Snoring

Short description: Vibratory sound made while asleep

Snoring

File:Schnarchen 01.ogg
Specialty| Otorhinolaryngology, sleep medicine

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Research suggests that snoring is one of the factors of sleep deprivation. File:Pig snoring.ogg

## Contents

* 1 Causes
* 2 Possible consequences
* 3 Treatment
* 3.1 Tongue exercises
* 3.2 Orthopedic pillows
* 3.3 Dental appliances
* 3.4 Positive airway pressure
* 3.5 Surgery
* 3.6 Pillar procedure
* 4 Epidemiology
* 5 References
* 6 Further reading

## Causes

Snoring is the result of the relaxation of the uvula and soft palate.[1] These tissues can relax enough to partially block the airway, resulting in irregular airflow and vibrations.[2] Snoring can be attributed to one or more of the following:

* Genetic predisposition, a proportion of which may be mediated through other heritable lifestyle factors such as body mass index, smoking and alcohol consumption.[3]
* Throat weakness, causing the throat to close during sleep.[4]
* Mispositioned jaw, often caused by tension in the muscles.[2]
* Obesity that has caused fat to gather in and around the throat.[3][4]
* Obstruction in the nasal passageway.[2]
* Obstructive sleep apnea.[2]
* Sleep deprivation.[2]
* Relaxants such as alcohol or other drugs relaxing throat muscles.[2][3]
* Sleeping on one's back, which may result in the tongue dropping to the back of the mouth.[2]
* Mouth breathing[5]

## Possible consequences

Snoring is known to cause sleep deprivation to snorers and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido.[6] It has also been suggested that it can cause significant psychological and social damage to those affected.[7] A 2008 study shows a positive correlation between loud snoring and the risk of heart attack (about +34% chance) and stroke (about +67% chance).[8] A 2021 meta-analysis reports up to a 46% increased risk of stroke.[9]

Though snoring is often considered a minor condition, snorers can sometimes experience severe impairment of lifestyle. The between-subjects trial by Armstrong et al. discovered a statistically significant improvement in marital relations after snoring was surgically corrected. This was confirmed by evidence from Gall et al.,[10] Cartwright and Knight[11] and Fitzpatrick et al.[12]

Studies have associated loud snoring with the development of carotid artery atherosclerosis.[13] Amatoury et al.[14] demonstrated that snoring vibrations are transmitted to the carotid artery, identifying a possible mechanism for snoring-associated carotid artery damage and atherosclerotic plaque development. These researchers also found amplification of the snoring energy within the carotid lumen at certain frequencies, adding to this scenario. Vibration of the carotid artery with snoring also lends itself as a potential mechanism for atherosclerotic plaque rupture and consequently ischemic stroke.[14] Researchers also hypothesize that loud snoring could create turbulence in carotid artery blood flow.[15] Generally speaking, increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis. While there is plausibility and initial evidence to support snoring as an independent source of carotid artery/cardiovascular disease, additional research is required to further clarify this hypothesis.[16]

## Treatment

So far, there is no certain treatment that can completely stop snoring. Almost all treatments for snoring revolve around lessening the breathing discomfort by clearing the blockage in the air passage. Medications are usually not helpful in treating snoring symptoms, though they can help control some of the underlying causes such as nasal congestion and allergic reactions. Doctors, therefore, often recommend lifestyle changes as a first-line treatment to stop snoring.[17] This is the reason snorers are advised to lose weight (to stop fat from pressing on the throat), stop smoking (smoking weakens and clogs the throat), avoid alcohol and sedative medications before bedtime (they relax the throat and tongue muscles, which in turn narrow the airways)[18] and sleep on their side (to prevent the tongue from blocking the throat).

A number of other treatment options are also used to stop snoring. These range from over-the-counter aids such as nasal sprays, nasal strips or nose clips, lubricating sprays, oral appliances and "anti-snore" clothing and pillows, to unusual activities such as playing the didgeridoo.[19][unreliable medical source] Many over-the-counter snoring treatments, such as stop-snoring rings or wrist-worn electrical stimulation bands, have no scientific evidence to support their claims.

### Tongue exercises

Myofunctional therapy, which incorporates oropharyngeal and tongue exercises, reduces snoring in adults based on both subjective questionnaires and objective sleep studies. Snoring intensity was reduced by 51%.[20]

### Orthopedic pillows

Orthopedic pillows are the least intrusive option for reducing snoring. These pillows are designed to support the head and neck in a way that ensures the jaw stays open and slightly forward. This helps keep the airways unrestricted as possible and in turn leads to a small reduction in snoring.

