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Snoring

Topic Overview

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This topic is about simple snoring. If you stop breathing, choke, or gasp during sleep, you may have a problem called sleep apnea, which can be serious. For more information, see the topic Sleep Apnea.

What is snoring?

You snore when the flow of air from your mouth or nose to your lungs makes the tissues of your throat vibrate when you sleep. This can make a loud, raspy noise. Loud snoring can make it hard for you and your partner to get a good night's sleep.

You may not know that you snore. Your bed partner may notice the snoring and that you sleep with your mouth open. If snoring keeps you or your bed partner from getting a good night's sleep, one or both of you may feel tired during the day.

Snoring may point to other medical problems, such as obstructive sleep apnea. Sleep apnea can be a serious problem, because you stop breathing at times during sleep. So if you snore often, talk to your doctor about it.

Snoring is more common in men than in women.

What causes snoring?

When you sleep, the muscles in the back of the roof of your mouth (soft palate), tongue, and throat relax. If they relax too much, they narrow or block your airway. As you breathe, your soft palate and uvula vibrate and knock against the back of your throat. This causes the sounds you hear during snoring.

The tonsils and adenoids may also vibrate. The narrower the airway is, the more the tissue vibrates, and the louder the snoring is.

How is it treated?

You may be able to treat snoring by making changes in your lifestyle and in the way you prepare for sleep. For example:

  • Lose weight if you are overweight.
  • Quit smoking.
  • Sleep on your side and not your back.
  • Limit your use of alcohol and medicines such as sedatives before you go to bed.
  • If a stuffy nose makes your snoring worse, use decongestants or nasal corticosteroid sprays to help you breathe.
  • Try using devices that you attach to the outside of your nose to help with breathing while you sleep. These include nasal strips and nasal disks.
  • When you sleep, use a device in your mouth that helps you breathe easier. This device pushes your tongue and jaw forward to improve airflow.

If these treatments don't work, you may be able to use a machine that helps you breathe while you sleep. This treatment is called continuous positive airway pressure, or CPAP (say "SEE-pap"). In rare cases, your doctor may suggest surgery to open your airway.

Snoring isn't always considered a medical problem, so find out if your insurance covers the cost of treatment.

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Cause

You snore when the flow of air from your mouth or nose to your lungs makes the tissues of the airway vibrate. This usually is caused by a blockage (obstruction) or narrowing in the nose, mouth, or throat (airway).

When you inhale during sleep, air enters the mouth or nose and passes across the soft palate (the back of the roof of the mouth) on its way to the lungs. The back of the mouth—where the tongue and upper throat meet the soft palate and uvula—is collapsible. If this area collapses, the airway becomes narrow or blocked. The narrowed or blocked passage disturbs the airflow, which causes the soft palate and uvula to vibrate and knock against the back of the throat, causing snoring. The tonsils and adenoids may also vibrate. The narrower the airway is, the more the tissue vibrates, and the louder the snoring is.

You do not snore when you are awake because the muscles of the throat hold the tissues in the back of the mouth in place. When you sleep, the muscles relax, allowing the tissues to collapse.

Snoring may be caused by:

  • Enlarged tissues in the nose, mouth, or throat. Enlarged tonsils are a frequent cause of snoring in children.
  • Blocked nasal passages, which make it more difficult to inhale. This affects the tissue of the throat, which may pull together during the extra effort it takes to breathe, which in turn narrows the airway. A blocked nasal passage can be caused by an upper respiratory infection (such as a cold), an allergy, or nasal polyps.
  • A deviated nasal septum, which disturbs airflow in the nose.
  • Loss of muscle tone in the throat, which makes it easier for tissue to collapse. This can be due to aging or lack of fitness.

Other things that may contribute to snoring include:

  • Drinking alcohol, which depresses the part of the brain that regulates breathing. This can overly relax the tongue and throat muscles, causing them to partially block air movement.
  • Obesity. Fat in the throat may narrow the airway.
  • Medicines that relax you or make you drowsy, such as those taken for allergies, depression, or anxiety.

Symptoms

Snoring is a noise that you may make while breathing during sleep. Snoring can be soft, loud, raspy, harsh, hoarse, or fluttering. Your bed partner may notice that you sleep with your mouth open and that you are restless while sleeping. If snoring interferes with your or your bed partner's sleep, either or both of you may feel tired during the day.

