All you need to know about snoring

Snoring may inspire jokes but it is no laughing matter if you are one of the estimated 40 per cent of adults affected in the UK. Anyone can snore, but, according to the British Snoring and Sleep Apnoea Association (BSSAA), more than two-thirds of snorers are men.

‘Men are more likely to carry weight around their neck and throat, and are more likely to drink and smoke – all factors that contribute to snoring,’ admits Marianne Davey, co-founder of the BSSAA.

‘When we sleep, the muscles of our throat relax and become floppy, the tongue falls backwards and the throat narrows. Breathing causes the walls of the throat to vibrate when you breathe in and to a lesser extent, when you breathe out. The greater these vibrations, the louder the noise.’

Around half of people who snore also suffer from a condition known as sleep apnoea, which is when the throat muscles collapse completely and block the airway.

Sleep apnoea, which happens when breathing is constantly interrupted, is the most common sleep disorder in the UK affecting around 700,000 people. Sufferers wake up frequently throughout the night, and are very sleepy during the day.

Mr Bhik Kotecha is a consultant ENT surgeon based at the Royal National Throat Nose and Ear Hospital in London says: ‘Around four per cent of the adult population in the UK suffer from sleep apnoea to some degree, and it tends to affect more men than women. Obstructive sleep apnoea can be caused by a variety of factors, but it is more likely to occur in someone who is overweight because fat around the neck acts as a kind of compressor. Alcohol, and other sedatives, tends to make the problem worse because it relaxes the muscles at the back of the tongue, which can cause an obstruction of the airway.’

Studies show that it can increase the risk of ischaemic heart disease, heart attack, strokes and high blood pressure. It is also very stressful and can make the sufferer very sleepy during the day. ‘This is particularly dangerous when someone is driving and sleep deprivation is shown to increase the risk of road traffic accidents,’ says Mr Kotecha.

Poor sleep caused by snoring could even have an impact on your ability to maintain a stable relationship. According to the Great British Sleep Survey, 55 per cent of people with mild to severe insomnia had relationship problems, compared to 13 per cent of respondents who slept well.

“Not only can snoring have a big impact on your sleep but it can affect your partners too,” said The Sleep Council’s Lisa Artis. “Snoring is one of the top complaints when it comes to partner disturbance but there are also other reasons why couples prefer to have separate beds. This includes a partner hogging the duvet, tossing and turning or one being too hot/too cold than the other. “Lack of sleep can make you feel irritable and moody which can have a negative effect on your relationship and with around 50 per cent of sleep disturbance caused by sharing a bed, it means that sleeping separately can really help – not just your sleep but also your relationship.”

Whether you are snoring and waking yourself up regularly with your noisy breathing, or simply listening to your other half and missing out on valuable sleeping time, we ask what you can do to reduce or even cure the problem.

Lose weight and take up exercise

Even putting on a few kilos can lead to snoring as fatty tissue around the neck area squeezes the airway and prevents air flowing in and out freely. Getting fit can help by strengthening neck muscles which help to keep the airway open.

A 2015 study published in the May issue of the journal CHEST, (the American College of Chest Physicians) found that patients who suffered from primary snoring (and a mild form of sleep apnoea) were helped by mouth and tongue exercises. In fact, the exercise, which included pushing the tip of the tongue against the roof of the mouth and sliding the tongue backward, reduced the frequency of snoring by 36 per cent.

Sleeping on your side rather than your back

This helps keep your head in a neutral position which relieves pressure on the upper airway. Several studies have found that individuals who sleep on their backs are more likely to snore. ‘Although it would be desirable to prevent snorers sleeping on their backs, in practice this is difficult to achieve, says Marianne of the BSSAA.

Avoid alcohol before going to bed

Alcohol slows the brain’s responses and causes muscles to relax around the throat and airways. ‘Alcohol also causes nasal irritation and congestion that can increase airway resistance when breathing. It is best to avoid drinking alcohol at least four hours before you go to bed,’ says Marianne.

Allergy and nasal stuffiness.

Keep your nose clear – use antihistamines to clear mucus or use adhesive strips to keep the nasal passages open. Chin strips can help the mouth falling open during sleep or a vestibular shield is placed in your mouh and blocks the flow of air into your mouth, forcing you to breathe through your nose.

Devices

A mandibular advancement device (MAD) works by pushing your tongue and jaw forward, therefore opening up a wider space at the back of your throat. These cost from £30 for an off-the-shelf version to several thousand pounds for a custom made one. Surgery isn’t suitable for most snorers and is last resort for those with anatomical problems that make their snoring worse. This could involve removing large tonsils or palate implants.

CPAP

At the moment, the gold standard treatment for sleep apnoea is the CPAP (Continuous Positive Airway Pressure) mask, which is clamped tightly to the face and delivers continuous stream of air to the patient, keeping the airways open. “It’s a bit like sticking your head of the car window,’ says Mr Francis, who is funded by the British Heart Foundation. ‘It’s not very comfortable and a lot of people cannot tolerate it.’

In fact, around half of people who could benefit refuse to use the CPAP system at all. Of the remaining group, half give up very quickly and most people who stick with it only wear the mask for around three hours each night.

Laser uvulopalatoplasty

This is a procedure done under general anaesthetic which involves removing the tonsils and shortening the uvulo which is the soft portion that hangs down in the centre of the throat with a microscope mounted carbon dioxide laser. ‘The microscope allows me to see all the minute blood vessels,’ explains Mr Bhik Kotecha. ‘We also trim the soft palate, which can fall down and block the throat during sleep. ‘This achieved by making two deep cuts in the soft tissue and muscle, either side of uvulo.’ The idea is that the cuts heal, forming fibrous bands of scar tissue, which pull the whole soft palate upwards. ‘The operation is quite straightforward but it can be painful for the patient. There are lots of nerve endings in the soft palate, so we give the patient quite strong painkillers for a few days and some antibiotics to prevent infection. It usually takes around two weeks for the cuts in the soft palate to fully heal.

‘We have a high success rate doing this procedure. 90 per cent of patients report an improvement within three to four months, although only 75 per cent say that the situation is improved after a year.’

Singing

SINGING: Singing exercises designed to tone tissues of the tongue, mouth and throat could effectively reduce the type of snoring which worsens with age. In these cases, snoring is caused by lax tissue tone at the back of the mouth and throat. For info and a CD describing singing exercises, go to www.singingforsnorers.com.