Medical Edge Newspaper Column

Steps Can Be Taken to Reduce "Ordinary" Snoring

January 29, 2010
Dear Mayo Clinic:
Recently my wife has told me that my loud snoring has gotten worse and keeps her up at night. I was tested and thankfully do not have sleep apnea. What else could cause me to snore so loudly? Is there anything I can do that will lessen the snoring?

Answer:
Snoring has gotten a lot of attention in recent years due to its link to obstructive sleep apnea. Indeed, it's often recommended that loud, frequent snorers be tested to rule out this harmful problem.

Unlike sleep apnea, in which you actually stop breathing, ordinary snoring doesn't appear to harm your health. Still, many people appropriately seek treatment for snoring because it can cause embarrassment and, as you mention, can seriously disrupt the rest of a sleep partner.

As you doze off and progress from light to deeper sleep, your tongue relaxes, as do the soft tissues of your throat and the roof of your mouth (soft palate). These tissues can sag into the airway, causing it to narrow. As inhaled or exhaled air is forced through the smaller opening, the relaxed tissues of the soft palate vibrate, resulting in snoring.

Steps you can take to reduce snoring take aim at the many factors that can contribute to a more narrowed airway. These factors include:

• Being overweight or obese — Extra bulk in your mouth and throat narrow your airway.Losing weight can improve snoring.
• Alcohol consumption — This can cause excessive relaxation of muscles and tissues around your throat. Avoid drinking alcoholic beverages at least four hours before bed.
• Nasal obstruction — Upstream factors such as nasal obstruction can cause problems downstream, such as air flow at the level of the throat. Your doctor may suggest a range of therapies for obstructed nasal passages, such as adhesive nasal strips or corticosteroid nasal sprays.
• Sleep position — Lying on your back allows your tongue to sag and narrow your airway. A number of techniques can be used to train yourself to sleep on your side.
• Your mouth anatomy — Features such as large tonsils can obstruct your airway. Surgical removal of an obvious obstruction is likely to improve snoring.

Smoking is also associated with an increased risk of snoring, possibly through toxic effects on the airway lining or muscles. People who stop smoking have lower rates of snoring than do active smokers.

Medical devices can significantly reduce snoring, but they can be costly. Because you're a snorer who doesn't have sleep apnea, be sure to look carefully at the costs of treatment options, as many insurance plans don't cover them.

The most effective treatment for snoring is a continuous positive airway pressure (CPAP) machine. This delivers pressurized air through a mask, keeping your upper airway open during sleep. One downside is that some people have difficulty adjusting to wearing a mask at night.

Oral appliances available from specially trained dentists or orthodontists are designed to keep your throat open. They can reduce the frequency and intensity of snoring and may be a less obtrusive option than a CPAP machine.

Several surgical procedures are available to help reduce snoring, either by cutting away excess mouth and throat tissue or by stiffening tissues of the soft palate to prevent vibration and sagging.

But surgery is usually considered a last resort for snoring because it's costly, it can cause side effects or complications.

— Sean Caples, D.O., Pulmonary and Critical Care, Mayo Clinic, Rochester, Minn.