If you temporarily stop breathing during the night, you may have sleep apnea, a serious condition. For more information, see the topic Sleep Apnea.

What Happens

Snoring occurs when the flow of air from the mouth or nose to your lungs makes the tissues of the airway vibrate. This usually is caused by a blockage (obstruction) or narrowing in the nose, mouth, or throat (airway).

When you inhale during sleep, air enters the mouth or nose and passes across the soft palate (the back of the roof of the mouth) on its way to the lungs. The back of the mouth—where the tongue and upper throat meet the soft palate and uvula—is collapsible. If this area collapses, the airway becomes narrow or blocked. The narrowed or blocked passage disturbs the airflow, which causes the soft palate and uvula to vibrate and knock against the back of the throat, causing snoring. The tonsils and adenoids may also vibrate. The narrower the airway is, the more the tissue vibrates, and the louder the snoring is.

You do not snore when you are awake because the muscles of the throat hold the tissues in the back of the mouth in place. When you sleep, the muscles relax, allowing the tissues to collapse.

Snoring can be so loud that it keeps your bed partner awake. You may also have a less restful sleep. Sleep quality may decrease as the loudness of the snoring increases. And snoring can result in daytime sleepiness.

Snoring that affects how well you sleep may increase your risk of high blood pressure.footnote 1, footnote 2

Snoring may progress to upper airway resistance syndrome or sleep apnea, a serious condition. For more information, see the topic Sleep Apnea.

What Increases Your Risk

Things that may increase your risk of snoring include:

  • Being male. Men are more likely to snore than women.
  • Age. Snoring is most common in middle-aged people.
  • Heredity. Snoring may run in families.
  • Weight gain and obesity.
  • Smoking. Exposing children to tobacco smoke may also increase their risk of snoring.
  • Use of alcohol or sedative medicines.
  • Chronic nasal congestion during sleep. This is often caused by colds or allergies.
  • Jaw abnormalities, such as a small chin and overbite (class II malocclusion—the upper jaw and teeth overlap the bottom jaw and teeth). This may be an especially important factor in women.

When should you call your doctor?

Call your doctor if you or your bed partner:

  • Snores loudly and heavily.
  • Snores and feels sleepy during the day.
  • Snores and falls asleep at the wrong times, such as when talking or while eating.
  • Stops breathing, gasps, or chokes during sleep.

Snoring is the main symptom of sleep apnea. This is a potentially serious sleep disorder in which you periodically stop breathing during sleep.

Watchful waiting

Watchful waiting is a wait-and-see approach. It may be okay to try it if your snoring doesn't disturb your bed partner or if you aren't overly sleepy during the day. If home treatment doesn't help your snoring, contact your doctor.

Watchful waiting may not be the right choice if you or your sleeping partner snores loudly and heavily, is restless during sleep, is sleepy during the day, or stops breathing when sleeping. These may point to sleep apnea. Contact your doctor.

Exams and Tests

Diagnosis of snoring focuses on finding out whether you might have sleep apnea. Your doctor will do a physical exam and ask questions about your medical history. Because a physical exam and medical history cannot determine if you have sleep apnea, a sleep study almost always will be done if your doctor suspects the condition.

For more information, see the topic Sleep Apnea.

Children

According to the American Academy of Pediatrics:footnote 3

  • All children should be screened for snoring as part of a routine checkup.
  • If sleep apnea is suspected, a complete sleep study generally is needed.

Treatment Overview

Snoring is treated through lifestyle changes such as losing weight (if needed), quitting smoking, changing sleep habits (such as sleeping on your side instead of your back), and avoiding the use of alcohol and sedatives before you go to bed. Also, you can try over-the-counter medicines to reduce nasal congestion. Or you can use a device to help keep your airway open while you sleep.

If snoring continues despite these treatments, continuous positive airway pressure (CPAP) or surgery may be tried. Implants that stiffen your palate can help reduce snoring and the daytime sleepiness it causes.footnote 4 But snoring is not always considered a medical problem, so insurance may not cover treatment.

