Snoring

ARTICLE SECTIONS

 Definition  Complications
 Causes  Treatments and drugs
 When to seek medical advice  Lifestyle and home remedies

 Tests and diagnosis  Alternative medicine

Definition
Loud and frequent snoring can be more than just a nuisance to your partner. Snoring
may indicate a serious health condition, and it can disrupt your household.

Snoring is common. Almost half of adults snore at least occasionally. Snoring occurs
when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you
breathe, creating hoarse or harsh sounds.

Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or

sleeping on your side, can help stop snoring.

In addition, surgery is available that may reduce disruptive snoring. However, surgery
isn't suitable or necessary for everyone who snores.

Causes

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Snoring

As you doze off and progress from a lighter sleep to a deep sleep, the muscles in the
roof of your mouth (soft palate), tongue and throat relax. The tissues in your throat
can relax enough that they vibrate and may partially obstruct your airway.

The more narrowed your airway, the more forceful the airflow becomes. Tissue
vibration increases, and your snoring grows louder. Snoring may be an occasional
problem, or it may be habitual.

What contributes to snoring

A variety of factors can lead to snoring, including:
  Your mouth anatomy. Having a low, thick soft palate or enlarged tonsils or
tissues in the back of your throat (adenoids) can narrow your airway.
Likewise, if the triangular piece of tissue hanging from the soft palate (uvula)
is elongated, airflow can be obstructed and vibration increased. Being
overweight contributes to narrowing of your airway.
 Alcohol consumption. Snoring can also be brought on by consuming too
much alcohol before bedtime. Alcohol relaxes throat muscles and decreases
your natural defenses against airway obstruction.
 Nasal problems. Chronic nasal congestion or a crooked partition between
your nostrils (deviated nasal septum) may be to blame.
 Sleep apnea. Snoring may also be associated with obstructive sleep apnea. In
this serious condition, your throat tissues obstruct your airway, preventing you
from breathing. Sleep apnea is often characterized by loud snoring followed
by periods of silence that can last 10 seconds or more. Sometimes, complete
obstruction does not occur, but rather, while still snoring, the airway becomes
so small that the airflow is inadequate for your needs. Eventually, the lack of
oxygen and an increase in carbon dioxide signal you to wake up, forcing your
airway open with a loud snort or gasping sound. This pattern may be repeated
many times during the night.

When to seek medical advice

You may not be aware that you snore, but your bed partner likely is. Seeing your
doctor about your snoring can help both you and your partner. For you, snoring may
indicate another health concern, such as obstructive sleep apnea, nasal obstruction or
obesity. For your partner, your seeking medical advice about your snoring may result
in being able to get a restful sleep.

If your child snores, ask your pediatrician about it. Children, too, can have obstructive
sleep apnea, though most don't. Nose and throat problems, such as enlarged tonsils,
and obesity often underlie habitual snoring in children. Treating these conditions
could help your child sleep better.

Tests and diagnosis

Your doctor likely will perform a physical examination and take a medical history.
Your partner may need to answer some questions about when and how you snore to
help your doctor assess the severity of the problem. Parents are asked about the
severity of a child's snoring.

Your doctor may then refer you to an ear, nose and throat (ENT) doctor
(otolaryngologist) or sleep specialist for additional studies and evaluation. This may
require that you stay overnight at a sleep center to undergo an in-depth analysis of
your sleep habits by a team of specialists.
Complications
Habitual snoring may be more than just a nuisance and a cause of daytime sleepiness.
Untreated, persistent snoring caused by obstructive sleep apnea may raise your
lifetime risk of developing such health problems as high blood pressure, heart failure
and stroke. In children, obstructive sleep apnea may increase the risk of attention-
deficit/hyperactivity disorder (ADHD).

