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Snoring

Page last reviewed: 13/07/2011

Snoring is when a person makes a snorting or rattling noise while they are asleep. It occurs when the soft tissue at the back of the mouth, nose or throat vibrates when a person breathes in and out.

Healthcare professionals use a grading system to assess the severity of a person's snoring. There are three grades of snoring, which are described below.

Grade one snoring

Grade one snoring, also known as simple snoring, is where a person snores infrequently and the sound they make is not particularly loud.

In grade one snoring, a person's breathing is unaffected. This means they will not experience any significant health problems related to their symptoms. However, their snoring may cause problems or issues on a personal level if it is irritating or upsetting their partner.

Grade two snoring

Grade two snoring is where a person snores on a regular basis - more than three days a week. Some people with grade two snoring may experience mild to moderate breathing difficulties during sleep because the snoring causes their airways to become narrowed. The medical term for this is upper airway resistance syndrome (UARS).

The breathing difficulties can affect the quality of a person's sleep, which can make them to feel tired and sleepy during the day.

Grade three snoring

Grade three snoring is where a person snores every night, so loudly that it can be heard outside their room.

Many people with grade three snoring have a related condition called obstructive sleep apnoea (OSA). This is where a person's airways become partially or totally blocked for about 10 seconds.

The lack of oxygen causes the person to come out of deep sleep and into a lighter state of sleep, or to have brief period of wakefulness, in order to restore normal breathing.

Repeated episodes of snoring and waking can occur throughout the night leading to a person feeling very sleepy the following day. This may have an adverse impact on their day-to-day activities.

How common is snoring?

Snoring can affect people of all ages, including children, although it is more common in people between the ages of 40 to 60. Twice as many men than women snore.

Known risk factors for snoring include:

  • obesity - being very overweight with a body mass index (BMI) of 30 or above
  • drinking alcohol
  • smoking

When treatment is needed

If you are very sleepy during the day, your snoring may be affecting your breathing and treatment will be required.

As well as disrupting your sleep and daily activities, untreated UARS and OSA can increase your risk of developing more serious conditions, such as heart disease and stroke.

Another important risk to health is that excessive daytime sleepiness can increase the risk of a person being involved in a road traffic accident. It is estimated that up to one in five road traffic accidents are the result of excessive sleepiness.

You should also seek treatment if you have simple snoring (grade one) that is causing relationship problems with your partner. Your emotional wellbeing is just as important as your physical wellbeing, so you should not worry that your GP will dismiss your snoring as a trivial problem.

Lifestyle changes, such as losing weight, are usually recommended as the first treatment to try for snoring. 

There are also anti-snoring devices, such as mouth guards or nasal strips, that may help prevent snoring.

Surgery for snoring is usually regarded as a treatment of last resort and it is important to be aware that surgery can often have limited effectiveness and cause unpleasant side effects and complications.

Outlook

It may sometimes be possible to improve a person's snoring, but a complete cure may not be possible.

An important factor for improving or curing snoring is a person's willingness to make lifestyle changes, such as losing weight (if they are overweight) or quitting smoking (if they smoke). People who make these types of changes usually have a better chance of stopping snoring than people who do not. 


Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Page last reviewed: 13/07/2011

Snoring is where you make a noticeable sound when you breathe during sleep. The sound is caused by soft tissue at the back of your mouth, nose or throat vibrating. The exact sound you make will depend on the type of soft tissue that is vibrating.

For example, if the soft tissue at the back of your nose vibrates when you snore, it is likely that you will produce a pinched nasal sound that is not particularly loud. Whereas if the tissues at the top of your mouth (the soft palate) and the back of your throat (the uvula) vibrate, you will produce a louder, more guttural ("throaty") sound.

People tend to snore the most when they are in the deepest stages of sleep, around 90 minutes after falling asleep.

When to seek medical advice

Visit your GP if you are experiencing symptoms of excessive daytime sleepiness because it may be caused by your snoring affecting your breathing while you are sleeping.