Initial and ongoing treatment

Snoring is often treated successfully with lifestyle changes. You can:

  • Lose weight (if needed).
  • Go to bed at the same time every night and get plenty of sleep.
  • Sleep on your side, not on your back. Try sewing a pocket in the middle of the back of your pajama top, putting a tennis ball into the pocket, and stitching it closed. This will help keep you from sleeping on your back.
  • Avoid using alcohol and sedatives before bed.
  • Quit smoking.
  • Raise the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed (using pillows to raise your head and upper body will not work).
  • Promptly treat breathing problems, such as a stuffy nose caused by a cold or allergies.
  • Use a nasal dilator to help keep your airway open. This is a device, such as nose strips or disks, that you attach to the outside of your nose while you sleep.

If nasal congestion is present, you can try clearing your nasal passages or using medicines such as decongestants and nasal corticosteroid sprays. These open the airway, permitting a smoother airflow, and may reduce snoring. Be safe with medicines. Read and follow all instructions on the label. Do not use the medicine longer than the label says.

Oral breathing devices , which push the tongue and jaw forward to improve airflow, sometimes can treat snoring, especially if it is caused by jaw position during sleep.

If your bed partner is bothered by your snoring, he or she may try using earplugs or machines that play ambient music or natural sounds. These can block or cover up the noise.

If snoring continues, your doctor may want to examine you again to see whether you have developed upper airway resistance syndrome or sleep apnea, a potentially serious sleep disorder in which you periodically stop breathing during sleep. For more information, see the topic Sleep Apnea.

Treatment if the condition gets worse

If your snoring gets worse, talk to your doctor. You may need to be tested to see whether you have developed upper airway resistance syndrome or sleep apnea, a potentially serious sleep disorder in which you periodically stop breathing during sleep.

Your doctor may suggest continuous positive airway pressure (CPAP). CPAP is the standard treatment for sleep apnea but is rarely used for snoring. For more information on CPAP, see the topic Sleep Apnea.

In extreme cases, surgery may be performed. For more information, see Surgery.

Prevention

To help prevent snoring, you can:

  • Avoid the use of alcohol and medicines that slow your breathing, such as sleeping pills and tranquilizers.
  • Eat sensibly, exercise, and stay at a healthy weight.
  • Go to bed at the same time every night and get plenty of sleep. Regular sleep patterns help you sleep better, and more restful sleep may reduce snoring.
  • Sleep on your side, not on your back. Sleeping on your back can increase snoring. Try sewing a pocket in the middle of the back of your pajama top, putting a tennis ball into the pocket, and stitching it closed. This will help keep you from sleeping on your back.
  • Quit smoking. This reduces inflammation and swelling in the airway, which may contribute to the narrowing of the airway.
  • Raise the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed. (Using pillows to raise your head and upper body will not work.) Sleeping at a slight incline can prevent the tongue from falling toward the back of the throat and contributing to a blocked or narrowed airway.
  • Promptly treat breathing problems, such as a stuffy nose caused by a cold or allergies. Breathing problems can raise the risk of snoring.

Home Treatment

Snoring typically is first treated at home. Treatment includes:

  • Losing weight. Many people who snore are overweight. Weight loss can help reduce the narrowing of the airway and possibly reduce or stop the snoring.
  • Limiting the use of alcohol and medicines. Drinking excessive amounts of alcohol or taking certain medicines, especially sleeping pills or tranquilizers, before sleep may make snoring worse.
  • Going to bed at the same time each night and getting plenty of sleep. Snoring may be more frequent when you have not had enough sleep.
  • Sleeping on your side. Sleeping on your side may stop the snoring. Try sewing a pocket in the middle of the back of your pajama top, putting a tennis ball into the pocket, and stitching it closed. This will help keep you from sleeping on your back.
  • Promptly treating breathing problems. Breathing problems caused by colds or allergies can disturb airflow, leading to snoring.
  • Using a breathing device while you sleep. It helps keep your airway open. This could be a device that you put in your mouth. Other examples include strips or disks that you use on your nose.

Medications

Medicine can help prevent or reduce snoring when it is caused by nasal congestion. Nasal congestion is usually caused by colds or allergies. Medicine may open the nasal passageway, permitting a smoother airflow and reducing snoring.