### Dental appliances

One style of mandibular advancement splint

Specially made dental appliances called mandibular advancement splints, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. Such appliances have been proven to be effective in reducing snoring and sleep apnea in cases where the apnea is mild to moderate.[21] Mandibular advancement splints are often tolerated much better than CPAP machines.[22]

### Positive airway pressure

Main page: Engineering:Positive airway pressure

A continuous positive airway pressure (CPAP) machine is often used to control sleep apnea and the snoring associated with it. It is a relatively safe medical treatment. To keep the airway open, a device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.[23] A CPAP is usually applied through a CPAP mask which is placed over the nose and/or mouth. The air pressure required to keep the airway open is delivered through this and it is attached to a CPAP machine which is like an air compressor.

The air that CPAP delivers is generally "normal air"—not concentrated oxygen. The machine utilizes the air pressure as an "air splint" to keep the airway open. In obstructive sleep apnea, the airway at the rear of the throat is prone to closure.

### Surgery

Surgery is also available as a method of correcting social snoring. Some procedures, such as uvulopalatopharyngoplasty, attempt to widen the airway by removing tissues in the back of the throat, including the uvula and pharynx. These surgeries are quite invasive, however, and there are risks of adverse side effects. The most dangerous risk is that enough scar tissue could form within the throat as a result of the incisions to make the airway more narrow than it was prior to surgery, diminishing the airspace in the velopharynx. Scarring is an individual trait, so it is difficult for a surgeon to predict how much a person might be predisposed to scarring. Currently, the American Medical Association does not approve of the use of lasers to perform operations on the pharynx or uvula.

Radiofrequency ablation (RFA) is a relatively new surgical treatment for snoring. This treatment applies radiofrequency energy and heat (between 77 °C and 85 °C) to the soft tissue at the back of the throat, such as the soft palate and uvula, causing scarring of the tissue beneath the skin. After healing, this results in stiffening of the treated area. The procedure takes less than one hour, is usually performed on an outpatient basis, and usually requires several treatment sessions. Radiofrequency ablation is frequently effective in reducing the severity of snoring, but often does not eliminate it.[24][unreliable medical source]

Bipolar radiofrequency ablation, a technique used for coblation tonsillectomy, is also used for the treatment of snoring.

### Pillar procedure

The pillar procedure is a minimally invasive treatment for snoring and obstructive sleep apnea. In the United States, this procedure was FDA indicated in 2004. During this procedure, three to six+ Dacron (the material used in permanent sutures) strips are inserted into the soft palate, using a modified syringe and local anesthetic. While the procedure was initially approved for the insertion of three "pillars" into the soft palate, it was found that there was a significant dosage response to more pillars, with appropriate candidates.[citation needed] As a result of this outpatient operation, which typically lasts no more than 30 minutes, the soft palate is more rigid, possibly reducing instances of sleep apnea and snoring. This procedure addresses one of the most common causes of snoring and sleep apnea—vibration or collapse of the soft palate (the soft part of the roof of the mouth). If there are other factors contributing to snoring or sleep apnea, such as conditions of the nasal airway or an enlarged tongue, it will likely need to be combined with other treatments to be more effective.[25]

## Epidemiology

Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore.[26] One survey of 5,713 American residents identified habitual snoring in 24% of men and 13.8% of women, rising to 60% of men and 40% of women aged 60 to 65 years; this suggests an increased susceptibility to snoring with age.[27]

An observational study in the UK Biobank estimated that ~37% of 408,317 participants were habitual snorers, and confirmed positive associations with larger body-mass index, lower socio-economic status and more frequent smoking and alcohol consumption.[3]

