Snoring during sleep - Symptom of a Disease state

Snore is the sound produced due to vibration in the throat when the air is inhaled during breathing. This is more likely produced when there is partial obstruction to the air passage in the throat especially while lying down such as during sleep when the muscle tone is poor.  During sleep, the tissues in the throat get relaxed, partially block the airway and vibrate with breathing air. It is more common in obese people who are likely to have bulky throat tissue, as well as in people with a long soft palate or uvula. People who are heavy smokers and regularly drink alcohol are more likely to snore and develop other problems. Snoring also increases with age and body weight.

It is common for people to snore especially at night when sleeping. It is normal to have less than 5 snoring events per hour but more than 30 events per hour indicate a disease state. Snoring is not normal if chronic, frequent and troublesome or associated with sleep disturbance when it may point to a bigger problem.  It is wrong to believe that snoring is a sign of sound sleep. On the contrary, it indicates the presence of restless sleep. It is a sign that the air does not move freely through the nose and the throat due to some amount of obstruction in the respiratory pathways.

Snoring can have serious implications on health and can itself be a symptom of a disease like obstructive sleep apnea (OSA) especially when frequent or loud or accompanied with waking up through the night because of difficulty in breathing. Patients with OSA are excessively sleepy and drowsy during the day which can sometimes result in accidents while driving. This may also be accompanied with recurrent and transient cessation of breathing altogether (apnea episodes). Transient but significant falls in oxygen saturation (and rise in carbon-di-oxide) occur during each such episode.

OSA leads to several serious and chronic medical diseases such as diabetes, obesity, hypertension, stroke, heart attack and other cardiovascular problems. It also causes memory loss, cognitive and other intelligence disturbances. Snoring is frequently associated with respiratory symptoms such as breathlessness, chest congestion, wheezing and chronic bronchitis. Individuals with both sleep disordered breathing and chronic respiratory diseases have poorer sleep quality and overall quality of life. Other associated symptoms may include dryness of mouth, frequency of urination and sleep disturbances. Morning drowsiness and headaches are common. OSA can occasionally result in complete collapse and obstruction of upper airways. It is an important cause of sudden death during sleep.

OSA must be recognized in time and managed appropriately before the complications develop. It is common for people to ignore this important symptom as ‘normal’ or inconsequential.  Unfortunately, it is not so. Consult your best chest physician in case you or your partner has such a problem. Get general evaluation and ‘full sleep-study’ done for treatment advice.

 Other general health measures include the following:

i.   Regular exercise helps to reduce snoring, by toning various muscles in the body (arms, legs, and abdominals) as well as the muscles in the neck and throat.

ii.    Lose weight in case of obesity with exercise and diet-regulation.

iii.   Quit smoking and restrict use of alcohol and sedatives.

iv.   Sleep measures: try to sleep on one side; raise the head end of your bed.

v.    Treat nasal congestion or obstruction if present.

As of now, there is no drug therapy which can be used to manage OSA. The most successful method is the use of positive pressure breathing administered through the night with a CPAP or BIPAP machine and a tight fitting face mask (as per doctor’s prescription). It is always advisable to get the sleep-study done at your best chest centre, before instituting the treatment. Relief from various symptoms is highly rewarding