Common signs of excessive daytime sleepiness are when you find yourself falling asleep in certain situations during the day such as:

  • watching TV
  • sitting in a meeting
  • as a passenger in a car

You can also visit your GP if you suspect that a persistent lack of sleep is affecting your day-to-day activities and causing symptoms such as:

  • poor memory and concentration
  • headaches (particularly in the morning)
  • irritability and a short temper
  • anxiety
  • depression
  • lack of interest in sex

Also visit your GP if your snoring is causing relationship problems with your partner, such as keeping them awake at night or waking them up.

It is also recommended that you contact your GP if your child snores. Snoring in children is often caused by an underlying problem with their airways, such as enlarged tonsils, which may require further investigation and treatment.

Page last reviewed: 13/07/2011

Snoring is caused when the soft tissue in your head and neck vibrates as you breathe in and out. Tissue that can be affected includes:

  • nasal passages
  • soft palate - a soft layer of tissue in the roof of your mouth
  • base of your tongue
  • tonsils - the two small glands that sit above the tongue at the junction of the mouth and pharynx (the pharynx is the upper section of the throat)
  • uvula - a small cone-shaped section of tissue that hangs between your tonsils

Bernoulli principle

While you are asleep, the various airways in your neck and head will narrow. It is thought that the narrowing of the airways triggers an effect that is known as the Bernoulli principle.

The Bernoulli principle, which is named after the Dutch mathematician who first described it, helps to explain how the flow of a fluid or gas through a passageway will speed up if the passageway is narrowed.

The narrowing of your airways during sleep means that the speed at which you are breathing out increases. The increase in the speed of your breathing leads to a corresponding decrease in air pressure. It is the decrease in air pressure that causes the soft tissue to vibrate by sucking the sides of the airways in.

There is evidence to suggest that if snoring is left untreated it will get worse over time. The vibrations that occur during snoring appear to damage the blood vessels that supply the muscles in the head and neck. This may, over many years, cause the muscles to weaken.

If the muscles in your head and neck become weakened, their ability to keep your airways open will be affected, making you more likely to snore frequently and loudly.

Risk factors

Known risk factors for habitual snoring include:

  • being obese - particularly if you have a large amount of fat around your neck. People with a neck circumference (the distance around the neck) of more than 43cm (17 inches) usually snore a lot.
  • drinking alcohol - alcohol relaxes your muscles when you sleep, which increases the narrowing of your airways 
  • sedatives and some types of antidepressants - in some people, these medications can have a similar effect on the muscles as alcohol
  • smoking - tobacco smoke can cause your airways to become inflamed, which increases the narrowing of the airways when you smoke
  • allergic rhinitis - this is a condition where the inside of your nose becomes swollen and inflamed due to an allergic reaction to substances such as dust or pollen

Page last reviewed: 13/07/2011

When you visit your GP, they will ask you some questions about your snoring. For example, they may ask you:

  • How often do you snore?
  • Is your snoring loud enough to wake other people?
  • Is your snoring worse when you are lying in any particular position, such as on your back?
  • Are there any underlying factors that may be contributing to your snoring, such as alcohol, smoking or medication?
  • Do you feel properly refreshed after sleeping or do you still feel very sleepy the following day?
  • Have other people noticed that you make snorting or gasping noises in between snores?

If you answer yes to the last two questions, it may be a sign that you have obstructive sleep apnoea (OSA).

Your GP may weigh and measure you to assess your body mass index (BMI) and they may also measure the circumference of your neck.

They may also examine your mouth and throat in case an abnormality, such as swollen tonsils or a non-cancerous growth, is contributing to your snoring.

Further testing is usually only required if your symptoms suggest that you have OSA. This may involve referring you to a specialist sleep centre so that you can be monitored while you sleep. Or you may be given a monitoring device to wear at night while you sleep at home. This is known as a home sleep study. 

