Do you awaken in the dark to a raucous, ear-splitting sound broadcasting from the mouth of your bedmate?
You’re definitely not alone in that experience.
Some 20 million people in the United States snore. The problem gets worse as we get older. By age 60, 60 percent of men and 40 percent of women break the night’s stillness with their snorts, gasps and whistles. Women’s snores increase after menopause, when they experience a drop in progesterone, according to the American Sleep Disorders Association. Snoring also is more frequent among those who drink alcohol in the evening, carry excessive weight or who have a narrowing of the nasal or oral passages.
Some snoring can become quite loud. Imagine the poor bedmate of the noisy Englishman who emitted snores of 87.5 decibels, landing him a spot in the Guinness Book of World Records.
“Snoring occurs when there’s a blockage of the airways,” says Muhammad Hamadeh, M.D., director of the Christ Hospital and Medical Center Sleep Disorders Center, Oak Lawn. “The soft tissue in the rear of the throat collapses, flops and rocks back and forth, causing the noises.”
Often, snoring is more of a problem for the bed partner than the snorer.
“The bed partner usually is the one who complains the most,” says Hamadeh.
Snoring can be more than just noise pollution, however. It has been associated with serious medical conditions such as high blood pressure, coronary heart disease or asthma. In non-snorers, blood pressure typically drops while you sleep. Among those who snore, however, the blood pressure rises and falls-sometimes dramatically and dangerously.
“There are several clinical clues for snoring leading to something else,” says James Herdegen, M.D., medical director of the Sleep Disorder Service at Rush-Presbyterian-St. Luke’s Medical Center, Chicago. “They include waking frequently at night or choking, coughing or being short of breath. If the person’s bedmate describes loud, continuous snoring throughout the entire night, as well as periods where their bedmate stops snoring for 10 to 20 seconds and then resumes, that could be a sign that an apnea is going on.”
The apnea to which Herdegen refers is obstructive sleep apnea (OSA), and snorers are at high risk of developing it. Obstructive sleep apnea occurs when the airway becomes completely blocked by the relaxed soft tissue in the throat and breathing stops for 10 seconds to 60 seconds or more. The halted breathing can occur from 5 to 20 times an hour. And when your breath stops, the oxygen saturation level in your blood can drop as low as 70 percent, spiking your blood pressure and putting you at risk for strokes and heart attacks.
When someone snores frequently, he is continually awakened from deep sleep to try to get a breath and never gets a good night’s rest. By day, the snorer finds he is excessively tired and has trouble concentrating; his physical performance may be impaired, and he could be a potential danger behind the wheel.
Jason Mateika, a professor of applied physiology at Columbia University, New York, currently is conducting a study of people who snore but don’t have sleep apnea to determine the differences they may have in sleep behavior and physical functions compared to people who don’t snore.
The study, funded by the American Heart Association and the American Lung Association, is examining the connection between snoring and cardiorespiratory function.
“Thus far, we’re finding that when a person snores, because of changes that occur in the chest with regards to pressure, the blood pressure decreases. We also see an increase in heart rate,” says Mateika. “That’s something you don’t see in people who don’t snore. Their heart rate usually drops during the night.”
The snorers’ wild swings in blood pressure and heart rate elevations during sleep could lead to night-time cardiovascular problems such as strokes, heart attacks or daytime hypertension.
Mateika has found that hooking up a snorer to a continuous positive airway pressure machine (CPAP) reduces blood pressure variation and decreases heart rate to near normal levels.
“The CPAP has been around for a while. Basically, you put a mask over the person’s nose and a machine injects air into the airway, keeping it open and preventing snoring. The problem is with compliance.”
Not to mention what your bed partner thinks of your new look when the lights dim.
Mateika’s study involves adults. However, his findings may be of vital importance to children. Recent studies have linked behavioral problems or poor classroom performance to the reduced quality of sleep that occurs when children snore (usually because of enlarged tonsils and adenoids).
“A lot of work is now demonstrating that fragmented sleep leads to deficits in cognitive function. It also can alter behavior and lead to increased irritability,” says the professor.
