Snoring is the sound of someone struggling to breathe.
According to the National Sleep Foundation's (NSF) 2002 Sleep in America Poll, 37% of adults reported that during the previous year, they had snored at least a few nights a week. Additionally, 27% said that they snore every night or almost every night. This was more common in males than females.
Snoring is not a laughing matter as it is frequently portrayed.
If one were to go to the emergency room making the breathing sounds of snoring, that person would be immediately placed in the Intensive Care Unit for observation and treatment. Should we ignore it because it happens while we are asleep?
Why do we snore?
Snoring is caused by the turbulence of the air and the vibration of the soft palate during sleep. When we go to sleep, the muscles of our airway, palate, and tongue relax. This causes the airway to get narrower and decreases the ability for air to pass through it. As this happens, our body senses the problem, and we start exerting more effort to suck air in. This is what is recognized as Upper Airway Resistance and, even when mild, can be a cause of medical problems. Unfortunately, in many instances, the situation is even worse, and this increased effort to breathe backfires. Just like what happens when we try to drink out of a straw with an ice chip blocking the bottom, our airway gets even narrower, causing it to collapse and totally close down. The only way to overcome this is for us to momentarily wake up, activate those muscles, take a gasping breath, and go right back to sleep. This process is actually how we experience Sleep Apnea.
Snoring is a symptom of Sleep Disordered Breathing
About half of the people who snore loudly have Sleep Apnea. Although you may not may not be aware of your snoring, ask your bed partner how often you snore and whether or not you stop breathing.
Sleep Apnea is a life threatening disorder.
When a person experiences sleep apneic events several things can happen. Usually with the breathing event, the body experiences a reaction of fear which results in an increase in the adrenaline activity. Along with that, the oxygen level in the blood drops, the blood pressure increases, and the heart has to work harder, but without it's fuel.
This process results in chronic high blood pressure, heart attacks, heart failure and increased risk of stroke. Other health consequences of Sleep Disordered breathing include Diabetes, Gastro-esophageal Acid Reflux (GERD), headaches, depression, impotence,as well as memory and concentration problems.
In addition, the fragmentation of sleep causes daytime sleepiness with increased risk of motor vehicle accidents and job related injuries. Being sleepy means that you owe your body the rest it deserves, and if one can sleep anytime and anywhere during the day, it may not be the blessing that many think it is. Loud snoring can also annoy one's bed partner, whose sleep quality may be impaired due to their mate's snoring and may end up on medication when the real problem is someone else's.
Sleep Apnea Treatment Options
Continuous Positive Airway Pressure (CPAP) is a therapy device used to treat obstructive sleep apnea. CPAP provides constant air pressure into the patient's airway to prevent blockages from occurring.
Auto Adjusting Positive Airway Pressure (APAP) is a NPAP device which allows the clinician to set a range of pressure settings rather than a single pressure. It is useful when the optimal therapeutic pressure is difficult to determine. APAP may also be used in select patients to assess need for a change of settings and in patients who have variable nightly needs.
Bi-level Positive Airway Pressure (BPAP) delivers a lower pressure during exhalation as compared to exhalation. two separate pressures that allow the patient to breathe in and out at different pressures. BPAP is mostly used in patients requiring high pressure settings. BPAP is also used in patients with heart and lung disorders.
Adaptive Servo-Ventilation (ASV) is a sophisticated therapy device used in patients with Complex Apnea, Central Apnea, heart failure, and some respiratory disorders. ASV assists the patients' breathing when and if they need it.
Oral Appliance Therapy (OAT) is indicated in patients who have mild to moderate sleep apnea and in some patients who have difficulty adjusting to CPAP. OAT is recognized to have around a 50% success rate treating sleep apnea, and this is lower in severe patients. Furthermore, OAT is often combined with weight loss and/or positional therapy. In some instances OAT may be combined with NPAP therapy to ensure better comfort and lower pressures.
Although some dentists may provide OAT to their patients without proper testing, the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine recommend that the evaluation and management of patients with OSA should be overseen by a qualified physician trained in sleep medicine. Similarly, oral appliance therapy should be provided by a qualified dentist who completes additional education in dental sleep medicine.
It is also recommended that a follow up sleep study be performed upon completion of the OAT adjustments to ensure the success of the treatment.
Complications of OAT include:
TMJ (jaw joint) and muscle discomfort
Tooth Movement and Bite Changes
Mandibular Advancement Devices (MAD)
Mandibular advancement devices are by far the most common type of dental sleep device available for the treatment of snoring and Obstructive Sleep Apnea (OSA). They are also sometimes called oral appliances, or dental sleep devices. MAD's open the airway by holding the mandible (the lower jaw) forward. This helps pull the tongue forward causing the airway to become wider.
Tongue Retaining Devices (TRD)
Tongue Retaining Devices (TRDs) function by directly holding the tongue in a forward position by means of a suction bulb. They are less effective and less comfortable, and it may take several weeks or months to be worn comfortably.
Other Treatments: Weight Loss, Positional Therapy
Weight loss is very important as part of the overall approach to the treatment of OSA. Weight loss helps reduce the fat tissues that accumulate in the tongue and the airway, increasing airway space. Some patients may end up curing their sleep apnea with enough weight loss. Bariatric surgery may be recommended for morbidly obese patients, especially if OSA is difficult to control with NPAP.
Sleep Disordered Breathing (SDB) is usually worse when sleeping supine (on the back), and, in some patients, SDB only occurs when supine. Several techniques may be used to train patients to sleep on their sides.
NightTZ is a foam block worn during sleep.
Nightshift is a position sensor worn around the neck that alerts the patient to turn to their side.
Avoiding alcohol, muscle relaxants, and certain sedating medications may reduce the risk of SDB because they increase muscle relaxation, which causes increased airway collapsibility.
Surgical treatment of sleep apnea should be reserved for very few select patients. In the majority of cases, it may not be curative.
The most common surgery performed is the Uvulo-Palato-Pharyngoplasty or UPP (U triple P).
Maxillo-Mandibular Advancement involves the repositioning of both the upper and lower jaw.
Wedge resection of the tongue may also be performed to reduce the size of the tongue, thus enlarging the airway.
Hypoglossal Nerve Pacing has been recently approved by the FDA. Other treatment modalities for SDB include Somnoplasty, LAUPP, Palatal Pillar procedure, and others.