Snoring

Snoring is the production of upper airway noise via breathing during sleep.
• Snore- during sleep, the noise produced while breathing through the mouth.
• Snoring is a sound a person makes during sleep when his or her breathing is disrupted.
Aetiology /pathogenesis-
Snoring originates in the parts of the upper airway which have no rigid support to counteract compression from outside or collapse from inside. This narrowing leads to local acceleration and turbulence of the breathed air. This, in turn, causes vibration of the pharyngeal wall.
The structures concerned are-
• Soft palate
• Uvula
• Tonsils
• Base of the tongue
• Pharyngeal muscles and
• Pharyngeal mucosa.
Factors contributing to snoring-
The palate, tongue and pharyngeal muscles play a part in keeping the airway open during the inspiration. If, during the deep sleep phase, and especially during REM sleep, the muscle tone is insufficient, the tongue can fall backward due to gravity, and vibrate against the soft palate, uvula and pharynx. This occurs particularly in the supine position.
Anatomical abnormalities can limit the passage of air in the oropharynx and the hypopharynx. Such abnormalities include-
• Enlarged tonsils and adenoids
• Fatty tissue in the pharynx (due to obesity)
• A relatively large tongue (in the case of retrognathia, micrognathia and acromegaly).
• A narrow nasal passage causes an increase in negative pressure during inspiration, which increases the effect on the flaccid pharyngeal tissue. A particularly long palate and uvula also narrow the nasopharyngeal opening during inspiration. This explains why people who normally do not snore may do so when they have a cold or allergic rhinitis.
• Septal abnormalities, nasal polyps and tumours can also contribute to constriction.
• Hypothyroidism, neurological disorders, alcohol and hypnotics can intensify the overall effect.
Signs and symptoms-
• Unexplained tiredness or sleepiness during the day.
• Disrupted social activities and relationship problems (and even divorce). The snoring noise can sometimes be as loud as 50–70 db, which is similar to the noise of a low-flying jet plane.
• Sometimes, temporarily stopped-breathing (sleep apnoea), which can be very alarming.
Examination-
Very careful examination of the ear, nose and throat area, particularly the tonsils, palate, uvula and tongue is made. Nasal polyps, swollen turbinates, septal deviation, hyper reactive nasal mucosa, and abnormal anatomy of the lower jaw (relatively too small or recessed) is evaluated. Weighing the patient and blood pressure is next step. If hypothyroidism is suspected, the thyroid stimulating hormone level is checked.
Management-
The average snorer is a person more than 40 yrs old. While he inhales or exhales during sleep, the soft palate vibrates noisely. Snoring is usually caused by a condition which hinders breathing such as a cold, an allergy, a nasal polyp, tumor or deviated nasal septum. The cause must be removed to stop snoring. Snoring can also be diminished by reducing weight, stopping smoking and drinking alcohol in evening before sleeping.
Option 1-
If no abnormalities are found on the history or examination, no treatment is required.
Option 2-
If further investigations are found, general measures can be suggested. These include-
• Losing weight if necessary
• Avoiding lying on the back if the snoring is position-dependent and
• As appropriate, discouraging smoking, alcohol consumption and the use of hypnotics.
• Any underlying causes or contributory factors, such as hypothyroidism or allergies are treated.
• Mechanical devices placed in the nose and mouth only reduce snoring to a limited extent.
• If, in the case of habitual snoring, the patient temporarily stops breathing and/or the patient reports that he is sleepy and tired during the day, sleep apnoea syndrome must be considered.
• Snoring can also be cured about 80% by surgery. The operation is called uvulopalato-pharyngoplasty.
Prevention
Attention to weight, smoking, alcohol and hypnotics, and avoiding sleeping on the back are effective preventive measures. Reassurance is sometimes appropriate, particularly if there are groundless fears about sleep apnoea.