Snoring

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Overview

Snoring occurs when the flow of air inspired through the mouth or nose into the lungs is disturbed during sleep. Usually the cause is narrowing or blockage of airways in the nose, mouth or throat. Therefore, airway tissue are vibrating and hit the back of the neck, causing a sound that can be soft, velvety, high, rough or hoarse. It is possible that people who snore are not aware of it. Sometimes spouse / partner notices that the individual who sleeps with snore or sleep with their mouth open.

If snoring is disturbing for the person who snores or her partner, daytime fatigue may occur (daytime fatigue). In the past, snoring was considered a mere annoyance for your partner. Recently has been shown that people who snore may suffer from the syndrome of upper airway resistance (disease in which airflow inspired face a degree of resistance to the passage through the upper airway) and obstructive sleep apnea, a serious condition of sleep, in which the person can stop breathing (apnea) during sleep, because of a degree of obstruction in the airways. It is therefore important that when snoring becomes a routine to be consulted a doctor. Snoring is a common condition, about 25-50% of men and 25-30% of women snore frequently.
 


Causes

Snoring occurs when the column of air that enters through the mouth or nose into the lungs, causes airway’s tissue vibrating. Usually this happens as a result of a narrowing or airway obstruction in the nose, mouth (oral cavity) or neck. During sleep, the inspiration air enters through the mouth or nose and passes the soft palate (the back of the upper wall of the mouth) to get then into the lungs.

The back of the mouth where the tongue and upper throat meet the soft palate and uvula (extension musculoskeletal suspended lining the posterior border of the soft palate in the mouth floor), is collapsed. If this area collapses enough, the airway narrows or obstruct (blocks). The narrowing or obstruction of the airway disrupt the airflow path, which makes the soft palate and uvula to vibrate, thus hitting the back of the throat causing snoring.

Tonsils and adenoids (chronic increases in volume of the tonsils, located behind the nasal passages, called popular “polyps”) and they can vibrate, causing snoring. As the airways are narrowed, with both tissues vibrate, snoring becomes louder and noisier. Snoring can not appear when you don’t sleep because the throat muscles are fixed in the back of the throat tissues. During sleep the muscles relax, allowing the tissue to collapse,.
The airways are narrowed or blocked in several situations, which include:
- Tissue hypertrophy (increase in volume of tissue) in the nose, mouth or throat; tonsils grown in size are a common cause of snoring in children
- Blocked nasal airway causes difficulty breathing, thus affected tissues in the neck, which can shrink during extra effort made in trying to breathe and has therefore narrowing the airway; nasal airway blockage can be caused by upper respiratory infections (like colds), allergies or nasal polyps
- Deviated nasal septum that disrupt airflow at the nose
- Loss of muscle tone in the neck, which allows tissue to collapse; this can happen in the absence of movement or with age
Other factors that may contribute to the occurrence of snoring are:
- Alcohol consumption, leading to the inhibition part of the brain responsible for controlling breathing, this inhibition cause excessive relaxation of the tongue and throat muscles, causing a partial obstruction of airflow
- Obesity, by the deposit of fat in the neck narrows the airway
- Drugs that cause drowsiness or muscle relaxants, such as those taken for allergies, depression or anxiety

Symptoms

Snoring is a noise that occurs when breathing during sleep. This sound may be soft, velvety, high, rough or hoarse. Sometimes spouse / partner can notice that the individual who they sleep with, snoring or sleep with their mouth open and have a restless sleep. If snoring is disturbing for the person who snores or the partner, daytime fatigue may occur (daytime fatigue). If breathing stops temporarily during sleep (apnea) patient may have a serious condition called sleep apnea.


Pathophysiological mechanism

Snoring occurs when the column of air that enters through the mouth or nose into the lungs, causing airway tissue vibrating. Usually this happens due to airway narrowing or obstruction of the nose, mouth (oral cavity) or neck. During sleep, the inspiration air enters through the mouth or nose and passes the soft palate (the back of the upper wall of the mouth) to get then into the lungs. The back of the mouth where the tongue and upper throat meet the soft palate and uvula (extension musculoskeletal suspended lining the posterior border of the soft palate in the mouth floor), is collapsed.

If this area collapses enough, the airway narrows or obstructs (blocks). The narrowing or obstruction of the airway disrupt the airflow path, which makes the soft palate and uvula to vibrate, thus hitting the back of the throat causing snoring. Tonsils and adenoids (tonsils chronic increases in volume located behind the nasal pharynx, popularly called “polyps”) and they can vibrate, causing snoring. As the airways are narrowed, with both tissues vibrate snoring becomes louder and noisier. Snoring does not happen when the person doesn’t sleep because the throat muscles are kept fixed in the back of the throat tissues. During sleep the muscles relax, allowing the tissue to collapse. Snoring can be so strong that people who sleep with snorers can be awakened.

People who snore often wake up tired. There are studies showing that snoring can cause daytime sleepiness and snoring intensity is inversely proportional to the quality of sleep, that is, the more intense the sound is, the less restful the sleep is. Snoring can cause sleep apnea syndrome or upper airway resistance. These are diseases with greater severity than simple snoring.

