It has ruined many a relationship, but at least one group of snorers has been offered new hope this week researchers announced that taking an epilepsy medication was associated with a marked reduction in sleep apnea symptoms. What causes snoring? And how can it be tackled?
How many people snore?
Estimates vary but this is a common characteristic. According to Prof Ram Dhillon, a consultant ear, nose and throat (ENT) surgeon with a special interest in snoring and obstructive sleep apnea, about 25% of people snore. The British Snoring and Sleep Apnea Association puts the figure higher, at 41.5% of the UK adult population.
No. Dhillon says snoring is caused by the upper airways narrowing, resulting in turbulent airflow.
If the airways continue to narrow, they can become closed and cause obstructive sleep apnea, a temporary interruption of breathing that lasts longer than 10 seconds. Bed partners of those affected may find that their partner snores for a period, then stops and then suddenly makes a gasping, choking sound.
Dhillon says more than five cases of this in an hour indicates mild sleep apnea, and more than 30 per hour is classified as severe sleep apnea.
Dr Sriram Iyer, a consultant respiratory and sleep physician, says: “Most people with sleep apnea, if not all, will snore. But that doesn’t mean that all snorers will have sleep apnea.”
What causes the upper airways to narrow?
Dhillon says it is important to realize that the airway is not a rigid structure, but has soft parts. Most importantly, muscles that keep the upper airway open relax when we go to sleep, which means the tubes tend to narrow.
Iyer notes that alcohol makes the throat muscles more relaxed, which explains why many people snore after a few drinks. Lying on one’s back can also increase the chances of snoring thanks to the effect of gravity.
But there are other explanations. Iyer says, “In general, the most common reason people snore is because they are overweight or obese,” since weight gain can lead to extra tissue around the neck, which reduces the diameter of the upper airway.
Genetic factors can also play a role. “Some people will have a lower jaw that is pushed back more than usual, or some people will have a larger than usual tongue, or lax upper airway muscle base,” says Iyer.
Is snoring dangerous?
It depends. Iyer says: “Snoring in itself does not necessarily mean that your sleep will be affected or that it is dangerous. It simply indicates that there is vibration.”
But sleep apnea should be taken seriously. As the NHS notes, without treatment it can lead to problems including heart disease, high blood pressure, increased risk of stroke and type 2 diabetes.
Why does snoring get worse with age?
“[The] The most common reason, of course, is that we tend to put on weight as we age,” says Iyer.
There are other reasons. “As we age, changes occur in the upper airway muscles and airway diameter, as well as how we respond to events in our sleep, making older people more susceptible to both sleep disorders (snoring and sleep apnea) and their consequences,” he continues.
Iyer says men are more likely to snore than women, with one reason being that men tend to put more weight around their necks.
Dhillon says, “We tend to drink more, [are] probably more likely to be overweight, less likely to watch our weight and exercise.”
However, Dhillon notes that the incidence of snoring and sleep apnea increases in women around menopause—something he suggests is due to hormonal changes that affect muscle tone in the upper airways.
Why do some children snore?
Dhillon says the vast majority of children who snore or have sleep apnea will have large tonsils and adenoids that can block the upper airway.
Children can grow out of it, and Dhillon notes that it can be treated with surgery. “You can cure them with an adenotonsillectomy in the vast majority of cases,” he says.
How can snoring be treated in adults?
For common snoring and sleep apnea, weight loss and sleeping on a person are some of the recommended actions.
To help with the latter, ribbed nightgowns can keep people from sleeping on their backs. “More recently, there was a medical trial with a belt that vibrates and causes you to change your position when you’re lying on your back,” says Iyer.
Dhillon says the gold-standard treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine. It involves wearing a mask at night through which air is pumped. “When the airway narrows, the machine senses it and it increases the pressure of the airflow and unblocks you,” he says.
There are other options underway, including a device that can be implanted in the chest and is connected to the nerve that moves the tongue. If it detects an apnea event, it stimulates the tongue to move, allowing air to flow in and out of the lungs.
The epilepsy pill may also benefit people with sleep apnea, although Dhillon stresses that the study was small, it is unclear whether the pill reduced outcomes such as cardiovascular and strokes, and its effectiveness needs to be compared with that of Cpap.
Dhillon says a type of mouth guard known as a mandibular advancement device can help some people with obstructive sleep apnea, and Iyer says such devices are an effective solution to snoring in general. “With these devices, your lower jaw is actually pulled forward, and it creates more space at the back of the throat,” says Iyer.
He emphasizes that it is important to tailor treatments to individuals. “The best treatment for someone is one they will use,” he says.
What about surgery for adult snorers?
“For several decades, ENT surgeons have been using a surgery called uvulopalatopharyngoplasty (UPPP),” says Iyer. This involves removing soft tissue around the back of the throat, including the uvula, and shaving the soft palate.
But it can be very painful and, says Iyer, “has not been shown to improve the situation in all but the most carefully selected patients. So it is not a routine operation that we would recommend.”
