SNORING

Many people do not think of snoring as a significant health problem and often underestimate the negative health implications associated with it. Snoring has been associated with uncontrolled high blood pressure(1) and. can also be a symptom of obstructive sleep apnoea which is a serious condition where oxygen is restricted to the brain. Snoring can also greatly disrupt the sleeping patterns of both you and your household which can significantly impact the physical health, mental clarity and personal relationships of all members of your family.

What is snoring?

Snoring occurs during sleep when the muscles at the back of the throat start to relax leading to a  floppy, narrow airway. The lower jaw also drops back into the throat. When breathing occurs, air passes through this narrowed area, causing vibration of the floppy soft tissues and resulting in a snoring sound. Depending on the individual the sound can be a very soft "purring" like sound or loud enough to wake the whole household.

Snoring can originate from several parts of the airway including the nostrils, nasal passages, soft palate and throat and is worsened by the following:

• Nose and throat obstructions - deviated nasal septum, swollen nasal turbinates, nasal polyps, large tongues and enlarged tonsils and uvula can decrease the size of the airway.
• Allergies, hay fever, smoking and blocked noses - can decrease size of airway and reduce airflow.
• Being overweight or obese - increases the soft tissue pressure around your throat and decreases the size of the airway.
• Alcohol and certain medications eg sleeping tablets, oral steroids - can further relax the throat muscles during sleep.
• Sleeping on your back and mouth breathing - increases the risk of the tongue and lower jaw dropping back into the airway and decreasing the size of the airway

How is snoring treated?

Treatment for snoring will differ depending on where the snoring is coming from. Often a combination of therapies is needed to adequately treat snoring. Treatment options include:

• Lifestyle changes -avoid alcohol (especially in the evenings), weight loss, smoking cessation and avoid use of sedative medications.
• Positional therapies - sleep on your side with the use of an anti-rotational mechanical or electronic device.
• Nasal therapies - nasal steroid sprays, nasal strips or nasal cones may temporarily improve nasal opening.
• Oral appliances - Mandibular Advancement Splints (MAS) hold the lower jaw, tongue and soft palate in a forward position to keep the airway open. These have been recommended as first line treatment for snoring by the Australasian Sleep Association (2) and American Academy of Sleep Medicine(3).
• Surgery - Tonsillectomy (surgery to remove the tonsils) is the first line of therapy for snoring in children. In some cases adults may also benefit from surgery. An ENT (ear, nose and throat) surgeon will be able to assess your airway and advise if this is an appropriate option for you.

    References:

1.  Lechat B, Naik G, Appleton S, Manners J, Scott H, Nguyen DP, Escourrou P, Adams R, Catcheside P, Eckert DJ. Regular snoring is associated with

     uncontrolled hypertension. NPJ Digit Med. 2024 Feb 17;7(1):38. doi: 10.1038/s41746-024-01026-7. PMID: 38368445; PMCID: PMC10874387.

2. Sarkis et al (2023). ASA position paper - Consensus and evidence based treatment for primary snoring. 

                 https://onlinelibrary.wiley.com/doi/10.1111/resp.14443

3. Ramar et al. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance - Therapy: An Update for  2015.

    https://jcsm.aasm.org/doi/10.5664/jcsm.4858