Page last reviewed: 13/07/2011

Your treatment plan

Your GP will usually advise you to make lifestyle changes, to see if these help your snoring (see below).

If these prove ineffective, there devices that can be fitted inside your mouth or nose that are designed to ease snoring.

Several surgical techniques can also be used to correct snoring.

Lifestyle changes

The following lifestyle changes may help you to stop snoring:

  • losing weight (if you are overweight) 
  • not drinking alcohol, particularly during the evening 
  • giving up smoking (if you are a smoker)
  • taking regular exercise - this will help strengthen the muscles in your neck, which may help to prevent the airways in your neck and mouth from narrowing. .

If you feel that your medication may be contributing to your snoring, talk to your GP about it. They may be able to prescribe alternative medication.

However, do not stop taking any prescribed medication without first consulting your GP.

If your snoring is worse when you are sleeping on your back, stitching a pocket into the back of your pyjamas (between the shoulder blades) and putting either a golf ball or a tennis ball in the pocket may stop you sleeping on your back.

Ear plugs

If your snoring is not causing you any health problems but is annoying your partner, asking them to wear ear plugs during the night may be a cheap and effective way of resolving the issue.

Anti-snoring devices

Anti-snoring devices are devices that can help prevent snoring, they are available at many larger pharmacies.

The different types of anti-snoring devices are described below.

Nasal devices

If your snoring is mainly coming from your nose, you may benefit from using nasal strips or nasal dilators.

Nasal strips are small pieces of self-adhesive tape that are similar in appearance to sticking plasters. Before you go to sleep, you place the nasal strip on the outside of your nose. The strip pushes your nostrils apart, which can help prevent them narrowing during sleep.

A nasal dilator is a plastic or metal device that looks a bit like a nose ring. You place the dilator inside your nose before going to sleep and it pushes your nostrils apart while you are asleep.

Currently, there has not been much research to compare the effectiveness of each type of nasal device in treating snoring. For most people, the choice of which device to use is based on personal preference. 

Oral devices

If your snoring is mainly coming from your mouth, you may benefit from chin strips or a vestibular shield. Chin strips are strips of tape that are placed under your chin. The strips help stop your mouth falling open while you sleep.

A vestibular shield is a plastic device that is similar in appearance to a boxer's gum shield. It fits inside your mouth, blocking the flow of air into your mouth. This forces you to breathe through your nose which may prevent you from opening your mouth and snoring.

As with nasal devices, there is limited evidence regarding which type of oral device is more effective, so the choice will be down to your personal preference.

Mandibular repositioning splint (MRS)

If your snoring is mainly due to the base of your tongue vibrating, a mandibular repositioning splint (MRS) (also known as a mandibular advancement device) may be recommended.

A MRS is similar to a vestibular shield, but rather than keeping your mouth closed it is designed to push your jaw and tongue forward. This will increase the space at the back of your throat and reduce the narrowing of your airway that is causing your tongue to vibrate, resulting in snoring.

You can buy a MRS off the shelf , which should be suitable to use for most cases of simple snoring (snoring that does not cause any breathing difficulties).

However, if your snoring is associated with breathing difficulties, such as sleep apnoea, it is recommended that a MRS is made specifically for you by an orthodontist (a dental specialist) using impressions of your teeth and jaw. The cost will depend on the complexity of the device and the materials used.

A MRS lasts about 18 months before it needs to be replaced.

Surgery

Surgery for snoring is usually regarded as a treatment of last resort, when all other treatment options have been tried and proven to be ineffective. Surgery is also not suitable for all cases of snoring. For example, it has limited effectiveness in treating nasal snoring.

Surgery is not usually recommended for people with sleep apnoea because there are more effective treatments available, such as using breathing devices to help with breathing.

