Do you snore so loud it sounds like you’re sawing logs throughout the night? Don’t worry, you’re not alone. It’s estimated snoring affects around 90 million people.
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While some snorers may never realize how loud they are until someone points it out, the snores of a sleeping partner or even even yourself can be loud enough to startle you awake.
But why are you snoring? It turns out there are several possible causes, some more serious than others. We spoke with Harneet Walia, MD, of Cleveland Clinic’s Sleep Disorder to look at some of the main causes of snoring and how they can be treated.
The causes of snoring
Snoring occurs when there’s a narrowing in the upper airway of the nose and the flow of air through the mouth and nose is physically obstructed. “There’s an enhanced resistance in the airway,” says Dr. Walia, “and the airway is more collapsible.”
Air flow can be blocked by several different factors and some can be more easily treated than others.
Long soft palate or uvula
A long soft palate (roof of the mouth) or a long uvula (the dangling tissue in the back of the mouth) can narrow the opening from the nose to the throat, partially blocking the airway. When one breathes, these structures vibrate and bump against one another and a snoring sound is produced
Obstructed nasal airways
People who have partially blocked nasal passages have to make an extra effort to transfer air through them. This can pull together or collapse the soft and dangling tissue, resulting in snoring. Some people snore only during allergy seasons or when they have a sinus infection. Defects of the nose, such as a deviated septum (the wall that separates one nostril from the other) or nasal polyps (inflammatory growths) can also cause obstruction.
“Sleeping on the back is more likely to be associated with snoring,” Dr. Walia says. Sleeping in that position can cause the tongue to relax towards the back of the throat, resulting in a partially obstructed airway. A 2009 study of 2,077 sleep disorder patients conducted in Israel found that snoring was caused by sleep position in 54% of patients.
Poor muscle tone in throat and tongue
Throat and tongue muscles can be too relaxed, which allows them to collapse and fall back into the lower airway. Other factors, like consuming too much alcohol before bed or a lack of sleep, can result in throat relaxation, too, causing snoring.
Obstructive Sleep Apnea
One of the more concerning reasons for snoring is obstructive sleep apnea. Untreated obstructive sleep apnea symptoms include daytime sleepiness or tiredness, gasping for air or choking episodes at night and witnessed pauses in breathing while sleeping.
The primary condition of obstructive sleep apnea is, according to Dr. Walia, when someone has repetitive episodes of either stopping breathing or decreased breathing in their sleep.
“These episodes happen regularly during sleep. The disease defining metric for measuring obstructive sleep apnea is called the Apnea-Hypopnea Index, or sometimes the Respiratory Disturbance Index, which tells how bad a patient’s apnea is,” she says.
According to Dr. Walia, the threshold for being diagnosed with obstructive sleep apnea is five episodes an hour and, if other conditions like hypertension, mood disorders or cardiac issues are present, should lead to treatment even if the patient’s Apnea-Hypopnea Index is at or above that level.
That’s because obstructive sleep apnea can be associated with serious heart damage. “There is a very strong association between sleep apnea and cardiac arrhythmia. Research also shows episodes of upper airway collapse in sleep apnea may trigger arrhythmia events,” says Reena Mehra, MD, Director of Sleep Disorders Research in the Sleep Center of the Neurologic Institute at Cleveland Clinic.
Other ways that obstructive sleep apnea can increase risk of arrhythmia and heart failure include:
- Repeated episodes of oxygen lowering (what doctors call hypoxia)
- Changes in carbon dioxide levels
- Direct effects on the heart due to pressure changes within the chest
- Increased levels of markers of inflammation
“Obstructive sleep apnea is still an under-recognized and under-treated disorder,” says Dr. Walia, “and a very common symptom of it is particularly loud snoring. However, absence of snoring does not rule out sleep apnea.”
According to Dr. Walia, the daytime consequences of obstructive sleep apnea include excessive daytime sleepiness, fatigue, impaired concentration, drowsy driving and even poor memory.
Ways to curb snoring
If obstructive sleep apnea isn’t suspected of being the cause of your snoring, “lifestyle changes should always be the first line of treatment,” Dr. Walia says. These include:
- Dropping extra pounds. For overweight or obese people, snoring may be caused by extra weight around the throat, which leads to the collapse of the upper airway. Because of this, weight loss may decrease the frequency of snoring.
- Banishing the brew before bed. Alcohol may cause relaxation of the airway muscles while you sleep, so avoid it for several hours before bedtime.
- Changing your sleep position. Sleeping on your back can cause your airway to close. If you snore, try sleeping on your side to open your airway.
- Quitting smoking. Doing so may improve nasal congestion and thereby reduce snoring.
A trip to the drugstore will show no shortage of over-the-counter solutions for snoring, but they are not always backed by research, cautions Dr. Walia. However, some treatments may help under a doctor’s guidance:
- Intranasal decongestants. These may be useful if your snoring is caused by nasal congestion — especially the common cold. For chronic nasal congestion, intranasal steroid sprays may be used.
- Nasal strips. These strips, designed to open the airway, can ease snoring in some patients, says Dr. Walia.
Treatments for serious snorers
About half of those with loud snoring have obstructive sleep apnea. For obstructive sleep apnea, your doctor might order a sleep study in the lab, called a polysomnogram, or a home sleep apnea test.
After diagnosis, these treatments along with lifestyle changes can help reduce snoring and improve your sleep, says Dr. Walia:
- Continuous positive airway pressure (CPAP). This is the most commonly used therapeutic treatment for sleep apnea. You’ll wear a face or nasal mask overnight, which forces air through your airway to keep it open.
- Oral appliances. These mouthpieces increase the size of the upper airway during sleep, advance the jaw and the tongue forward, and can help reduce snoring. They may be safer than surgery and effective in certain patients if used correctly. They can be used in isolated snoring as well, Dr. Walia says.
- Surgery. The surgery involves removing excessive soft tissue from the throat to widen the upper airway, which can reduce snoring in some cases. You and your doctor should weigh the risks and benefits before surgery — and try other treatments first.
- Implants. An implantable device can be used in the treatment of sleep apnea in select patients.