Risk Factors

Factors that may increase the risk of snoring are:
- Male: snoring occurs more often in men than in women
- Age: snoring is more common in people of middle age; studies have shown that among men the risk of snoring increases with age until around age 50-60 years
- Hereditary factors: snoring can occur in several family members
- Weight gain and obesity
- Smoking: children’s exposure to cigarette smoke may increase the risk of snoring
- Alcohol and sedative drugs
- Chronic nasal congestion (abnormal accumulation of blood in an organ or a tissue known as the hyperemia) during sleep: is often caused by allergies or acute upper respiratory infections (colds)
- Malformation of the mandible, as retrognathism (mandible is smaller than normal, giving the impression of small chin) and reverse bite, the latter is a second class mal-occlusion (poor settlement from a maxillary teeth in relation to the other jaw), which exceeds the upper jaw and teeth during jaw and lower teeth bite, these malformations are more common among women.


Specialist’s consult

You should visit a physician when:
- Snoring is pitched low and with high intensity;
- The person who snores feels tired during the day;
- The person who snores falls asleep at inappropriate times such as during conversations or meals;
-Beside the snoring during sleep, there occurs periods of apnea, when the person seems to drown or wheezes.

Snoring is the primary symptom of sleep apnea, which is a more serious disorder characterized by periods of stopping breathing (apnea) during sleep.


Watchful waiting

Watchful waiting is a period during which the doctor and the patient, monitors the disease and its symptoms without using medical treatment. Watchful waiting is required when snoring is disruptive to others or if snoring does not cause excessive daytime sleepiness. If outpatient treatment is not helpful in stopping snoring, your doctor should be contacted. Watchful waiting is not indicated if the snoring is pitched low and with high intensity, if the patient have a restless sleep or is sleepy during the day or have periods of apnea during sleep. These symptoms may indicate that the patient has sleep apnea and in these conditions it is necessary performing a medical consult.


Recommended medical specialists

Snoring can be treated by the following specialists:
- GP
- Doctor of internal medicine
- Pediatrician
- Doctor O.R.L. (otorhinolaryngology)
If your doctor is suspecting the existence of sleep apnea, a physician specializing in treatment of sleep disorders can make diagnosis and perform necessary tests. These doctors are usually neurologist or pneumologists. If they recommend using an oral breathing device, it is necessary the consultation of a dentist.

Investigations

Snoring diagnosis has an important part in highlighting the presence or absence of sleep apnea in that patient. The doctor will perform a physical examination of the patient and his medical history, but because they can not be diagnosed with sleep apnea usin this method, it is usually performed a sleep study (the patient is monitored and some investigation is done while sleeping) if this condition is suspected based.
International associations recommend:
- Examination screening for snoring during routine examinations of children
- If sleep apnea is suspected, they recommend a complete sleep study

Treatment – Overview

Snoring is treated through lifestyle changes, including weight loss (if necessary), quitting smoking, changing the way to sleep (sleeping on your side instead of sleeping on your back) and avoiding alcohol and sedatives, before bedtime. If chronic nasal congestion is the cause for snoring, drugs can be used as nose vasodilator, nasal decongestants and inhaled corticosteroids. Oral breathing devices push the tongue and jaw forward, thus improving breathing. If snoring persists despite the above treatment, you can try using devices that provide a continuous positive airflow pressure. Another treatment option is surgery.

Initial and maintenance treatment

Treatment of snoring by changing lifestyle was often successful.
Lifestyle changes include:
- Weight loss (if necessary)
- Same bedtime every night and long enough to sleep
- Recommend that position during sleep to be on one side and not on the back; such a position can be maintained during sleep as follows: sew a small pocket in the middle rear of the pajama’s tops, where it is introduced a tennis ball
- Avoid alcohol and sedatives before bedtime
- Quitting smoking
- Raising the head of the bed by 10-15 cm, using bricks placed under the foot of the bed (using pillows to raise your head and upper chest is not an effective method)
- Prompt treatment of respiratory diseases such as allergies and colds
- Using special nasal device that increases the diameter of the nostrils and improve airflow entering through the nostrils

If nasal congestion is present, it is recommended to clean the nostrils or the use of medicines such as nasal decongestants and inhaled corticosteroids (intranasal route). These drugs increase the airway opening, allowing easier penetration of the column of air and can thereby reduce the snoring. However nasal decongestants should not be used for a long time. Oral breathing apparatus may be useful sometimes to treat snoring, especially if it is caused by jaw position during sleep. If your partner sleep is disturbed by the snoring, he / she can use earplugs or audio tapes ambient music or sounds of nature, which may cover the snoring. If the person continues to snore, he needs a medical specialist to highlight the syndrome of the upper airway resistance and obstructive sleep apnea.

