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About Snoring

What Causes Snoring?

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The noisy sounds of snoring occur when the airflow through the passages at the back of the mouth and throat causes instability in the soft palate tissue. The instability then causes these tissues to vibrate, which results in snoring sounds. Studies estimate that the soft palate contributes, entirely or in part, to 90% of all snoring.

As throat muscles relax during sleep, unsupported tissues in the back of the mouth (soft palate) and throat (pharynx) may collapse reducing the size of the airway. The reduction in the size of the airway causes air speed to increase during breathing, further increasing soft palate instability. The soft palate tissue begins to vibrate, producing the snoring sounds. Stiffening, or reduction in length, of the palate increases the “critical” air speed required to initiate this vibration, leading to a reduction in snoring.

It is estimated that the soft palate contributes to 90% of all snoring.

Possible Causes of Snoring

  • Excessive bulkiness of throat tissue-
    Large tonsils and adenoids can contribute to snoring, as can cysts or tumors.  People who are overweight generally have bulky neck tissue.
  • imagesObstructed nasal airways-
    An obstruction in the nose (for example: nasal congestion due to allergies) requires more effort to pull air through.  This creates an exaggerated vacuum in the throat, pulling together the floppy tissues and causing snoring.
  • Poor muscle tone in tongue and throat-
    When the muscles of the throat are too relaxed, the tongue falls backwards into the airway, or the throat muscles draw in from the sides into the airway.
  • Long soft palate and uvula-
    A long palate narrows the opening from the nose into the throat.  As it dangles, it acts as a noisy flutter valve during relaxed breathing.
  • Deviated septum-
    A deviated septum, a deformity in the wall that separates one nostril from the other, can cause obstruction to the airflow through the nose, resulting in snoring.

 

Why is snoring a problem?

Snoring sometimes can be the only sign of a more serious problem. People who snore should be evaluated to be certain that other problems such as sleep apnea, other sleeping problems, or other sleep-related breathing problems.

If the snorer sleeps and breathes normally, then snoring is only a problem for the snorer’s bed partner or family members. In fact, snoring often disrupts the sleep of family members and partners more than it affects the snorer. Frequently, partners of snorers report leaving the bedroom (or making the snorer leave the bedroom) many nights per week. Snoring (without sleep apnea) may not be a medical problem, but it can become a significant social problem for the snorer and sleep problem for the bed partner.

 

What is the clinical importance of snoring?

It is important to determine if snoring is related to an underlying or other medical condition or is an isolated (primary) problem (not associated with any underlying disease).

More specifically, primary snoring is not associated with obstructive sleep apnea (OSA), upper airway resistance, insomnia, or other sleep disorders. This distinction is important because of the associated link between the underlying conditions and other adverse health effects.

For example, obstructive sleep apnea (OSA) is associated with higher risks of cardiovascular disease such as heart attacks and strokes. This association is thought to exist because of higher prevalence of high blood pressure (hypertension) in individuals with obstructive sleep apnea. On the other hand, studies have shown that people with primary snoring did not have higher rates of elevated blood pressure compared to the general public. if a patient’s history is concerning for sleep apnea, the physician my request a sleep study for further evaluation.

How is it determined if snoring is associated with a medical problem?

People who sleep (or lie awake not sleeping) near a snorer often report signs that may indicate a more serious problem. Witnessed apnea (stopping breathing) or gasping can suggest a breathing problem like sleep apnea (see below) or heart problems. Leg kicking or other jerking movements can indicate a problem such as periodic limb movement disorder or restless leg syndrome. Referral to a sleep specialist may be recommended if obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder are suspected.

If someone’s sleep is disrupted because of snoring, the person may also notice other symptoms. Frequently, people complain of difficulty waking up in the morning or a feeling of insufficient sleep. They may take daytime naps or fall asleep during meetings. If sleep disruption is severe, people have fallen asleep while driving or performing their daily work.

How should someone with snoring be evaluated?

To thoroughly evaluate someone with a snoring problem, a complete history and physical examination is performed. The patient may be asked about sleep patterns and sleep hygiene, daytime symptoms of sleepiness, daytime napping, and frequency of awakening at night.

A thorough physical examination may also be performed including assessing the patient’s body weight and/or BMI, assessment of the neck circumference (area around the neck), and visualization of the throat, nasal, and oral cavities to determine how narrow the passages are.