Snoring

Medical Author: Siamak Nabili, MD, MPH

Medical Editor: Medical Editor: Jay W. Marks, MD

 What is snoring?
 How common is snoring?
 What are the causes of snoring?
o Mouth breathing and snoring
o The soft palate and snoring
o Narrowed airways and snoring
o Stage of sleep and snoring
o Find a local Sleep Specialist in your town
 How do medications and alcohol affect snoring?
 Why is snoring a problem?
 What is the clinical importance of snoring?
 What are different levels of snoring?
 How should someone with snoring be evaluated?
 How is it determined if snoring is a medical problem?
 What are some objective tests to measure sleepiness?
 What are the treatments for snoring?
 What are some non-surgical treatments for snoring?
 What are the surgical options for snoring?
 What is the success of surgery for snoring?
 Snoring At A Glance

What is snoring?

Snoring, like all other sounds, is caused by vibrations that cause particles in the air to form sound waves. For
example, when we speak, our vocal cords vibrate to form our voice. When our stomach growls (borborygmus),
our stomach and intestines vibrate as air and food move through them.

While we are asleep, turbulent airflow can cause the tissues of the nose and throat to vibrate and give rise to
snoring. Essentially, snoring is a sound resulting from turbulent airflow that causes tissues to vibrate during
sleep.

How common is snoring?

Any person can snore. Studies estimate that 45% of men and 30% of women snore on a regular basis.
Frequently, people who do not regularly snore will report snoring after a viral illness, after drinking alcohol, or
when taking some medications.

People who snore can have any body type. We frequently think of a large man with a thick neck as a snorer.
However, a thin woman with a small neck can snore just as loudly. In general, as people get older and as they
gain weight, snoring will worsen.
What causes snoring?

While we are breathing, air flows in and out in a steady stream from our nose or mouth to our lungs. There are
relatively few sounds when we are sitting and breathing quietly. When we exercise, the air moves more quickly
and produces some sounds as we breathe. This happens because air is moving in and out of the nose and mouth
more quickly and this results in more turbulence to the airflow and some vibration of the tissues in the nose and
mouth.

When we are asleep, the area at the back of the throat sometimes narrows. The same amount of air passing
through this smaller opening can cause the tissues surrounding the opening to vibrate, which in turn can cause
the sounds of snoring. Different people who snore have different reasons for the narrowing. The narrowing can
be in the nose, mouth, or throat.

The function of the nose in normal breathing

For breathing at rest, it is ideal to breathe through the nose. The nose acts as a humidifier, heater, and filter for
the incoming air. When we breathe through our mouth, these modifications to the air entering our lungs occur to
a lesser extent. Our lungs are still able to use the colder, drier, dirtier air; but you may have noticed that
breathing really cold, dry, or dirty air can be uncomfortable. Therefore, our bodies naturally want to breathe
through the nose if possible.

The nose is made up of two parallel passages, one on each side, called the nasal cavity. They are separated by a
thin wall in the middle (the septum), which is a relatively flat wall of cartilage, bone, and lining tissue (called
the nasal mucosa). On the lateral side (the wall of the nose closer to the cheeks) of each passage, there are three
nasal turbinates, which are long, cylindrical-shaped structures that lie roughly parallel to the floor of the nose.
The turbinates contain many small blood vessels that function to regulate airflow. If the blood vessels in the
turbinates increase in size, the turbinate as a whole swells, and the flow of air decreases. If the vessels narrow,
the turbinates become smaller and airflow increases.

Everyone has a natural nasal cycle that generally will shift the side that is doing most of the breathing about
every eight hours. For example, if the right nasal turbinates are swollen, most of the air enters the left nasal
passage. After about eight hours, the right nasal turbinates will become smaller, and the left nasal turbinates will
swell, shifting the majority of breathing to the right nasal passage. You may notice this cycle when you have a
cold or if you have a chronically (long standing) stuffy nose. The turbinates may also swell from allergic
reactions or external stimuli, such as cold air or dirt.

How do medications and alcohol affect snoring?

The root cause of snoring is vibration of the tissues while breathing. Some medications as well as alcohol can
lead to enhanced relaxation of muscles during sleep. As the muscles of the palate, tongue, neck, and pharynx
relax more, the airway collapses more. This leads to a smaller airway and greater tissue vibration. Some
medications encourage a deeper level of sleep, which also can worsen snoring.

Why is snoring a problem?

Snoring sometimes can be the only sign of a more serious problem. People who snore should be evaluated to be
certain that other problems such as sleep apnea, other sleeping problems, or other sleep related breathing
problems.

If the snorer sleeps and breathes normally, then snoring is only a problem for the snorer's bed partner or family
Sleeping position and snoring

When we are asleep, we are usually (though not always) lying down. Gravity acts to pull on all the tissues of the
body, but the tissues of the pharynx are relatively soft and floppy. Therefore, when we lie on our backs, gravity
pulls the palate, tonsils, and tongue backwards. This often narrows the airway enough to cause turbulence in
airflow, tissue vibration, and snoring. Frequently, if the snorer is gently reminded (for example, with a gentle
thrust of the elbow to the ribs or a tickle) to roll onto his or her side, the tissues are no longer pulled backwards
and the snoring lessens.