What is snoring and why does it happen?
Snoring refers to loud, harsh noises during sleep. This happens due to the narrowing of the air passages of the nose, mouth and throat due to falling back of the tongue and relaxation of the throat muscles, seen during sleep especially while lying on one’s back.
Quick read – Daily exercises to reduce snoring
Who are the people predisposed to snoring?
The following are some of the factors which make a person more likely to snore:
- Male gender and Increasing age
- Alcohol intake in the late evening
- A late heavy meal/dinner
- Sleeping in dry environments or lack of hydration
- Obesity (more fat around the neck) or being overweight
- Certain medicines like muscle relaxants or antianxiety pills (benzodiazepine group) taken at bed-time
- Problems in the nose:
- Nasal allergies
- Heavy cold
- Presence of outgrowths in the nose (called polyps)
- Swollen/enlarged turbinates (turbinates are structures made of bone, blood vessels and tissue in the sidewall of the nose which help warm and moisten the air which enters the nose)
- When the dividing bone of the nose is slanting (deviated nasal septum -DNS)
- Throat infections
- Presence of enlarged tonsils or adenoids (a common reason for snoring in children)
What is sleep apnea?
Apnea refers to stopping to breathe. If the air passages of the throat, nose or mouth narrow down to such an extent during sleep that there are moments when breathing stops completely, it is called sleep apnea. The person makes grunting, gasping or choking loud sounds during sleep apnea episodes. This helps the person momentarily wake up so that air passages open and breathing starts again, though the person may not realize or remember the same. These multiple episodes of apnea and waking during sleep prevents deep and restful continuous night sleep.
This type of sleep apnea is called ‘obstructive sleep apnea (OSA)’ which is the one seen most commonly as compared to the rarer ‘central sleep apnea’ where the brain signals to breathing muscles during sleep are improper, seen in some brain diseases like infections and stroke, or with some narcotic drugs.
Snoring in sitting posture as seen in many plane/vehicle passengers is an indication of more airway obstruction and has an even higher risk for sleep apnea.
Does snoring cause any health problems?
People who snore often have a feeling of tiredness in the morning as if they have not slept or rested enough. This may be accompanied by daytime sluggishness, sleepiness or irritability and not able to concentrate optimally. The feeling of dryness in the mouth and nose may also occur.
If sleep apnea is present along with snoring, the feeling of daytime tiredness and sleepiness maybe even more, sometimes with morning headaches. Loss of sexual drive may also occur.
Snoring with sleep apnea in the long term are risk factors for developing diabetes, weight gain, increased blood pressure, heart disease and stroke. Research is also showing now that sleep apnea can hasten the progression of fatty liver disease.
Therefore, from both short term and long term health and wellness perspective it is important to look for solutions to reduce and control snoring and sleep apnea.
What are the Health solutions for Snoring?
Snoring can be reduced considerably by lifestyle solutions.
- Train to sleep on your side than on your back. Using an extra pillow to prop up the head or elevating head end of the bed can help. If you snore while sitting in flights/vehicles, avoid reclining.
- Avoid heavy meals and alcohol at least 3 hours before bedtime.
- If overweight, consult a nutritionist for a weight loss and exercise plan with a target reduction of at least 2-3 kgs to have an effect on reducing snoring.
- Avoid intake of muscle relaxants and antianxiety/sleeping pills (of the benzodiazepine group of medicines)
- Get a complete medical examination done to rule out the mentioned issues in the mouth, throat or nose.
- Treatment of nasal stuffiness due to nasal allergies or cold with decongesting medicines or nasal sprays can help reduce snoring.
- AC and closed dry environment (like seen in flights) can cause drying of air passages and increased tendency to snore. A humidifier spray or saline nasal spray can help. Have a few sips of water just before going to sleep.
- There is some research to suggest that smoking increases snoring risk therefore smokers are advised to restrict and give up the habit.
The aim of these exercises is to
- Increase the tone and strength of throat, tongue and palate muscles
- Keep air passages open at all times
Here are 5 exercises below (Hold time 5 seconds; 5 repetitions)
- Stick the tongue out of the mouth fully as much as possible, then move it to one side and then to the other side as much as possible without curling the tongue. Hold in each position for 5 seconds, and then put back in. Do this at least 5 times.
- With the tongue in the mouth, open the mouth wide, hold for 5 seconds and close. Then open wide again, move the lower jaw to one side, hold for 5 seconds, bring back and close. Then open again wide and move lower jaw to the other side, hold for 5 seconds, bring back and close mouth. Repeat this set of 3 exercises 5 times.
- Press the tip of the tongue on the roof of the mouth, then move it as back then as front as possible on the roof of the mouth (palate). Repeat this back and forth motion 5 times.
- With your index finger in the mouth, push the cheek away from the teeth for 5 seconds then release. Do this on each side around 5 times each.
- Pronounce the 5 vowels for 5 seconds each, one by one with full mouth stretch for the particular vowel.
In all the above exercises, you will be able to feel a tension and stretch in your mouth, and throat. There are other kinds of exercises which may be recommended by trainers. Interestingly vocal music training is known to be helpful in preventing snoring!
These help to keep the air passages open as shown below. Some of them now come with memory or microbead foam and are called ‘smart pillows’ as they adjust to the head size and neck curvature.
- Nasal devices or strips – to keep nasal air passages open.
- Mouth devices – to keep mouth, tongue and palate in position to keep air passages open.
- Chin straps – They help by preventing jaw-dropping and thereby preventing tongue falling backward.
It is important to note that the above devices may be useful in some but not others.
Therefore, it is best to go ahead with one of them after medical consultation and examination with a physician, ENT specialist or Dentist.
The devices mentioned below are for patients with diagnosed Sleep apnea after evaluation through sleep tests (polysomnography, calculation of certain indices), in a sleep clinic or through sleep tests medically conducted at home
- Upper Airway Muscle stimulators – This device monitors the breathing patterns while sleeping and based on that, delivers mild stimulation to the airway muscles to keeps the air passages open while sleeping. It is mainly for patients who have snoring with obstructive sleep apnea.
- Positive Airway Pressure (PAP) – This device is usually recommended for patients with prominent day time functioning impairment or high cardiac risk due to sleep apnea.
PAP uses a stream of high pressure compressed air to keep the airway open and prevent its collapse and closure, which causes sleep apnea episodes.
The airstream in PAP can be :
- Constant and Continuous (CPAP- Continuous Positive Airway Pressure). Now micro-CPAP devices are available which combine a nasal device with blowing in pressurized air to keep nasal passages open.
- Variable or Bilevel (VPAP/BPAP- the air stream pressure is less when the patient breathes out as compared to breathing in- this is useful in patients with breathing problems)
- Automatic (APAP- has sensors for air pressure to adjust according to the patient’s breathing pattern and force).
Rarely surgical correction of anatomical abnormalities in nose, mouth or throat may be required to treat snoring or sleep apnea. These may include removal of enlarged tonsils or adenoids, correcting a deviated septum in the nose, removing a thickened nose turbinate or, removing excess tissue in the back of the throat. Other procedures include stiffening of the palate and forward advancement of tongue or jaw.
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