Snoring

Snoring is a source of jokes in families, and is often denied by the snorer as a hoax perpetrated by family members. But snoring can be a serious matter if it is associated with its close anatomic cousin, obstructive sleep apnea (OSA).

The pathophysiologic association relating OSA and snoring is the anatomic proximity of tissues aligning together in the pharynx during sleep. With the head back, the tongue, tonsillar structures (pillars remain even after tonsillectomy), soft palate and uvula may all fall together. If they remain slightly open and vibrate they create a snore sound, and if they close there is no way for air to get through, resulting in apnea or near-complete apnea (hypopnea). See the related discussion about OSA to understand the reasons having OSA is a serious matter.

Even snoring without apnea can be disturbing to sleep by causing brief arousals that break sleep continuity. These arousals appear to be due to airway resistance sensed by the snorer’s brain rather than sound interferences. Roughly 15% of 20 year olds, rising with age to over 45% of 60 year olds, will snore, and at least 10% of these will have treatable sleep apnea. Men in their 20’s are twice as likely as women to snore, but later in life, women almost catch up.

Treatments

The same therapy available for sleep apnea applies to snoring. Occasionally snoring is a matter of airway relaxation after significant alcohol consumption so avoidance of alcohol close to bedtime can help.

More often, it is worse any time the sleeper is supine, not sidelying . If so, a dental device (see OSA disussion) may be very helpful. A minor surgery that is at times effective if the snoring is without accompanying OSA is uvuloplasty, an office procedure for most ear/nose/throat surgeons. Another ENT office procedure is the relatively new Pillar procedure, involving the implantation of three inert plastic pillars into the soft palate to stiffen and support it up, opening the pharynx. CPAP therapy always will eliminate snoring if it is used properly (see OSA section of website).

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