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Snoring can be a sign of more serious health problems

When is snoring more than just an annoyance for your spouse?

While snoring can annoy your spouse or significant other, it can also be a sign of more serious health problem. Dr. Steven A. Schonfeld, director of the Sleep Lab at Sinai Hospital in Baltimore, explains why it is important to figure out its root cause.

What is snoring?

Snoring is a sound caused by vibration of soft tissues in the nose or throat. It has been estimated that virtually everyone snores occasionally. However, persistent loud snoring may be disruptive to sleep and may be an early sign of disorders such as sleep apnea.

What causes snoring, and why do some people snore and others don't?

Snoring can be caused by narrowing of the airway in the nose or throat and may occur nightly. It may be related to intermittent obstruction with a respiratory infection, such as the common cold, that will resolve spontaneously. Congenital facial or airway abnormalities can also lead to snoring. More worrisome is snoring caused by intermittent blockage to airflow in the back of the throat which is called obstructive sleep apnea.

Can snoring be a cause of other health-related problems and dangers?

Yes. Snoring can be an early sign of sleep apnea. Sleep apnea is a very common problem, estimated to occur in 15 percent to 20 percent of adults. Sleep apnea is caused by intermittent relaxation of the tongue and muscles in the mouth and throat. When the tongue relaxes during sleep, it falls back in the throat and blocks breathing. This blockage may last anywhere from 10 seconds to a minute or more. As a result, sleep is disturbed and less oxygen is available to the body. The combination of the blockage and the reduced oxygen levels creates stress on the heart, brain and other organs. If snoring is the result of sleep apnea, this represents a very important and serious disorder that needs to be treated. Severe untreated sleep apnea can lead to poor control of blood pressure, poor management of diabetes, heart rhythm irregularities, heart failure and stroke. It can also be responsible for daytime sleepiness.

Snoring, unrelated to sleep apnea, is not known to definitely lead to other health problems, but can also cause daytime sleepiness and impair sleep quality.

Can snoring cause other serious problems?

In addition to health-related challenges, being excessively tired during the day can cause other problems. Untreated sleep apnea may lead to severe daytime sleepiness, which can cause cognitive impairment with decreased memory, focus and concentration. These can severely compromise the way work, school and other activities are performed. Many times, people are not even aware that interrupted sleep at night is causing these disruptions.

Excessive sleepiness can also jeopardize driving. It is widely recognized that many motor vehicle crashes are the direct result of sleepiness from untreated sleep apnea. This is such a significant problem that it is becoming a common practice for high-risk commercial drivers to be tested for sleep apnea. Recent data has shown a marked reduction in motor vehicle crashes in truck drivers who have been treated for previously undiagnosed sleep apnea.

How is snoring diagnosed?

Evaluation of snoring should include a thorough history and examination by a sleep specialist. To determine if the snoring is a sign of sleep apnea, an overnight study in a sleep center is necessary. This type of supervised testing can evaluate for sleep apnea as well as other sleep related problems. If the patient is relatively healthy without severe lung or heart disease, a home test can be performed. This test is very sensitive and specific for sleep apnea.

What are the treatments, and is there any way to stop snoring?

The standard treatment for sleep apnea is CPAP (continuous positive airway pressure), which involves wearing a small mask at night that delivers airflow to prevent blockage to breathing and to restore normal restful sleep. If snoring is related to sleep apnea, CPAP will not only control the snoring but the obstructions to breathing and improve sleep and future consequences.

A small percentage of patients can be managed with dental devices to prevent the blockage. Dental devices are not as widely used or accepted, and are only effective for milder sleep apnea. Although there are surgical procedures that have been performed for treating sleep apnea, they are not frequently performed today because of the availability of safe and successful nonsurgical techniques.

Snoring, whatever the cause, is frequently diminished by sleeping on one's side, though this is not usually sufficient to treat sleep apnea.

If snoring is not related to sleep apnea, other medical, dental and surgical approaches are available. If snoring is due to nasal congestion, decongestants or antihistamines can be used. Inhaled nasal steroids are safe and can often ease congestion and snoring. Inhaled decongestants are not recommended for use on a regular basis. External nasal dilator devices, adhesive strips that attach over the nose, are safe and may diminish snoring intensity. Additionally, weight loss will oftentimes cut back on snoring.

If snoring is still resistant to therapy, surgical interventions can be considered, and patients with congenital facial or airway abnormalities that cause snoring may also be managed surgically. Referral to an ear, nose and throat specialist would be advised for proper evaluation.

amcdaniels@baltsun.com

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