Treatment if the condition gets worse

If snoring is worse is recommended a medical specialist. Additional tests are necessary to diagnose the syndrome of the upper airway resistance and obstructive sleep apnea. Your doctor may indicate the use of devices that provide a continuous positive airflow pressure. These are the standard treatment for sleep apnea, but are rarely used to treat snoring.
In extreme cases the next surgical interventions are performed:
- Uvulopalatopharyngoplasty: is a surgical technique that removes fat tissue (fat) in the neck, thus expanding the airways and facilitating the passage of air column;
- Uvulopalatoplasty assisted laser: is a technique that removes excess tissue in the neck, using laser technology;
- Tonsillectomy and adenoidectomy: can be used if tonsils and adenoid vegetation are hypertrophied (increased volume) and blocks the airway during sleep;
- Nasal septoplasty: is a surgical procedure to repair and / or strengthen bone and tissue that separates the two nostrils (nasal septum), this procedure is performed if there is a change in the shape of the nose that affects airflow inspired;
- Nasal polypectomy: this technique removes the soft, round, usually pedunculated nose (nasal polyps).

Prophylaxis

Snoring can be prevented by:
- Avoiding alcohol and drugs that slow down the breathing, such as sedatives and tranquilizers;
- Soft diet, exercise and maintaining body weight close to normal weight;
- Same bedtime every night and a long enough sleep, regular sleep schedule provides a better rest and more restful sleep, which reduce snoring;
- Recommend that position during sleep to be on one side and not back; such a position can be maintained during sleep as follows: sew a small pocket in the middle rear of the pajama’s top, where it is introduced a tennis ball;
- Quitting smoking: it reduces the inflammation of the airways, which can help them narrow;
- Raising the head of the bed by 10-15 cm with bricks placed under the feet of the bed (using pillows to raise your head and upper chest is not an effective method);
- Prompt treatment of respiratory diseases such as allergies and colds; respiratory problems increase the risk of snoring.

Home Treatment

Generally, snoring is a condition that is treated first at home.

This treatment includes:
- Weight loss: Many people who snore are overweight; weight loss can decrease airway narrowing and can reduce or eliminate snoring
- Limit your intake of alcohol and drugs: alcohol abuse and consumption of certain drugs, especially sedatives or tranquilizers, before sleep, may worsen the snoring
- Same bedtime every night and long enough to sleep: regular sleep schedule offers a better rest and more restful sleep to reduce snoring
- Recommend that position during sleep to be on one side and not back, such a position can be maintained during sleep as follows: sew a small pocket in the middle rear of the pajama’s top, where is introduced a tennis ball
- Prompt treatment of respiratory diseases such as allergies and colds: respiratory problems increase the risk of snoring
- Using special nasal device: increases the diameter of the nostrils and improves the airflow entering through the nostrils

Overview

Medications
Drugs can prevent or reduce snoring when it is due to nasal congestion. This is usually caused by colds or allergies. Drugs may issue nasal cavity, allowing a better passage of air that enters through the nostrils in breathing and thus helping reduce snoring. Nasal decongestants and inhaled corticosteroids both reduce nasal congestion, but the last can be used only for a short time.

Surgical treatment

They appeal to them very seldom, if severe snoring is present and which could not be treated by other means.
Surgery is used to:
- Removing excess tissue in the neck, to wide the upper airway; it may mean even adenoidal removal of tonsils or tissue or other tissues in the back of the neck (Uvulopalatopharyngoplasty)
- Correction of malformations or removal of nasal polyps that block airflow through the nasal cavities
- Changes in the position of the bones of the upper airway, allowing the flow of air inspired, especially during sleep when it is needed more than one surgery
Types of surgery:

- Uvulopalatopharyngoplasty: is a surgical technique that removes fat tissue (fat) in the neck, thus expanding the airways and facilitating the passage of air column
- Uvulopalatoplasty assisted laser: is a technique that removes excess tissue in the neck, using laser technology
- Tonsillectomy and adenoidectomy: can be used if tonsils and adenoid vegetation are hypertrophied (increased volume) and blocks the airway during sleep
- Nasal septoplasty: is surgical procedure to repair and / or strengthen the bone and tissue that separates the two nostrils (nasal septum), this procedure is performed if there is a change in the shape of the nose that affects airflow inspired
- Nasal polypectomy: this technique removes the soft, round, usually pedunculated, nose (nasal polyps).
Remember!

Surgical techniques are rarely used to treat snoring and may not completely cure the disease and the risk may be too large for the net profit made.

Other treatments

Alternative treatment includes devices that provide a continuous positive airflow pressure, oral breathing apparatus and special nasal device that increases the diameter of the nostrils and improve airflow entering through the nostrils. Dietary adjustments can help treat snoring, for people who are overweight and have this condition. Oral breathing apparatus may be useful sometimes to treat snoring, especially if it is caused by jaw position during sleep. Devices that provide a continuous positive airflow pressure, is the standard treatment for sleep apnea, but are rarely used to treat snoring.
Remember!

There are many products that claim to have effect in curing snoring. While some are indeed effective, others are totally ineffective or even dangerous. Even if there are products that reduce snoring, it is important to call your doctor, because snoring is the main symptom of sleep apnea, which is a more serious condition.

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