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Snoring

  • A harsh, noisy breathing caused by an improper inflow and outflow of air during sleep
  • Associated with obesity, pregnancy, nasal obstruction, and sleep apnea
  • Treatments include lifestyle changes, a CPAP machine, and surgery
  • Involves Pulmonary, Critical Care & Sleep Medicine, Pediatric Sleep Medicine Program
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Overview

Snoring may seem like it’s no big deal, just a minor annoyance to your partner. You may not even realize it’s happening. However, snoring can be a sign of something more serious, so it’s important to discuss this problem with your doctor.  

As many as 90 million Americans report snoring at one time or another, while 37 million say they snore regularly. Sometimes their snoring really is harmless. But it’s a problem if it makes you wake up throughout the night and, as a result, you feel tired all day. In the worst cases, snoring can signal a serious condition such as obstructive sleep apnea, a common condition is linked to cardiac problems and can be fatal if left untreated.

Snoring is a problem to talk to the doctor about, as is anything that interferes with a good night’s sleep. “Getting regular sleep is important to our physical and mental health,” says Christine Won, MD, medical director of the Yale Centers for Sleep Medicine. “Inadequate or poor sleep may make us prone to obesity and cardiovascular disease. Sleep is also important for well-being, stress management, and resilience.”

What is snoring?

Snoring is harsh, noisy, rattling breathing that is caused by an improper inflow and outflow of air while you’re sleeping. When you fall asleep, your throat muscles naturally relax, your tongue slips backward, and your throat narrows. If there is anything obstructing the free flow of air at the back of your mouth and nose—a sinus infection, a nasal polyp, tonsillitis—it can exacerbate the narrowing of your airway. That leads to vibrations in the loose throat muscles, causing the snoring sound.

Snoring is not just an adult problem. Children snore, too, and it’s important to talk to a pediatrician if your child’s snoring is loud or irregular, or chronic. The American Academy of Pediatrics recommends that all children be screened for snoring, as it can signal a problem with the tonsils or adenoids, or be a symptom of sleep apnea. Pediatricians will routinely ask parents if their child snores, and follow up with a thorough history and examination. If they find signs of sleep apnea, they will refer the child to a sleep specialist who may recommend an overnight visit to a sleep laboratory.

What causes snoring?

More men than women report that they snore—42% of men compared to 31% of women, according to the National Sleep Foundation. (Because this is self-reported, and because snoring is qualified by the person listening to it, these percentages are estimates.)

Many underlying conditions can lead to snoring (see below). Some can be addressed with simple lifestyle changes, while others may require help from a specialist.

  • Obesity or excess weight. Bulky throat tissue in the neck area can cause a narrowing of the airway, and cause or worsen snoring.
  • Weak muscle tone in the throat and tongue. This can be a natural result of aging. Alcohol and medications can cause further muscle relaxation, making this problem worse.
  • Pregnancy, especially in the last month when surging hormones can cause swelling of tissue in the nose, which can cause congestion during sleep 
  • An anatomical problem, such as a crooked nasal septum, which is the wall formed by bone and cartilage between the nostrils
  • Nasal obstruction. A stuffy nose from allergies, a cold, or a sinus infection. Polyps or growths in the nostrils can also block breathing.   
  • Long palate or uvula (the fleshy structure that hangs above the throat). If the palate or uvula is too long, it narrows the opening between the nose and throat, which affects breathing.
  • Sleeping on your back causes the tongue to collapse to the back of the throat. Something as simple as changing your sleep position might help. (While the tongue relaxes to some degree in everyone when they sleep, it only causes airway obstruction in some people, and that can lead to snoring and, in some cases, sleep apnea.)   

What is sleep apnea?

Sleep apnea is the biggest concern linked to snoring. It affects 30 million Americans and it has been linked to heart disease and even sudden cardiac death. Sleep apnea is a condition that causes people to stop breathing periodically while they’re asleep. It’s characterized by loud snoring, and sometimes choking or gasping sounds. People with sleep apnea are typically very tired during the day. 

When should I talk to a doctor about snoring?

Because snoring can be a symptom of something more serious, you should alert your primary caregiver if you snore. This is especially important if you are waking up with headaches, feeling tired in the morning and drowsy during the day, or if your snoring is accompanied by weight gain, changes in your memory, or ability to concentrate. If you have a bed partner, you may want to ask them if they hear snoring at night.

If you snore and are worried about sleep apnea, talk to your doctor. Since sleep apnea can run in families, he or she will take a family medical history and perform a physical exam. If your doctor finds reason to be concerned about another serious condition, you may be referred to a sleep specialist, who may recommend a sleep study, which may be performed in a sleep lab or at home. A sleep study is a painless test that typically involves attaching electrodes on wires to the head and body to generate a report about such factors as rapid eye movements, oxygen levels, heart rate, and snoring, among others, while you sleep.  

What treatments are available?

In some cases, the doctor may recommend some simple lifestyle changes. Since alcohol and extra weight can be factors, they may advise avoiding alcohol and urge you not to eat heavy meals in the hours before you go to bed. Your physician may also suggest changing some of your medications or avoiding sleeping pills. A solution could be as simple as sleeping on your side instead of your back, or elevating the head of your bed.

If you have been diagnosed with sleep apnea, your doctor may recommend use of the CPAP (continuous positive airway pressure appliance). This device consists of a blower that delivers a small amount of air pressure through a mask that fits over your nose to keep your airway open while you sleep. New models of CPAP devices are smaller, quieter, and more comfortable. Another approach is to have a specialist, usually a dentist, custom-fit an appliance that will move the lower jaw forward so that the tissues of the back of the throat can relax and the tongue will not collapse and block the airway.  

If nonsurgical treatments don’t help, otolaryngologists may suggest surgical procedures to treat snoring or sleep apnea—or both.

  • Tonsillectomies and adenoidectomies: These may help with snoring and sleep apnea in some people.
  • Thermal ablation: Ablation methods such as bipolar cautery, laser, and radiofrequency can reduce tissue in the nasal turbinates (networks of bones, vessels and tissue), tongue base, and/or soft palate. These methods are nonsurgical.
  • Stiffening the soft palate: This can be done by injection or via the insertion of rods into the soft palate. It stiffens loose or floppy palates that cause the characteristic flutter sound associated with loud snoring.
  • Hypoglossal nerve stimulation: This new treatment for sleep apnea involves implanting a pacemaker-like device with a sensor that detects when you are breathing and then stimulates the muscles of the tongue to move out of the airway when you inhale. 

What makes Yale Medicine unique in its treatment for snoring?

Yale Medicine specialists have a breadth of knowledge in treating snoring, sleep apnea, and other related conditions. Our ear, nose and throat (ENT) surgeons are highly skilled in the latest minimally invasive surgeries for treating anatomical defects, blockages and other problems. If your child is diagnosed with sleep apnea, which often involves the removal of the tonsils or adenoids, our ENT surgeons may be able to perform a partial tonsillectomy, a procedure not widely available elsewhere, that allows for a quicker recovery and fewer complications.

If your doctor recommends a sleep study, Yale New Haven Hospital has a state-of-the-art sleep center. Few places in the state have pediatric-only sleep laboratories, and Yale has two: one at Yale New Haven Children’s Hospital and the other at Bridgeport Hospital.

“Sleep has implications for our health, both mental and physical,” Dr. Won says. “Achieving good sleep is a fundamental part of a healthy lifestyle.”