace that turns nights into nightmares. If you, or someone you love, is affected by snoring, please go to see your GP. It might be the first step towards sleeping soundly.
If you have enjoyed this blog post on snoring, and found it useful, please consider sharing it on social media using the buttons below. And we would love you to like and follow our blog and FB pages for further health updates and advice! Wishing you well, Winchester GP xx