Snoring can also be a sign of a more serious condition known as obstructive sleep apnea (OSA), which is present in three percent of the general population. OSA is characterized by multiple pauses in breathing during sleep of greater than 10 seconds at a time due to upper airway narrowing or collapse. This lowers the amount of oxygen in the blood, and causes the heart to work harder. Because the snorer does not get a good rest, they may be sleepy during the day, which decreases their performance. Also, the lack of oxygen during sleep can produce brain fog that can persist well into the next day. Untreated OSA can contribute to high blood pressure, stroke, heart disease, workplace or motor vehicle accidents, and more.
Symptoms associated with OSA can include:
- Loud snoring
- Pauses in breathing during sleep
- Waking up gasping or choking
- Waking up with a dry mouth or sore throat
- Daytime sleepiness or fatigue
- Frequent nighttime urination
- Morning headache
- Irritability, mood changes, depression, difficulty concentrating
- High blood pressure, heart disease, stroke, or other cardiac issues
Snoring can occur without sleep apnea, but diagnostic testing is often necessary to rule out more significant sleep disorders when some of these symptoms are present.
What Are the Treatment Options?
Heavy snorers—people who snore constantly in any position or who negatively impact a bed partner’s sleep—should seek medical advice to ensure that sleep apnea is not a problem. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction, or enlargement of tonsils and adenoids. A sleep study in a laboratory or at home may be necessary to determine if snoring is due to OSA.
OSA is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered by an appliance through either the nose and/or mouth that is worn during sleep. This treatment is called continuous positive airway pressure, or CPAP, and it is currently the initial treatment of choice for patients with OSA. The challenge of treating OSA is that obstruction can occur at multiple levels of the airway. CPAP stabilizes pressure at all parts of the upper airway and can be very effective, but some wearers cannot tolerate CPAP and must seek other options.
A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/OSA. This should be fitted by an ENT specialist, dentist, or oral surgeon with expertise in sleep dentistry. Often, significant weight loss can also improve snoring and OSA.
There are numerous surgical treatments for snoring/OSA, including:
- Uvulopalatopharyngoplasty (UPPP) is a plastic surgery of the throat involving tissue repositioning, or removal of excess soft tissue, to open the airway. In addition, the remaining tissue stiffens as it heals, helping to minimize tissue vibration. A tonsillectomy can also help enlarge the airway.
- Thermal ablation procedures reduce tissue bulk in the nasal turbinates (structures on the side wall of the inside of the nose), tongue base, and/or soft palate. These procedures are used for both snoring and OSA, and several treatments may be required.
- The soft palate may be stiffened by inserting stiffening rods into the soft palate, or by injecting an irritating substance that causes stiffness in the injected area near the uvula.
- “Hypoglossal nerve stimulator” technology implants a tongue pacemaker, which stiffens and projects the tongue forward during sleep.
- Other procedures may be used to surgically target tongue muscles or the boney configuration of the midface.
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