Snoring is a sign of partial airway blockage where apnea refers to periods (of at least 10 seconds) where the airway is completely blocked. According to Dr. David Fairbanks, author of Snoring and Sleep Apnea, Third Edition (2003) there are 5 factors which act alone or in combination to cause snoring.

1. Insufficient muscle tone: All muscles are more relaxed during sleep. Some people have poor muscle tone in their neck – the throat and tongue muscles are too floppy. This is even worse when they are asleep.  It is hard to detect this when awake, but one of the signs is extra folds of tissue in the throat behind the tonsils (referred to as redundant pharyngeal folds).

2. Extra soft tissue mass in the airway: In children this is usually large tonsils and adenoids. In adults, tonsils still can be the culprit. Fat accumulation under the surface of the throat or base of tongue, narrows the air passage and makes tissues floppy. Diseases like untreated hypothyroidism and acromegaly cause fluid buildup or a large tongue. Cysts and tumors are rare causes but should be ruled out.

3. Receding chin / maxillary hypoplasia: Some people are born with a small jaw. There isn’t enough space in the mouth to keep the tongue forward during sleep. The tongue falls back into the airway, causing partial airway obstruction.

4. Excessive length of the soft palate and uvula: The soft palate and uvula can dangle down the throat in the area of the tongue, narrowing the airway. Now if the tongue falls back slightly the airway can obstruct.

5. Blocked Nose: If the nose is blocked for any reason, the airflow speeds up through the narrow parts causing a vacuum (the Bernoulli effect). The vacuum pulls in floppy tissues making them vibrate and causing snoring. A blocked nose also forces mouth breathing.  This puts the tongue in a position more likely to block off the airway.  Causes of a blocked nose are a deviated nasal septum, swollen turbinates, sinusitis, and nasal polyps.

A full examination by a sleep surgeon, looks for which of these factors are causing your problem. It includes a complete history, head and neck examination, and pharyngoscopy. A small camera is placed into the nose and it looks down the back of your throat to see where obstruction is occurring. Different maneuvers are often used to try to replicate what is happening during sleep, such as lying down, sucking in against a closed nose (called the Müller maneuver), and imitating your snoring. It is very helpful to have your bedpartner accompany you during a snoring evaluation. This determines which treatment options are best for you and what is the likelihood of surgical success.