## References

1. ↑ 100 Questions & Answers About Sleep And Sleep Disorders. Jones & Bartlett Learning. 2007. pp. 124. ISBN 978-0763741204.
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 "Snoring Causes". 26 April 2015. http://www.mayoclinic.org/diseases-conditions/snoring/basics/causes/con-20031874.
3. ↑ 3.0 3.1 3.2 3.3 "Insights into the aetiology of snoring from observational and genetic investigations in the UK Biobank". Nature Communications 11 (1): 817. February 2020. doi:10.1038/s41467-020-14625-1. PMID 32060260. Bibcode: 2020NatCo..11..817C.
4. ↑ 4.0 4.1 "Obstructive sleep apnea". University of Maryland Medical Center. 19 September 2012. http://umm.edu/health/medical/reports/articles/obstructive-sleep-apnea.
5. ↑ "Guidelines proposal for clinical recognition of mouth breathing children". Dental Press Journal of Orthodontics 20 (4): 39–44. July–August 2015. doi:10.1590/2176-9451.20.4.039-044.oar. PMID 26352843.
6. ↑ "Decreased pituitary-gonadal secretion in men with obstructive sleep apnea". The Journal of Clinical Endocrinology and Metabolism 87 (7): 3394–3398. July 2002. doi:10.1210/jcem.87.7.8663. PMID 12107256. "Decreased libido is frequently reported in male patients with obstructive sleep apnea (OSA).".
7. ↑ "The effect of surgery upon the quality of life in snoring patients and their partners: a between-subjects case-controlled trial". Clinical Otolaryngology and Allied Sciences 24 (6): 510–522. December 1999. doi:10.1046/j.1365-2273.1999.00307.x. PMID 10606999.
8. ↑ "Cardiovascular disease and health-care utilization in snorers: a population survey". Sleep 31 (3): 411–416. March 2008. doi:10.1093/sleep/31.3.411. PMID 18363318.
9. ↑ "Snoring Is Associated With Increased Risk of Stroke: A Cumulative Meta-Analysis". Frontiers in Neurology 12: 574649. 2021. doi:10.3389/fneur.2021.574649. PMID 33868139.
10. ↑ "Quality of life in mild obstructive sleep apnea". Sleep 16 (8 Suppl): S59–S61. December 1993. doi:10.1093/sleep/16.suppl_8.s59. PMID 8178027.
11. ↑ "Silent partners: the wives of sleep apneic patients". Sleep 10 (3): 244–248. June 1987. doi:10.1093/sleep/10.3.244. PMID 3629086.
12. ↑ "Snoring, asthma and sleep disturbance in Britain: a community-based survey". The European Respiratory Journal 6 (4): 531–535. April 1993. doi:10.1183/09031936.93.06040531. PMID 8491303.
13. ↑ "Heavy snoring as a cause of carotid artery atherosclerosis". Sleep 31 (9): 1207–1213. September 2008. PMID 18788645.
14. ↑ 14.0 14.1 "Snoring-related energy transmission to the carotid artery in rabbits". Journal of Applied Physiology 100 (5): 1547–1553. May 2006. doi:10.1152/japplphysiol.01439.2005. PMID 16455812.
15. ↑ "Snoring: A Precursor to Medical Issues". Apnea Sciences. April 2015. https://www.snorerx.com/Snoring-Precursor-to-Medical-Issues.pdf.
16. ↑ "Health Check: is snoring anything to worry about?". The Conversation. 16 January 2017. https://theconversation.com/health-check-is-snoring-anything-to-worry-about-68142.
17. ↑ "How to Stop Snoring: Causes, Cures, and Remedies". Medical-Reference. 15 December 2022. http://www.medical-reference.net/2013/09/how-to-stop-snoring-causes-remedies.html.
18. ↑ "Obstructive sleep apnea: Overview". U.S. National Library of Medicine — Pubmed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072458/.
19. ↑ "Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial". BMJ (Clinical Research Ed.) 332 (7536): 266–70. February 2006. doi:10.1136/bmj.38705.470590.55. PMID 16377643.
20. ↑ "Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis". European Archives of Oto-Rhino-Laryngology 275 (4): 849–855. April 2018. doi:10.1007/s00405-017-4848-5. PMID 29275425.
21. ↑ "An oral elastic mandibular advancement device for obstructive sleep apnea". American Journal of Respiratory and Critical Care Medicine 161 (2 Pt 1): 420–425. February 2000. doi:10.1164/ajrccm.161.2.9903079. PMID 10673180.
22. ↑ "Comparisons of oral devices for snoring". Journal of the California Dental Association 26 (8): 611–23. August 1998. doi:10.1080/19424396.1998.12221713. PMID 9852857. http://www.cda.org/Library/cda_member/pubs/journal/jour898/devices.html.
23. ↑ "Continuous Positive Airway Pressure (CPAP)". American Academy of Otolaryngology−Head and Neck Surgery. http://www.entnet.org/healthinfo/snoring/cpap.cfm.
24. ↑ "Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing". Chest 113 (5): 1163–74. May 1998. doi:10.1378/chest.113.5.1163. PMID 9596289.
25. ↑ "What Is Pillar". Pillar Procedure. http://www.pillarprocedure.com/what-is-pillar/.
26. ↑ "New Vaccine Could Cure Snoring (statistics insert)". BBC News. 2001-09-19. http://news.bbc.co.uk/2/hi/health/1552168.stm.
27. ↑ "Some epidemiological data on snoring and cardiocirculatory disturbances". Sleep 3 (3–4): 221–224. 1980. doi:10.1093/sleep/3.3-4.221. PMID 7221330.