Treatments and drugs

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Continuous positive airway pressure (CPAP)

Your doctor will likely first recommend lifestyle changes, such as losing weight,
avoiding alcohol close to bedtime and changing sleeping positions. If lifestyle
changes don't eliminate snoring, your doctor may suggest:

 Oral appliances. Oral appliances are form-fitting dental mouthpieces that

help advance the position of your tongue and soft palate to keep your air
passage open. If you choose to use an oral appliance, visit your dental
specialist at least once every six months during the first year, and then at least
annually after that, to have the fit checked and to make sure that your
condition isn't worsening.
 Traditional surgery. In a procedure called uvulopalatopharyngoplasty
(UPPP), you're given general anesthesia and your surgeon tightens and trims
excess tissues — a type of face-lift for your throat.
 Laser surgery. In an outpatient surgery for snoring called laser-assisted
uvulopalatoplasty (LAUP), your doctor uses a small hand-held laser beam to
shorten the soft palate and remove your uvula. Removing excess tissue
enlarges your airway and reduces vibration. You may need more than one
session to get your snoring under control. Laser surgery isn't advised for
occasional or light snoring, but it's an option if your snoring is loud and
disruptive. Laser surgery generally isn't recommended for sleep apnea.
 Radiofrequency tissue ablation (somnoplasty). In this type of surgery,
doctors use a low-intensity radiofrequency signal to remove part of the soft
palate to reduce snoring. It's an outpatient procedure performed using local
anesthesia. The technique causes slight scarring of the soft palate, which may
help to reduce snoring. The effectiveness of this newer procedure needs
further study.
  Continuous positive airway pressure (CPAP). This approach involves
wearing a pressurized mask over your nose while you sleep. The mask is
attached to a small pump that forces air through your airway, which keeps it
open. CPAP (SEE-pap) eliminates snoring and prevents sleep apnea. Although
CPAP is the preferred method of treating obstructive sleep apnea, some people
find it uncomfortable.

Lifestyle and home remedies

To prevent or quiet snoring, try these tips:

 If you're overweight, lose weight. Being overweight is a common cause of

snoring. Loose throat tissues are more likely to vibrate as you breathe, and
extra bulkiness in the throat narrows your airway.
 Sleep on your side. Lying on your back allows your tongue to fall backward
into your throat, narrowing your airway and partially obstructing airflow. To
prevent sleeping on your back, try sewing a tennis ball in the back of your
pajama top.
 Nasal strips. Adhesive strips applied to your nose help many people increase
the area of their nasal passage, enhancing their breathing.
 Treat nasal congestion or obstruction. Having allergies or a deviated septum
can limit airflow through your nose. This forces you to breathe through your
mouth, increasing the likelihood of snoring. Don't use an oral or spray
decongestant for more than three days in a row for acute congestion unless
directed to do so by your doctor. Ask your doctor about a prescription steroid
spray if you have chronic congestion. To correct a deviated septum, you may
need surgery.
 Limit or avoid alcohol and sedatives. Avoid drinking alcoholic beverages at
least four hours before bedtime, and let your doctor know about your snoring
before taking sedatives or hypnotics. Sedatives and hypnotics (sleeping pills)
and alcohol depress your central nervous system, causing excessive relaxation
of muscles, including the tissues in your throat. In addition, if you stop
breathing due to obstructive sleep apnea, it may take longer for you to begin
breathing again because alcohol, sedatives and hypnotics blunt the brain's
ability to arouse from sleep.

Alternative medicine
Didgeridoo. Playing the didgeridoo, a musical instrument that produces a droning
sound, may help train muscles of the upper airway. A February 2006 British Medical
Journal study evaluated use of the instrument by those with sleep apnea who
complained about snoring. The research showed that those who played the instrument
for about 25 minutes a day most days of the week experienced less daytime sleepiness
— a complication of sleep apnea and snoring . However, this research is preliminary
and needs more study.
Hypnosis. Some have suggested that hypnosis may help improve snoring. For
example, a hypnotherapist can suggest to you under hypnosis that you turn on your
side if you begin snoring.