In cases where there are obvious anatomical problems that are contributing towards snoring, such as having large tonsils, the recommended surgical option may be to correct the problem by removing the tonsils. Otherwise, there are four main types of surgery that are used to treating snoring. These are:

  • uvulopalatopharyngoplasty (UPPP)
  • uvulopalatoplasty (UP)
  • palate implants
  • radiofrequency ablation of the soft palate

However, these types of surgery are not usually available. They are described below.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is a surgical technique that is used when it has been confirmed that the soft tissue in your mouth (excluding your tongue) is responsible for your snoring.

During UPPP the surgeon will remove:

  • your uvula - the piece of tissue that hangs from the roof of your mouth
  • some of your soft palate
  • some of the excess tissue around the base of your throat
  • in some cases, your tonsils and your adenoids (small lumps of tissue that are located at the back of the throat, above your tonsils)

UPPP is carried out under general anaesthetic, which means that you will be asleep during surgery and unable to feel any pain or discomfort. 

However, UPPP can cause considerable pain afterwards, which can sometimes persist for up to three weeks.

Removing your uvula can affect your ability to pronounce certain sounds. However, this will not affect your ability to speak English because the English language does not make use of any of the sounds made with the uvula (known as uvular consonants).

Removal of the uvula will affect your ability to pronounce certain words in other languages, such as French (the "ree" sound in the word Paris) or Spanish (the "ju" sound in the Spanish word enjuto, which means "dry").

UPP is successful in completely curing snoring in about half of all people who have the procedure. Serious complications occur in an estimated 1% of cases. They include:

  • excessive bleeding
  • pneumonia (lung infection)
  • stroke 
  • heart attack

These can cause death in an estimated 1 in 500 cases.

Uvulopalatoplasty (UP)

Uvulopalatoplasty (UP) is increasingly being used as an alternative technique to UPPP because it carries a lower risk.

However, evidence suggests that UP may not be as effective as UPPP in the long term. UP can also cause considerable post-operative pain that lasts up to two weeks.

During UP, lasers or high-energy radio waves are used to burn away the uvular and some of the soft palate.

Soft palate implants

Soft palate implants can be used to treat simple snoring (snoring that does not cause any breathing difficulties) when it has been confirmed that the vibration of the soft palate is causing it.

During the procedure, a local anaesthetic injection will be used to numb the roof of your mouth. Several implants that are made out of synthetic material are then injected into your palate, causing it to stiffen. This should help prevent the soft palate vibrating while you sleep.

In 2007, the National Institute for Health and Clinical Excellence (NICE) released guidance about soft palate implants. They stated that there are no safety concerns regarding the use of implants, but people who are considering using them should be aware that there is limited evidence about whether they are an effective long-term treatment.

Radiofrequency ablation

Radiofrequency ablation of the soft palate is an alternative type of treatment to soft palate implants. It is used to treat cases where vibrations of the soft palate are responsible for snoring.

During radiofrequency ablation, the roof of your mouth will be numbed with local anaesthetic and an electrode will be implanted in the tissue of your soft palate. The electrode will then be used to deliver high-energy radio waves that will shrink and harden the tissue of the soft palate. This should help to make it less likely to vibrate when you are asleep.

NICE guidance for radiofrequency ablation is similar to the guidance for soft palate implants. There are no obvious safety concerns about the procedure, but there is currently limited evidence as to the long-term effectiveness of the treatment. 

Medication

There are no medications available that can directly treat the symptoms of snoring, but there are some that can help treat some of the underlying causes.

For example, if allergic rhinitis (nasal irritation and swelling) is responsible for your snoring, an antihistamine nasal spray may help relieve your symptoms. Antihistamines are a type of medication that has proved to be very effective in treating allergic reactions.

Alternatively, if your snoring becomes particularly troublesome as the result of having a blocked nose, a short course of nasal decongestants may help. However, never use nasal decongestants for more than seven days in a row because it can make your symptoms worse.

Your GP will be able to advise you about whether medication will be able to help with your snoring.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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