## Further reading

* Breath: The New Science of a Lost Art. Riverhead Books. 2020. ISBN 978-0735213616.

Classification|

* ICD-10: R06.5
* ICD-9-CM: 786.09
* MeSH: D012913
* DiseasesDB: 12260

|

External resources|

* MedlinePlus: 003207

* v
* t
* e

Psychophysiology: Sleep and sleep disorders (F51 and G47 / 307.4 and 327)

Sleep stages|

* Rapid eye movement (REM)
* Non-rapid eye movement
* Slow-wave

Brain waves|

* Alpha wave
* Beta wave
* Delta wave
* Gamma wave
* K-complex
* Mu rhythm
* Sensorimotor rhythm
* Sleep spindle
* Theta wave

Sleep
disorders|

| Dyssomnia|

* Hypersomnia
* Insomnia
* Kleine–Levin syndrome
* Narcolepsy
* Sleep apnea
* Central hypoventilation syndrome
* Obesity hypoventilation syndrome
* Sleep state misperception

|

Circadian rhythm
disorders

* Advanced sleep phase disorder
* Delayed sleep phase disorder
* Irregular sleep–wake rhythm
* Jet lag
* Non-24-hour sleep–wake disorder
* Shift work sleep disorder

Parasomnia|

* Catathrenia
* Night terror
* Rapid eye movement sleep behavior disorder
* Sleepwalking
* Somniloquy

Other|

* Bruxism
* Cyclic alternating pattern
* Night eating syndrome
* Nocturia
* Periodic breathing
* Nocturnal myoclonus

Benign
phenomena|

* Dream
* Exploding head syndrome
* False awakening
* Hypnagogia / Sleep onset
* Hypnic jerk
* Lucid dream
* Nightmare
* Nocturnal clitoral tumescence
* Nocturnal emission
* Nocturnal penile tumescence
* Sleep paralysis
* Somnolence

Related
topics|

* Bed
* Bunk bed
* Daybed
* Four-poster bed
* Futon
* Hammock
* Mattress
* Sleeping bag
* Bed bug
* Bedding
* Bedroom
* Bedtime
* Bedtime story
* Bedtime toy
* Biphasic and polyphasic sleep
* Chronotype
* Dream journal
* Excessive daytime sleepiness
* Hypnopompic state
* Hypnosis
* Lullaby
* Microsleep
* Nap
* Nightwear
* Power nap
* Second wind
* Siesta
* Sleep and creativity
* Sleep and learning
* Sleep debt
* Sleep deprivation
* Sleep diary
* Sleep hygiene
* Sleep induction
* Sleep inertia
* "Sleeping sickness"1
* Sleeping while on duty
* Sleepover
* Snoring
* Somnology
* Polysomnography
* Sleep medicine

* 1 Not a sleep disorder.

* v
* t
* e

Symptoms and signs relating to the respiratory system (R04–R07, 786)

Medical examination and history taking

Auscultation|

* Stethoscope
* Respiratory sounds
* Stridor
* Wheeze
* Crackles
* Rhonchi
* Stertor
* Squawk
* Pleural friction rub
* Fremitus
* Bronchophony
* Terminal secretions
* Elicited findings
* Percussion
* Pectoriloquy
* Whispered pectoriloquy
* Egophony

Breathing|

| Rate|

* Apnea
* Prematurity
* Dyspnea
* Hyperventilation
* Hypoventilation
* Hyperpnea
* Tachypnea
* Hypopnea
* Bradypnea

|

Pattern|

* Agonal respiration
* Biot's respiration
* Cheyne–Stokes respiration
* Kussmaul breathing
* Ataxic respiration

Other|

* Respiratory distress
* Respiratory arrest
* Orthopnea/Platypnea
* Trepopnea
* Aerophagia
* Asphyxia
* Breath holding
* Mouth breathing
* Snoring

Other|

* Chest pain
* In children
* Precordial catch syndrome
* Pleurisy
* Nail clubbing
* Cyanosis
* Cough
* Sputum
* Hemoptysis
* Epistaxis
* Silhouette sign
* Post-nasal drip
* Hiccup
* COPD
* Hoover's sign
* asthma
* Curschmann's spirals
* Charcot–Leyden crystals
* chronic bronchitis
* Reid index
* sarcoidosis
* Kveim test
* pulmonary embolism
* Hampton hump
* Westermark sign
* pulmonary edema
* Kerley lines
* Hamman's sign
* Golden S sign

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