MSM (methylsulfonylmethane). MSM is marketed in a nose drop formula to treat

snoring, but there's no evidence it has any effect on snoring.

Singing. Singing can help improve muscle control of the soft palate and upper throat.
One preliminary study found some decrease in snoring in participants who sang
prescribed singing exercises for 20 minutes a day for three months. These participants
all began snoring as adults, had no nasal problems and were not overweight. More
study of this technique is needed.

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Chronic sinusitis

ARTICLE SECTIONS

 Definition  Preparing for your appointment

 Symptoms  Tests and diagnosis
 Causes  Treatments and drugs
 Risk factors  Lifestyle and home remedies

 Complications  Prevention

Definition
With chronic sinusitis, the cavities around nasal passages (sinuses) become inflamed
and swollen. This interferes with drainage and causes mucus to build up. This
common condition is also called chronic rhinosinusitis.

If you have chronic sinusitis, it may be difficult to breathe through your nose. The
area around your eyes and face may feel swollen, and you may have throbbing facial
pain or a headache.

Chronic sinusitis may be caused by an infection but can also be caused by growths in
the sinuses (nasal polyps) or a deviated nasal septum. While most people have a short-
lived bout of sinusitis at some point (known as acute sinusitis), chronic sinusitis is
sinusitis that lasts more than eight weeks or keeps coming back.
Symptoms
Chronic sinusitis symptoms include:

 Drainage of a thick, yellow or greenish discharge from the nose or down the
back of the throat
 Nasal obstruction or congestion, causing difficulty breathing through your
nose
 Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
 Aching in your upper jaw and teeth
 Reduced sense of smell and taste
 Cough, which may be worse at night

Other signs and symptoms can include:

 Ear pain
 Sore throat
 Bad breath (halitosis)
 Fatigue or irritability
 Nausea

The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except they
last longer and often cause more significant fatigue. Chronic sinusitis is sinusitis that
lasts more than eight weeks or keeps coming back. Unlike with acute sinusitis, fever
isn't a common sign of chronic sinusitis.

When to see a doctor

You may have several episodes of acute sinusitis, lasting less than four weeks, before
developing chronic sinusitis. You may be referred to an allergist or an ear, nose and
throat specialist for evaluation and treatment.

See a doctor:

 If you've had sinusitis a number of times and the condition fails to respond to
treatment
 If you have sinusitis that lasts more than 7 days
 If your symptoms don't get better after you see your doctor

See a doctor immediately if you have symptoms that may be a sign of a serious
infection:

 Pain or swelling around your eyes

 A swollen forehead
 Severe headache
 Confusion
 Double vision or other vision changes
 Stiff neck
 Shortness of breath
Causes

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Sinusitis

When you have sinusitis, the mucous membranes of your nose, sinuses and throat
(upper respiratory tract) become swollen. This swelling blocks the sinus openings and
prevents mucus from draining normally.

Blocked sinuses create a moist environment that makes it easier for infection to take
hold. Sinuses that become infected and can't drain become pus-filled, leading to
symptoms such as thick, yellowish or greenish discharge and other symptoms of
infection.

Common causes of chronic sinusitis include:

 Nasal polyps or tumors. These tissue growths may block the nasal passages
or sinuses.
 Allergic reactions. Allergic triggers include fungal infection of the sinuses.
 Deviated nasal septum. A crooked septum — the wall between the nostrils
— may restrict or block sinus passages.
 Trauma to the face. A fractured or broken facial bone may cause obstruction
of the sinus passages.
 Other medical conditions. The complications of cystic fibrosis,
gastroesophageal reflux, or HIV and other immune system diseases may result
in nasal blockage.
 Respiratory tract infections. Infections in your respiratory tract — most
commonly, colds — can inflame and thicken your sinus membranes, blocking
mucus drainage and creating conditions ripe for growth of bacteria. These
infections can be viral, bacterial or fungal in nature.
 Allergies such as hay fever. Inflammation that occurs with allergies may
block your sinuses.
 Immune system cells. With certain health conditions, immune cells called
eosinophils can cause sinus inflammation.

