TREATED - Snoring Causes And Remedies Apr 16 Proof2For obvious reasons, we often won’t know that we snore until someone else tells us. And even then, sadly, it might seem more like a problem for our partner to overcome rather than for us.

But there’s much more to snoring than potential insomnia for those we share a house with. While in many cases snoring can be harmless, in others it may be indicative of one or several health issues.

With National Stop Snoring Week taking place later this month, we thought we’d discuss the subject in more detail.

Who snores?

Estimates vary.

According to WebMD, about 45 percent of men and 30 percent of women snore at least infrequently; with roughly half of these estimated to be habitual snorers.

The NHS puts the snorer population of Britain at around 15 million (roughly one quarter of the total), with two out of three of these snoring to a degree which disrupts their partner’s sleeping pattern.

What causes it?

The physical reason why snoring occurs is to do with the soft tissue lining the airways at the back of the mouth and throat. Snoring sounds are made by the passage of air through these channels causing tissues to vibrate.

It happens when we breathe during sleep and not when we're awake because these tissues relax when we’re asleep. Consequently, the air passages will narrow and breathing may become faster or more forceful, leading to a change in pressure and causing the aforementioned vibration.

In lifestyle terms, there are plenty of contributing factors that have been linked with snoring.

These include:

  • alcohol use (this acts as a relaxant and causes the muscles to further loosen)
  • obesity (those carrying a lot of weight in their throat and neck may have narrower airways)
  • and smoking (tobacco inhalation can cause inflammation to air passages and in turn, cause them to constrict)

People with allergies affecting the airways (allergic rhinitis) are also more likely to snore.

How bad is your snore?

How severe someone's snoring habits are can be measured using the snore grading system.

Grade one

The first grade is also referred to as simple snoring. This is characterised by only occasional instances, will not be very loud, and will not pose any restraints on breathing.

Grade one snoring is largely harmless, but may be a nuisance for the snorer’s partner.

Grade two

The second grade is used to categorise those who snore around 50 percent or more of the time. Those who snore on more than three nights per week may find that they can’t breathe as well during sleep, and their daytime function will be somewhat inhibited as a result.

Grade three

The third and highest grade refers to those whose snoring can perhaps be heard throughout the house, and which will present an obstacle to breathing. In this case, snoring will occur on most nights, or perhaps even every night.

Obstructive Sleep Apnoea

Studies show that snoring gets worse with age. Persons with grade three snoring may develop (or in fact already have) Obstructive Sleep Apnoea.

Those with OSA may experience a blockage of the airways which means that they will not be able to breathe for around 10 seconds. The shortfall in oxygen then causes them to come out of stage three and four sleep into lighter stages, or wake up completely, as the body tries to regain a normal breathing rhythm.

In severe cases this can occur as frequently as every couple of minutes and as you might expect, those who have OSA may find their capacity to function normally the day following an episode significantly diminished.

Untreated, the condition can pose a practical risk in that it may lead to a loss of concentration while driving or operating machinery.

However physiological health risks, such as high blood pressure, and in turn heart attack and stroke, are also increased in those with sleep apnoea.

How do you know if you have OSA?

It might particularly be the case for those who live alone or whose partner is a deep sleeper that OSA could go undiagnosed.

But there will be signs of OSA that present themselves while a person is awake.

It’s common for those with the condition to feel as though they haven’t slept following a night in bed, feeling tired throughout the day. Headaches, feelings of irritability, moodiness, loss of concentration, loss of sex drive and in men loss of erectile function are all possible secondary symptoms.

Feelings of perpetual tiredness should be brought to the attention of your GP, as should any suspicions that you might have OSA.

Practices that can help to reduce snoring

There are some simple practices that can be applied to help reduce snoring and disruption to sleep in milder instances:

  • Sleep on your side

One of the drawbacks of sleeping on your back is that the soft tissue around the throat and under the chin can compress the airway, making snoring more likely. Moving onto your side can alleviate this, and help the airway to open up.