Decongestants (oral and nasal) and nasal corticosteroids both reduce nasal congestion. Be safe with medicines. Read and follow all instructions on the label. Don't use the medicine longer than the label says. Overuse of a nasal decongestant can cause rebound congestion. It makes your mucous membranes swell up more than before you used the spray.

Surgery

Surgery for snoring is rarely used and only considered in cases of very severe snoring when other treatments have failed.

Surgery is used to:

  • Remove excess soft tissue from the throat to widen the upper airway. This may involve removing the tonsils and adenoids and other tissues in the back of the throat (uvulopalatopharyngoplasty).
  • Correct an abnormally shaped wall (septum) between the nostrils or remove nasal polyps that block airflow through the nose.
  • Change the position of the bony structures in the upper airway, allowing air to flow more freely, especially during sleep. More than one surgery may be needed to make these changes.
  • Implant plastic cylinders in the soft palate to stiffen it to prevent it from vibrating. This can reduce snoring and the daytime sleepiness it causes.footnote 5

Surgery choices

  • Uvulopalatopharyngoplasty removes excess tissue in the throat, widening the airway and leading to a smoother airflow. This may reduce snoring.
  • Laser-assisted uvulopalatoplasty uses a laser to remove excess tissue in the throat.
  • Radiofrequency palatoplasty is a procedure that uses an electrical current to shrink and stiffen the back part of the roof of the mouth (soft palate and uvula). When the soft palate and uvula are stiffer, they are less likely to vibrate, and you are less likely to snore.
  • Tonsillectomy and adenoidectomy may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep.
  • Nasal septoplasty repairs and straightens the bone and tissues (septum) separating the two passages in the nose. This procedure is done if a nasal deformity interferes with breathing.
  • Nasal polypectomy removes soft, round tissues (polyps) that can project into the nasal passages.
  • Implanting plastic cylinders into the soft palate can stiffen it and help prevent it from vibrating.footnote 5

What to think about

Surgery is rarely used to treat snoring. It may not completely cure snoring, and the risks of surgery may not be worth the small benefit you gain.

Snoring is not always considered a medical problem, so insurance may not cover treatment.

Other Treatment

Other treatment for snoring includes continuous positive airway pressure (CPAP) and other breathing devices.

Nutritional counseling can help people who snore and are overweight.

Other treatment choices

Continuous positive airway pressure (CPAP) is the preferred treatment for sleep apnea. In rare cases, CPAP is considered for snoring. For information on CPAP, see the topic Sleep Apnea.

Oral breathing devices sometimes can treat snoring, especially if it is caused by jaw position during sleep.

Nasal dilators (such as nose strips and disks) can help keep your airways open while you sleep. Nose strips widen the nostrils and improve airflow. Nasal disks have a valve that makes it harder for you to breathe out. This causes a little back-pressure in your airways that may help keep them open. You can get many of these devices without a prescription. Talk to your doctor or pharmacist about your options.

What to think about

Many products claim to cure snoring. Some of them may provide some help, but others may be of no value or may be harmful. Even if a product helps reduce your snoring, it is important to see a doctor, because snoring is the main symptom of sleep apnea, a potentially serious condition.

References

Citations

  1. Knutson KL, et al. (2009). Association between sleep and blood pressure in midlife: The CARDIA sleep study. Archives of Internal Medicine, 169(11): 1055–1061.
  2. Li AM, et al. (2009). Blood pressure is elevated in children with primary snoring. Journal of Pediatrics, 155(3): 362–368.
  3. Marcus CL, et al. (2012). Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 130(3): 576–584.
  4. Palatal implants for snoring and obstructive sleep apnea (2008). Medical Letter on Drugs and Therapeutics, 50(1282): 23–24.
  5. Palatal implants for snoring and obstructive sleep apnea (2008). Medical Letter on Drugs and Therapeutics, 50(1282): 23–24.

Other Works Consulted

  • Collop NA, Cassell DK (2002). Snoring and sleep-disordered breathing. In TL Lee-Chiong Jr et al., eds., Sleep Medicine, pp. 349–355. Philadelphia: Hanley and Belfus.
  • Vlastos IM, Hajiioannou JK (2009). Clinical practice: Diagnosis and treatment of childhood snoring. European Journal of Pediatrics, July 21 (Epub ahead of print).

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