Risk factors
You're at increased risk of getting chronic or recurrent sinusitis if you have:
  A nasal passage abnormality, such as a deviated nasal septum, or nasal
polyps
 Aspirin sensitivity that causes respiratory symptoms
 A medical condition such as cystic fibrosis or gastroesophageal reflux
(GERD)
 An immune system disorder such as HIV/AIDS or cystic fibrosis
 Hay fever or another allergic condition that affects your sinuses
 Asthma — about one in 5 people with chronic sinusitis have asthma
 Regular exposure to pollutants such as cigarette smoke

Complications
Chronic sinusitis complications include:

 Asthma flare ups. Chronic sinusitis can trigger an asthma attack.

 Meningitis, an infection that causes inflammation of the membranes and fluid
surrounding your brain and spinal cord.
 Vision problems. If infection spreads to your eye socket, it can cause reduced
vision or even blindness that can be permanent.
 Aneurysms or blood clots. Infection can cause problems in the veins
surrounding the sinuses, interfering with blood supply to your brain putting
you at risk of a stroke.

Preparing for your appointment

When you see your doctor, you can expect a thorough examination of your sinuses.
Your doctor may also examine your eyes, ears, nose and throat. Be prepared to
answer detailed questions about your symptoms. Your doctor may want to know:

 Exactly what symptoms you have

 When your symptoms started
 What, if anything, seems to improve or worsen your symptoms
 Whether you currently have a cold or other respiratory infection, or you've had
one recently
 If you suffer from allergies
 If you smoke, are exposed to secondhand smoke or are regularly exposed to
other airborne pollutants
 What medications you take, including herbal remedies
 Any health problems you have

Your time with your doctor is limited, so preparing a list of questions will help you
make the most of your time together. For chronic sinusitis, some basic questions to
ask your doctor include:

 What is likely causing my symptoms or condition?

  Other than the most likely cause, what are other possible causes for my
symptoms or condition?
 What kinds of tests do I need?
 What is the best course of action?
 Are there any restrictions that I need to follow?
 Should I see a specialist? What will that cost, and will my insurance cover
seeing a specialist?
 Is there a generic alternative to the medicine you're prescribing me?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to
ask questions during your appointment at any time that you don't understand
something.

Tests and diagnosis

To look for the cause of your symptoms, your doctor will feel for tenderness in your
nose or throat. Your doctor may use a tool to hold your nose open and apply
medication that constricts blood vessels in your nasal passages. This makes it easier to
see inside your nasal passages. Your doctor will then shine a light into your nasal
passages to look for inflammation or fluid. This visual inspection will also help rule
out physical conditions that trigger sinusitis, such as nasal polyps or other
abnormalities.

Your doctor may use several methods to help screen for chronic sinusitis:

 Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light

inserted through your nose allows your doctor to visually inspect the inside of
your sinuses.
 Imaging studies. Images taken using computerized tomography (CT) or
magnetic resonance imaging (MRI) can show details of your sinuses and nasal
area. These may identify a deep inflammation or physical obstruction that's
difficult to detect using an endoscope.
 Nasal and sinus cultures. Laboratory tests are generally unnecessary for
diagnosing chronic sinusitis. However, in cases in which the condition fails to
respond to treatment or is progressing, tissue cultures may help pinpoint the
cause, such as identifying a bacterial pathogen.
 An allergy test. If your doctor suspects that the condition may be brought on
by allergies, an allergy skin test may be recommended. A skin test is safe and
quick and can help pinpoint the allergen that's responsible for your nasal flare-
ups.