  • Meet your daily fluids quota

Dehydration can make the soft tissues in the airways claggy, which can in turn increase the level of sound you make when you snore. Drinking the recommended amount of water throughout the day (eight glasses) can help to prevent these tissues from clinging together and reduce snoring.

  • Replace pillows regularly

This is particularly the case for those with allergic rhinitis. Pillows can harbor dust mites, which can aggravate allergy symptoms, causing inflammation and congestion of the airways.

Fluffing them once or twice a week and washing them every three to four months can help to limit the buildup of these allergens.

Those with allergies should also make sure they have antihistamines on standby, just in case a flare up of irritation causes them sleeping issues.

  • Maintain a healthy weight

The more weight you carry, especially around your head and neck, the higher the likelihood is that you’ll snore or develop a related disorder. Eating a balanced diet and getting regular exercise is key to keeping your weight at a healthy level, and to sleeping soundly.

  • Keep to as regular a pattern as possible

Longer active days and shorter resting nights will inevitably induce a state of severe tiredness, meaning that the muscles in the body and tissues in the mouth and throat will loosen even more; and heavy snoring may then result.

Getting the recommended 7-9 hours per night and going to bed at a reasonable time will help your muscles to feel less exhausted, and in turn, give you a quieter night’s rest.

  • Quit smoking and lower alcohol intake

High levels of alcohol consumption can exacerbate snoring, so exercising moderation can help to lower its disruptive effects; and giving up smoking will help to lessen the narrowing effect of inflammation.

What your doctor can do

A GP may be able to help you identify problem areas that are causing snoring, and suggest practical lifestyle adjustments to limit sleep disruption.

In cases where the above methods have not sufficed, a doctor may undertake tests to find out if an undiagnosed condition is causing fatigue or excessive sleepiness. These may include a blood pressure test and a blood test to eliminate high blood pressure or an underactive thyroid.

Once these conditions have been excluded as potential causes, a GP may refer you to a sleep specialist, who may conduct further tests to determine whether OSA is present. They may monitor and observe your sleeping habits overnight at a sleep clinic, or provide you with equipment so that you can undertake tests at home.

These tests will be used to determine whether mild, moderate or severe OSA is present. The type of treatment recommended will depend on your level of symptoms.

Devices for frequent snoring and mild OSA

For those who want to reduce snoring, nasal dilation treatment can help to prevent the nasal passages becoming narrowed and inhibiting breathing. These include:

  • nasal adhesive strips that are applied to the outside of the nose
  • or a nasal dilator which is placed inside the nostrils

Whereas oral devices are available in the form of:

  • adhesive chin strips, which help to keep the mouth closed during sleep
  • or a vestibular snore guard (resembling a gum guard)

The aim of oral devices is to limit snoring by keeping the mouth closed, encouraging breathing through the nose. These can be used to reduce snoring or treat mild cases of OSA.

MADs

Mandibular advancement devices are another type of oral treatment for mild OSA. Some are available to buy ready-made, but this type won’t be suitable for everyone. In some cases it may be necessary to have a MAD custom-built by an orthodontist.

They create breathing capacity in the airways by ‘advancing’ the tongue and jaw; bringing them forward and away from the back of the mouth and throat.

The cost of a MAD can vary significantly between those which are ready-made and bespoke, and they won’t always be available via the NHS.

CPAPS for moderate to severe OSA

Continuous positive airway pressure devices, or CPAPs, are available on the NHS and  are regarded by many as the most useful method for moderate or severe sleep apnoea.

These work by distributing compressed air into the airways to stop them from closing up and becoming obstructed. Initially the device may seem invasive and uncomfortable, but is effective when used regularly; patients who continue with CPAP will mostly become accustomed to its use.

If you feel as though snoring is affecting yours or your partner’s capacity to get a good night’s sleep, make an appointment with your doctor.

You can find out more about National Stop Snoring Week here.