Snoring & Sleep Apnea
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Facts about Snoring & Sleep ApneaSnoring is incredibly common. At least 40% of men and 20% of women snore nightly. While mild snoring is not a serious issue, louder snoring can be a sign of a much more serious disease, sleep apnea. Even when there isn't sleep apnea, snoring can interfere with a person's ability to get a good night's sleep, resulting in chronic fatigue. This is known as Upper Airway Resistance Syndrome (UARS). It can also interfere with a bed partner's ability to get a good sleep, resulting in separate rooms and marital stress. Snoring means the airway is partially blocked. The more blocked the airway gets, the louder the snoring becomes and the more likely that breathing is affected. In What increases risk for snoring and sleep apnea? We all know what snoring sounds like. Two important questions to understand when treating snoring is where is the sound coming from and why is it occurring. What is making the noise?What you are hearing is the sound of vibration of one or more structures in the airway. The most common location of snoring is the soft palate and uvula, that dangling thing in the back of your throat. Other common areas of vibration are the walls of the throat just behind the soft palate (roof of your mouth) or just behind your tongue. This area is called the lateral walls of the pharynx. The base of the tongue can also vibrate and make noise. Often multiple sites are involved, however the palatal vibration is usually the loudest and the first one addressed when treating snoring.
Just knowing and treating the site of snoring can lead to a lot of unhappy patients. Without treating the cause of snoring, the snoring often returns even with the most aggressive treatment.
What causes snoring?The vibration is caused by rapid pressure changes in the airway. Ever heard of the Bernoulli effect? If you have taken an airplane you have experienced it. That’s right, the same thing that allows airplanes to fly causes snoring. The Bernoulli effect says that as the speed of air increases, its pressure decreases - creating a sucking effect. The curved shape to the top of an airplane wing makes air travel faster over the top of the wing, creating a negative pressure and pulling the plane into the sky. This effect is also why papers blowing around your car get sucked out when the windows are down.
What we are trying to identify is areas where air travels quickly when you breathe in which happens to be the narrowest areas. The rapid moving air creates the same sucking force in your airway as the top of the airplane wing. As the airway gets sucked closed, airflow stops, pressure returns to normal, and the tissue goes back to their resting place only to be sucked shut again. This happens many times every second to cause the snoring noise. Treating the vibrating part alone might not help these narrow areas, so the sucking force remains. This is one of the reasons why people may say their snoring procedures ‘didn’t work’ (although there are many other factors that cause people to start to snore again).
Where are these narrow areas that cause snoring?
Anywhere and often in multiple areas. The sites are different in everyone. Answering this question requires a full nose and throat examination done by a qualified sleep surgeon.Common anatomical issues that can be identified and treated are:
Is there anything you can do to help snoring without surgery or any sleep device?
Weight loss and Excercise:
The most common reason for snoring is extra weight. Fat accumulates in the base of tongue and side walls of your throat. Not only does this narrow the airway but it makes it floppy. Weight loss, expecially in combination with excercise, often cures snoring and sleep apnea. It will at least improve it and improve your chances of cure through other methods.
Heartburn / Reflux:
This is when the acid from your stomach comes up into your esophagus and throat. It can occur only when sleeping which may not give much symptoms. The chance of having this problem goes way up in heavy snorers. When you snore, you have to suck in a lot harder to get a breath. This also sucks acid up from the stomach. People who snore are often overweight which makes reflux worse. When acid comes into your airway it causes swelling, making fluid build up under the surface. This makes the airway smaller and floppy, which worsens snoring, which worsens reflux, which worsens snoring....I think you get the picture. Reflux has also been shown to decrease the sensation in your throat. This decreases the reflex which makes the muscles in your throat tighten to open the airway if there is narrowing.
If there are any symptoms of reflux, you should talk to you doctor about treating this as it may make your snoring and sleep better.
Sinus problems:
Sinus problems include allergies, chronic sinusitis, nasal polyps, and chronic irritant exposures (like smoking). These can narrow the airflow through your nose, forcing the air to move faster, and resulting in worsening snoring. Any chronic inflamation also builds up fluid making things more collapsible. If your nose is mostly blocked, you will resort to mouth breathing. This pushes your tongue back further into the airway narrowing it and makes you inhale dry air. Treating sinus problems, using salt water sprays or irrigations, allergy pills, and prescription medications sprayed into the nose, can improve snoring.
I strongly recommend against regularly using decongestants sprayed into the nose! Within 5 days your nose gets used to them and congestion becomes worse than ever - creating a strong dependancy.
There are two types of nasal dilators which improve nasal airflow and can help snoring in some. These are nasal strips and nose cones. Nasal strips stick to the outside of your nose and pull up to open the airway. Nose cones are placed in the nose and lift up from the inside. These are available without prescription.
Smoking: This is a bit of a touchy subject for many people, but any toxin or chemical exposure causes airway inflamation or swelling. Some people get away with it, others do not (that is why 'so and so' smokes and doesn't snore). Inflamation means fluid is building up under the surface, narrowing the airway and making it more floppy. Notice a trend here?
So what I am saying is what all docs have been saying...stop smoking, lose weight, and excercise. No problem eh? So now what?
What are sleep devices?
There are some devices which will open the nasal airway such as nasal strips and nose cones. The strips pull up on the skin of your nose to open the nostrils. Nose cones are inserted completely in the nose which holds the airway evenly open by opening up the nostrils and pushing on the turbinates. Turbinates are structures on the sides of the inside of your nose which swell with allergies, colds, or chemical exposures. They are the reason why you feel 'stuffy'. If you look around, these devices will cost you 25 to 40 cents a night.
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Sleep Apnea, a person regularly stops breathing (an Apnea), or has episodes where a little bit of air squeaks by but it is not enough (Hypopnea). Both of these have the same negative effect on a persons sleep and health. This can make a person feel like they never get a good night's sleep, are tired during the day, may always be in a bad mood, and fall asleep easily. 
