Snoring

Snoring
by Norman J. Harris, MD
Affiliated Ear, Nose and Throat of Orange county
reprinted with permission from www.ocentdoc.com

Snoring - often considered comical - always means blocked breathing. The blockage varies in what is blocked and how severely.

Some snoring is so loud no one else can stay in the same room. Loud snoring is often associated with the "sleep apnea " syndrome. Patients who snore the most loudly are usually unaware of their difficulty in sleeping. Because of bad sleep patterns they awaken tired, stay sleepy all day, and often fall asleep at the most inconvenient times. Measurements during sleep show their blood oxygenation drops, and they often develop abnormal heart rhythms. Some physicians suspect the rhythm problems can cause death during sleep. Sleep apnea sufferers often have high blood pressure.

Not everyone who snores loudly has the life-threatening "sleep apnea" syndrome. When the snoring pattern includes long pauses, physicians begin to suspect the presence of more severe forms of sleep difficulties. Children tend to snore normally, especially when they have colds. They appear to tolerate it better than adults. Some pediatricians worry that there may be some danger in this sleeping pattern in this age group as well. The latest studies fortunately have shown no association between the history of snoring and choking spells in children and the presence of sleep apnea as measured by test.

Sleep breathing disorders often are caused by abnormal reflexes in the part of the brain that controls breathing. Studies show that 95% of patients have some structural abnormality in the air passages. The obstruction can be at the level of the nose, often by a deviated septum, or polyps. Most often, in the cases of loud snoring, the soft palate is the problem. Apparently growth and maturation lead to a mismatch in size between the size of the palate and the space in back of the throat so that during the relaxation of sleep, blockage occurs.

Occasionally, the tongue and throat muscles, during the relaxation of sleep, can collapse and obstruct the air passages. Tumor or paralysis of the voice box can also compromise the airway.

The evaluation of snoring includes a complete history and detailed examination of the air passages. Other studies will include x-ray examination of the airway, breathing tests, and most importantly, a monitored sleep session in a sleep laboratory looking for sleep apnea. These studies help to define both the origin and the degree of danger it represents.

How we treat snoring depends on severity. Antidepressant medications taken at bedtime seem to help some snoring. Surgical treatments used are variations of standard operations which have been applied to other problems for years. Surgery works well for snoring, but has been disappointing for sleep apnea. There doesn’t appear to be any advantage to surgery by laser compared with any other technique. The most reliable treatment so far for sleep apnea appears to be the CPAP device, a pneumatic ‘splint’ for the entire airway. We often rely on this device for the intermediate long term as we monitor developments in the definitive management of sleep apnea. Often, a well made dental night guard can correct snoring when sleep apnea is not involved.

Snoring isn't funny and doesn't have to be tolerated. Before accepting any treatment for snoring alone, be sure to check with your insurance, since most plans have determined treatment of snoring without sleep apnea to be ‘cosmetic’, and therefore not a covered benefit.