Treatments and drugs

 Endoscopic sinus surgery

The goal of treating chronic sinusitis is to:

 Reduce sinus inflammation

 Keep your nasal passages draining
 Eliminate the underlying cause
 Reduce the number of sinusitis flare-ups you have

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms. These
include:

 Saline nasal spray, which you spray into your nose several times a day to
rinse your nasal passages.
 Nasal corticosteroids. These nasal sprays help prevent and treat
inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort
Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and
beclomethasone (Beconase).
 Oral or injected corticosteroids. These medications are used to relieve
inflammation from severe sinusitis, especially if you also have nasal polyps.
Examples include prednisone and methylprednisolone. Oral corticosteroids
can cause serious side effects when used long term, so they're only used to
treat severe asthma symptoms.
 Decongestants. These medications are available in over-the-counter (OTC)
and prescription liquids, tablets and nasal sprays. Examples of OTC oral
decongestants include Sudafed and Actifed. Nasal sprays include
phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). These
medications are generally only taken for a few days at most; otherwise they
can cause the return of more severe congestion (rebound congestion).
 Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol,
others) or ibuprofen (Advil, Motrin, others). Because of the risk of Reye's
syndrome — a potentially life-threatening illness — never give aspirin to
children.
 Aspirin desensitization treatment, if you have reactions to aspirin that cause
sinusitis. However, this treatment can have serious complications such as
intestinal bleeding or severe asthma attacks.

Antibiotics
Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection.
However, chronic sinusitis is usually caused by something other than bacteria and
antibiotics won't help.

Antibiotics used to treat chronic sinusitis caused by a bacterial infection include

amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the
combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the
infection doesn't subside or if the sinusitis comes back, your doctor may try a different
antibiotic.

If your doctor does prescribe antibiotics, it's critical to take the entire course of
medication. Generally, this means you'll need to take them for 10 to 14 days or even
longer — even after your symptoms get better. If you stop taking them early, your
symptoms may come back.

Immunotherapy
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help
reduce the body's reaction to specific allergens may help treat the condition.

Surgery
In cases that continue to resist treatment or medication, endoscopic sinus surgery may
be an option. For this procedure, the doctor uses an endoscope, a thin, flexible tube
with an attached light, to explore your sinus passages. Then, depending on the source
of obstruction, the doctor may use various tools to remove tissue or shave away a
polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an
option to promote drainage.

Lifestyle and home remedies

These self-help steps can help relieve sinusitis symptoms:

 Get plenty of rest. This will help your body fight infection and speed
recovery.
 Drink plenty of fluids, such as water or juice. This will help dilute mucous
secretions and promote drainage. Avoid beverages that contain caffeine or
alcohol, as they can be dehydrating. Drinking alcohol can also worsen the
swelling of the lining of the sinuses and nose.
 Steam your sinus cavities. Drape a towel over your head as you breathe in
the steam from a bowl of hot water. Keep the steam directed toward your face.
Or take a hot shower, breathing in the warm, moist air. This will help ease
pain and help mucus drain.
 Apply warm compresses to your face. Place warm, damp towels around
your nose, cheeks and eyes to ease facial pain.
 Rinse out your nasal passages. Use a specially designed squeeze bottle
(Sinus Rinse, others), bulb syringe or neti pot to rinse your nasal passages.
This home remedy, called nasal lavage, can help clear your sinuses.
 Sleep with your head elevated. This will help your sinuses drain, reducing
congestion.

Prevention
Take these steps to reduce your risk of getting chronic sinusitis:
  Avoid upper respiratory infections. Minimize contact with people who have
colds. Wash your hands frequently with soap and water, especially before your
meals.
 Carefully manage your allergies. Work with your doctor to keep symptoms
under control.
 Avoid cigarette smoke and polluted air. Tobacco smoke and air
contaminants can irritate and inflame your lungs and nasal passages.
 Use a humidifier. If the air in your home is dry, such as it is if you have
forced hot air heat, adding moisture to the air may help prevent sinusitis. Be
sure the humidifier stays clean and free of mold with regular, thorough
cleaning.

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