Those who believe their snoring has become disruptive to their daytime life or physical well being should ask their physician to schedule a sleep study at a sleep center.
The study will determine whether the person’s problem is snoring or snoring with obstructive sleep apnea.
During a sleep study, which usually takes just one night, the person is hooked up to a variety of electrodes and monitoring devices.
“We monitor brain waves to tell whether the patient is asleep or awake, as well as eye movement to determine the stage of sleep they’re in,” says Hamadeh of Christ Hospital. “A microphone tells us if the patient is snoring. And we can check the airflow to see if he is breathing. We also measure the chest effort, oxygen and leg movement.”
Herdegen says a good sleep lab will want to see the person sleep in different body positions–on the left and right sides, supine and sometimes prone–because that information may be helpful in determining how to deal with the particular patient’s snoring problem and health issue.
The cost of a sleep lab study averages about $1,600 and usually is covered by insurance.
After the physician determines whether you have a snoring problem or a snoring problem with OSA, he can offer a variety of treatments or procedures to help curb it.
“There are treatments for people who snore without sleep apnea,” says Mateika. “For instance, there’s an oral appliance that you put it in your mouth that moves the jaw forward, increasing the size of the airway and reducing or eliminating snoring. How well it works depends on the severity of the disorder.”
Herdegen notes that some 100 or so such oral appliances exist, but few have been thoroughly studied. Among those considered more reliable are the TAP oral appliance and the Herbst appliance, he says.
“There’s also a tongue-retaining device resembling a football mouth guard that has a bubble in the front,” says Herdegen. “You put your tongue in it, then bite on the device.”
The efficacy of these oral devices depends on the person’s throat anatomy, says Hamadeh. “The problem is that they aren’t well tolerated and can cause a lot of gagging.”
Some people prefer to try over-the-counter devices such as bandage strips, which open up the nasal passages as you sleep; or the Nozovent, which is worn inside the nostrils. Proponents of natural medicine offer lozenges and a throat spray to curb the problem. Hamadeh has heard anecdotal information on these aids, but says he hasn’t seen any well-controlled studies on their effectiveness.
If simple solutions aren’t helping the snoring problem, you may want to consider one of three minimal surgical procedures.
Laser-assisted uvulopalatopharynoplasty (UPPP) and scalpel UPPP have been around for a while.
“With this type of surgery, the uvula usually is taken out, as well as part of the soft palate,” says Hamadeh. “The throat basically becomes wider. The short-term improvement in snoring after surgery is about 80 percent. But after several months or a year, the snoring comes back in about 30 percent of patients.”
A more recently approved minimal surgery, called radio frequency ablation, uses high frequency radio waves injected through a small metal needle to ablate–or reduce in size–the soft tissue in the soft palate at the back of the throat.
“Through the energy of the radio frequency waves, the tissue becomes hot, mushy and then begins retracting, because we’re inducing a scarring in that tissue so it will shrink. This method is done under a local anesthetic and doesn’t require an in-patient hospital stay,” says Herdegen.
There is pain involved in each. Herdegen cited a Stanford University-based study that compared the three procedures for post-operative discomfort. The group that underwent the radio-frequency procedure took narcotic pain medication for an average of just one day compared to the laser and standard UPPP surgical patients, who took narcotic painkillers for about 12 days.
“It’s important for people to understand the limitations and indications for surgeries,” says Herdegen. “They may not be covered by insurance if done simply for snoring. They may be approved if a sleep study shows the procedure is needed for a medical condition.”
Although a patient may see a 50 percent to 70 percent improvement in snoring after these procedures, Herdegen says most people probably won’t be completely cured of snoring.
So the question is, is that much improvement enough?
“If you’re happy with an improvement, maybe that is enough for people to go through the surgery,” he says. “Many times after surgery, people will find their snoring is worse on their back, but better on their sides.”
Yet if the snores continue to disrupt your bed partner’s sleep, it may be time to purchase good ear plugs, invest in a “white noise” machine or, perhaps, head for a separate bedroom.
