What's Behind The Snore? Sagging, Floppy Tissue
Interactive: What A Snore!
If you're kept awake at night by someone who snores, you're not alone. And, snoring becomes more common as we age — by age 60, more than half of adults snore.
The log-sawing vibrations are often the result of air trying to move through narrowed or floppy, soft passages in the mouth, throat and nose. Other times, the air is obstructed by anatomical abnormalities, such as over-sized tonsils or uvula — that boxing-bag like thing that hangs in the back of the throat.
"I hear these stories every day," says Sonya Malekzadeh, an ear, nose and throat doctor at Georgetown University Hospital in Washington, D.C. Lots of patients come into her office at the urging of their partners. They report being "kicked out" of their bedrooms for their loud snoring.
Many men don't even realize they're doing it, Malekzadeh says. And, yes, men are twice as likely as women to snore.
"The reason men are affected more than women is likely due to fat distribution. When men gain weight, it is usually in the neck, upper torso and abdomen," she says. "On the other hand, women usually gain weight in the hips and thighs."
Fat in the neck area can constrict airway passages and lead to increased snoring. And, as we age, the soft tissue inside the mouth and palate can sag, just as wrinkles develop with aging skin.
Home Remedies
Sleep Position
Experts recommend starting by adjusting your body position: Try to sleep on your side. Many people snore only when they're on their backs.
Also, elevating the head with an extra pillow "may help prevent collapsing in the back of the throat," says Malekzadeh.
Avoiding Alcohol
Alcohol and sedatives can relax the palate of your mouth and decrease the opening in the throat, which leads to snoring.
"I tell people to avoid alcohol for the three to four hours before going to bed," says Malekzadeh.
Over-The-Counter Fixes
Dental Appliances
Dental appliances are designed to pull the tongue forward to prevent constriction in the back of the mouth. But many people spit them out, says Malekzadeh, and it's not an effective option if you can't keep it in your mouth. Custom-fitted dental appliances, crafted by a dentist or oral surgeon, can be effective for some snorers.
Treating A Stuffy Nose
If you have trouble breathing through your nose, over-the-counter decongestants or breathing strips that adhere to your nose could help, says Stacey Ishman, an ENT doctor and the director of the Center for Snoring and Sleep Surgery at Johns Hopkins School of Medicine in Baltimore.
"There can be a narrowing or a collapse in your nose, and [breathing strips] can keep that area open," says Ishman.
About 25 percent of patients with a stuffy nose can decrease snoring significantly by using the strips, she says. Or, sometimes saline spray can help increase air flow in the nose, Ishman says. In more severe cases, steroids can be prescribed.
When Snoring Turns Dangerous
Sometimes, snoring can be a sign of sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts. Sleep apnea is more common in overweight people, though normal weight people can also develop it.
For someone who is already prone to sleep apnea, weight gain can increase the risk, says Ishman. Fat "pads" can constrict the airway and lead to snoring, or in cases of sleep apnea, a complete collapse of the airway.
Additionally, researchers are looking into how snoring may increase the risk of memory issues, mood disorders and learning problems — in part because snoring can interrupt rest.
A few studies have also found an association between snoring and higher rates of cardio-vascular risk factors including high-blood pressure.
It's impossible to say what amount of snoring, and over what period of time, is dangerous, says Ishman. "But we feel comfortable saying that if you can do something to treat the snoring we think it's going to reduce your risk factors."
When Is Surgery Recommended?
Experts say there are many factors to consider. But, generally speaking, doctors recommend surgery when anatomical problems are causing excessive snoring.
The Nose
For example, some people have a deviated septum, which is when the thin wall that separates the right and left side of your nose is displaced to one side. When a deviated septum is severe, it can block one side of your nose and reduce airflow.
ENTs also perform surgeries on people who have over-sized "turbinates," or shelves on the inside the nose.
"These shelves help warm and clean the air" says Malekzadeh, "but if they're big or become enlarged they can crowd the nasal cavity."
The surgery shaves the bone in the nose down to a normal size. After the surgery, the reduced turbinate ridges open up space so air can move through unobstructed.
The Mouth And Throat
An adult tonsillectomy, the removal of the tonsils, is a common treatment for sleep apnea. It entails about a two-week recovery period.
But a tonsillectomy is almost never performed to alleviate snoring in the absence of sleep apnea, says Malekzadeh.
When sleep apnea isn't the cause, snoring is often considered a "cosmetic" problem and most treatments are not covered by insurance companies.
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LINDA WERTHEIMER, host:
This is MORNING EDITION from NPR News. I'm Linda Wertheimer.
