London - Chances are you’re reading this after suffering yet another night of disturbed sleep thanks to snoring. Between a third and a half of the UK population is estimated to snore.
The noise is generated by vibration as air rushes past the tissues in the mouth, nose or throat. But while the classic image of the snorer is the overweight older man, it affects everyone, explains Dr Guy Leschziner, sleep physician at Guy’s and St Thomas’S NHS Trust, and London Bridge Hospital Sleep Centre. “Snoring is viewed as a bit of a joke – but for many people it can have a major impact on their health, as well as causing marital strife,” says Leschziner.
“It can also induce anxiety in single people because they worry their snoring will put new partners off. The problem is many people don’t really know what provokes their snoring in order to treat it.”
A thick neck is a common snoring trigger, as extra fat around the throat can stop air flowing smoothly. Another typical cause is sleeping on your back, as the tongue falls back in the throat.
Other triggers include a deviated nasal septum – where the partition of cartilage between the nostrils is crooked. About 80 percent of us have some degree of septum deviation, though it doesn’t provoke snoring in everyone.
An allergy or cold can also trigger snoring by causing tissue in the nose to swell.
Lifestyle factors play a role, too, says Leschziner. “Drinking too much alcohol or taking sleeping pills can cause the throat muscles to relax.”
The health consequences of snoring can be serious. Around 6-7 percent of men and 3-4 percent of women have obstructive sleep apnoea – where they repeatedly, momentarily, stop breathing in the night.
As well as daytime sleepiness and concentration problems, the condition is linked to a raised risk of high blood pressure, heart disease, type 2 diabetes and Alzheimer’s.
Leschziner says it’s important to find out the stimulus of snoring to establish appropriate treatment – with sleep apnoea, for instance, this is with a continuous positive airway pressure (CPAP) mask, which gently forces air into the airways to keep them open at night.
The five persistent snorers here were put through a “snoring MOT” to establish the cause – this included a nasal endoscopy (where a flexible tube with a camera is inserted through the nostrils) and a sleep apnoea test to measure how many times they stop breathing in an hour (a score of 10 is classed as obstructive sleep apnoea).
They were also assessed for daytime sleepiness. Leschziner and Elfy Chevretton, an ear, nose and throat (ENT) consultant, analysed the results – with some fascinating insights into this universal problem.
Deviated septum
Anne Webster, 43, says:
I’ve been snoring for more than eight years and find it highly embarrassing. My ex-husband complained I snored and now my daughter says she can hear me through the bedroom wall.
I have a bunged-up nose all-year round and wonder if this might be the cause. I’ve tried using a nasal dilator device to keep my nostrils open at night. It works when it stays in place, but it can fall out.
I’m 79kg (at 1.7m, her BMI is 27.4, officially “overweight”) and I know my weight is probably a factor, but I snored when I was slimmer so there must be other factors involved.
Expert comment: Anne’s main cause of snoring is narrowed nasal passages. She has a combination of allergic rhinitis and a deviated nasal septum. Allergic rhinitis probably contributes to snoring in about 20 percent of cases. Symptoms include nasal congestion, facial pain and headaches.
You may be able to tell if you have a deviated nasal septum by pressing the side of one nostril with your mouth closed, then breathing through your other nostril – test both nostrils this way. If one side is blocked compared with the other, you should seek an examination by an ENT surgeon.
She’s also got inflammation of her vocal cords (suggesting acid reflux), which could exacerbate her snoring. She has mild obstructive sleep apnoea, and stops breathing seven times (at least 10 seconds per time) in an hour.
Suggested treatment: Anne could try a steroid nasal spray to tackle her nasal congestion, and a saline solution to clean out her nostrils. Both of these, available from chemists, should be used twice a day. We’d recommend antacids to neutralise stomach acid for her acid reflux problem and have allergy testing to determine the cause of her rhinitis. Losing weight would help, too.
Restless legs
Simon Pargeter, 35, says:
I’ve been snoring for 10 years and it has become a big issue for me in relationships. I broke up with my last girlfriend because I didn’t want to fall asleep beside her because I knew I woke her up with my loud snoring, which she complained about. I’m not overweight, but I do smoke and most evenings drink a couple of glasses of wine – I tend to feel restless before going to sleep. I also have some nerve pain in my legs owing to a car accident injury and sleep on my back; any other position is painful.
When I was younger I also had to have an operation to correct an orthodontic problem (my jaw was broken and pushed back).
