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Snoring It is estimated that between 25-50% of the adult population snores, and although it is not as common in children, this age group certainly is not immune. When mild or infrequent it may not be a significant issue. However, snoring is a major social problem for the individual sharing the bed with the snorer. It can lead to sleeping in another room and even puts pressure on relationships. Most importantly however, is that snoring is an indication that the individual’s airway is partially obstructed. Over time partial obstruction can become total obstruction. In some patients this may be the only sign or symptom that this obstruction is leading to a medical condition known as sleep apnea, which can have significant side effects. |
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There certainly can be many causes for mild or intermittent snoring. Any medication that may induce relaxation or the muscles may play a role. The most common culprit is alcohol, especially when it is consumed right before bed. Other medications such as sleeping aids can also aggravate snoring. Weight gain also can contribute to snoring. This may simply amplify an existing anatomic problem which was causing mild obstruction previously.
The most common cause, however, is simply an anatomic abnormality leading to obstruction. The most common sites are the roof of the mouth (palate, uvula, and tonsils), throat, and nose. Although certain temporary changes can aggravate these problems, such as allergies or a cold causing swelling in the nose, most conditions are actually longstanding and simply worsen with age. The diagnosis is usually apparent to the patient- or more commonly the patient’s family. However, habitual (night after night) snoring is truly a medical problem. If it is persistent, full evaluation by a physician is necessary. This examination may include a polysomnogram (sleep study) to determine if sleep apnea is present. This is important since the patient’s own history of apnea or fatigue has been shown to be an inaccurate source of information, and sleep apnea may be present in as many as 80% of all habitual “heroic” snorers. Treatment may include eliminating those outside factors that may be playing a role. This may include weight loss, the avoidance of alcohol or other medications, or even the treatment of nasal congestion with medication or nasal dilating strips. However, these efforts are rarely successful in those patients with significant snoring. Evaluation by a physician is indicated to rule out sleep apnea. If the patient is a “simple snorer” (intermittent) and still desires treatment, several options exist. Most treatment is directed at the soft palate since this is the most common site of snoring. Traditional surgery of this area (known as uvulopalatopharyngoplasty or UPPP) is effective in 80-90% but can be associated with postoperative pain for 7-10 days. Alternatively, radiofrequency reduction of the palatal tissue is appropriate for some patients. It can be performed as an outpatient and results in less discomfort. The other sites of obstruction that may contribute to snoring are the nose and the base of tongue, and should also be evaluated. In the nose a deviated (crooked) septum, the bone and cartilage wall which divides the nose internally into sides, may cause obstruction. In addition, normal structures known as turbinates protrude from the lateral wall and if chronically enlarged can also block airflow. The base of tongue also can be enlarged and impede airflow during sleep. Obstruction at these sites can be treated by a variety of methods depending on the severity. Habitual snoring can also be a significant social issue. However, at times it may be the only sign of the more important medical condition of sleep apnea. A comprehensive examination can identify the cause of the problem and determine what options are appropriate for treatment. |
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