STEVE INSKEEP, host:
And I'm Steve Inskeep. Today in Your Health, who snores, why, and what you can do about it. We have team coverage of this important problem, beginning with NPR's Allison Aubrey.
Allison, good morning.
ALLISON AUBREY: Good morning. I know that you usually get to ask the questions, Steve, but I've got one for you this morning.
INSKEEP: Okay.
AUBREY: Do you snore?
INSKEEP: Do I snore?
AUBREY: Right. That's the question.
INSKEEP: That assumes that I sleep.
(Soundbite of laughter)
AUBREY: Yes, that is an assumption I'm making.
INSKEEP: Well, yes. Yes. I'm told. I don't know, but I'm told by wife.
AUBREY: You're told by your wife?
INSKEEP: Yes.
AUBREY: But it doesn't wake you up?
INSKEEP: No.
AUBREY: Huh, interesting. You know, it sounds similar to a couple I interviewed for this story, Brad and Pam Harries. They're in their early 50s, past their childbearing, baby stage of life. Pam told me she thought she was headed into some years of solid, uninterrupted sleep, but there was a glitch. Guess what he did?
INSKEEP: Sawing logs.
AUBREY: Absolutely. And you know what? He was blissfully unaware of it. Here's what Brad had to say when I asked him to recall the confusion when he was told that he snored. He remembers saying to his wife…
Mr. BRAD HARRIES: I'm sleeping fine. You know, why is everybody else complaining? But I would have a great deal of conversations with my family in the morning about the noise that was emanating out of our bedroom.
AUBREY: Pam Harries says she wasn't sleeping well, and neither were their four kids. But other than kicking her husband in bed, which silenced his snore temporarily, she didn't know the way to fix the problem. Talking with her friends, turned out many of them had the same issue. They discussed the same possible resolution.
Ms. PAM HARRIES: He had always said, you know, we can go to separate bedrooms, but…
But Pam went on to explain that this didn't sound like a healthy marriage. So finally she and her husband sought help. Doctors had him try a bunch of remedies, starting with saline sprays and breathing strips for his nose. The strips can physically open up space in the nasal passages, and they do bring relief to some snorers.
Mr. HARRIES: I'd used the strips on the nose. I used the sprays in the throat. I would, as a matter of procedure, basically sleep on my side to try and keep the noise down.
AUBREY: When none of these worked, Brad ended up in the office of Sonya Malekzadeh, an ear, nose and throat doctor at Georgetown University. She explained to him that by late middle age up to 50 percent of adults snore, and it tends to intensify over time
Dr. SONYA MALEKZADEH (Georgetown University): Basically what snoring is, is air passing over crowded tissues, and snoring can stem from narrow passages in your nose or it can stem from crowding in the back of your throat.
AUBREY: When Malekzadeh examined Brad Harries nose and throat, she saw what's very common - and this may sounds sort of gross: the soft tissue in the roof of his mouth was sagging and floppy. Think of it as something akin to wrinkles on the inside. Malekzadeh explains the trouble with floppy tissues is that they crowd the mouth and narrow the passages.
Dr. MALEKZADEH: And then air vibrates against those passages and that's where you get the snoring.
AUBREY: People who are overweight or drink alcohol before bed are more likely to snore. Alcohol relaxes tissues in the throat that can constrict the airway. And extra weight contributes because fat pads on both sides of the throat narrow air passages even further. That's why specialists first recommend weight loss.
But Brad Harries wasn't overweight. So Malekzadeh suggested to him a procedure called a pillar implant, which he decided to try. She does them in her office and it takes about an hour. She uses a local anesthesia, similar to what you'd get in a dentist chair. She makes one incision in the roof of the mouth. Then she inserts three matchstick-sized implants into the soft tissue.
Dr. MALEKZADEH: And when you put those implants in there, little matchsticks, they cause a reaction where the tissues get inflamed.
AUBREY: The inflammation leads to scarring of the skin. And as those scars harden up, all that floppy tissue in the roof of the mouth firms and tightens. Brad Harries says he went back to work the next day and he estimates his snoring is now about 50 percent better.
Mr. BRAD HARRY: The change has been dramatic.
AUBREY: Pam Harry says she and her husband are sleeping much more peacefully these days, and yes, in the same bed.
Allison Aubrey, NPR News, Washington.
INSKEEP: True story: There are pictures of Allison Aubrey and her science desk colleague that you can try to match with recordings of their snores. That's right, NPR's enterprising Science Desk has a quiz: Match the snore to the reporter at npr.org. Transcript provided by NPR, Copyright National Public Radio.