Expert comment: He didn’t know it, but Simon suffers from restless legs syndrome, a common condition which gives the patient an overwhelming, irresistible urge to move the legs. This condition, combined with the pain from his accident and routine insomnia makes it difficult for him to fall asleep, so he drinks alcohol. This makes his muscles relax – including those at the back of his throat. Just one glass of wine is enough to trigger snoring.
Jaw problems are a really common cause of snoring – the tongue is anchored to the jaw and if the jaw is then too far back, then the tongue can fall back and partially block the airway. The surgery on Simon’s jaw has pushed it backwards. Sleeping on his back also makes snoring more likely. He also has mild obstructive sleep apnoea.
Suggested treatment: Prescription medication to treat the restless legs and cognitive behavioural therapy to try to resolve his problems getting to sleep – this will hopefully make giving up the alcohol before bed easier.
Simon should also give up smoking, because it can inflame the lining of the mucous membranes in the nose and throat, which can contribute to snoring as it narrows the airways.
He’d also benefit from a mouth guard to hold the lower jaw and tongue forward.
Big tonsils
Simon Deans, 54, says:
I’ve snored every night very loudly since my 20s – Karen says she hears it outside the house. I wake myself up three or four times a night because I’m so loud – I am sometimes gasping for breath. Karen started off with ear-plugs, but now sleeps in a separate bedroom. On holiday we have to book apartments with an extra bedroom because Karen wouldn’t get any sleep otherwise.
I’m not overweight, and don’t smoke or drink heavily, so it’s a puzzle really.
Expert comment: Investigations revealed Simon has reduced airway space at the back of his throat, which is making him snore.
This is due to a combination of factors, including a large uvula (soft tissue which hangs down at the back of his throat) and tonsils.
He also has an overbite – his chin recedes, causing his tongue to narrow the airway further in sleep.
Suggested treatment: In the longer term, Simon may benefit from surgery to remove his tonsils and part of the uvula. This would stop the narrowing of his airways and make snoring less likely. A custom-made mouth guard may help with his overbite problem.
In the short term, we recommend he also uses steam inhalation to clear his airways.
Short, fat neck
Pat Marks, 66, says:
My neighbours once banged on the bedroom wall because my snoring was so loud – it’s a problem I’ve had for 20 years.
I wake myself up at night with my snoring and I feel shattered, as if I’ve got a hangover, the next day.
A few years ago I was diagnosed with obstructive sleep apnoea and have used a CPAP mask over my nose, but it’s quite claustrophobic, so I don’t always use it.
I used to weigh a lot more – about 79kg (I’m 1.6m tall) and my snoring was worse then, but even after losing weight I still snored. I also have a very short, fat neck.
Expert comment: Pat has – by her own admission – a short thick neck and this is probably the main cause of her snoring. This can be a problem even if you are skinny.
She has mild sleep apnoea (she scored 10 on the test), but when she was last tested her results were much higher, so her weight loss has helped.
Suggested treatment: Further weight loss may help. She would benefit from tweaking her CPAP, changing her mask for one that covers her mouth as well as her nose, or using a chin strap to keep her mouth closed. Some people find the mask uncomfortable, but there are several different types, so it’s worth experimenting.
Cat allergy
Enrico Riva, 39, says:
I’ve snored since I was a teenager. Over the years, I’ve tried various snoring aids including a plaster over the bridge of my nose and a nasal dilator to stick inside my nostrils – which helps if the device stays in. If it doesn’t, I snore and wake up feeling very tired with a headache that lasts 30 minutes.
I also always have a stuffy nose and struggle to breathe at night. I’d love not to have to sleep with gadgets attached to my nose.
Expert comment: Enrico suffers from nasal congestion – which is worse on the left side of his nose partly because he has a deviated septum – but also due to some rhinitis. However, his nasal congestion worsened when he moved in with his partner and she brought her cat.
Suggested treatment: A steroid nasal spray would help alleviate the allergic component of the congestion in Enrico’s nose.
Antihistamines may also help, but he should try to keep the cat out of the bedroom (ideally, he shouldn’t have a cat in the house at all). If he can tolerate it, the nasal dilator he is using would seem to be a useful way of stopping his snoring, too.
Losing weight – Enrico weighs 104kg and, at 1.8m, has a BMI of 29.7 (officially overweight) – would also take the pressure off his airway. – Daily Mail