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Encyclopaedia


Snoring

Introduction

Snoring

Snoring is where a person makes a snorting or rattling noise when they breathe during sleep.

The noise comes from the soft palate and tissue in the mouth, nose or throat vibrating.

Some people snore infrequently and the sound they make isn't particularly loud, while others may snore every night, loud enough to be heard in the next room.

Healthcare professionals use grading systems to assess a person’s snoring. The higher the grade, the more severe the snoring is.

Read more about the symptoms of snoring.

When to see your GP

You should see a GP if your snoring is affecting aspects of your life, such as causing excessive tiredness and poor concentration, or relationship problems with your partner.

Excessive daytime sleepiness should be taken seriously, because it increases the risk of a road traffic accident. The Department for Transport estimates that one in five road traffic accidents are caused by excessive sleepiness. It can also cause accidents with the use of machinery and vehicles, such as cranes and forklift trucks.

Snoring can sometimes indicate a more serious related condition called obstructive sleep apnoea, where a person’s airways repeatedly become partially or totally blocked for about 10 seconds throughout the night. See your GP if you wake up gasping or choking during the night.

Read more about how snoring is diagnosed.

If your child snores, you should also speak to your GP.

Who snores?

As many as one in four people in Wales snore regularly.

Snoring can affect people of all ages, including children, although it's more common in adults aged 40-60. Twice as many men than women snore.

What causes snoring?

Snoring is caused by the vibration of soft tissue in your head and neck as you breathe in and out during sleep. This includes the nasal passages, the soft palate in the roof of your mouth, and your tonsils.

While you sleep, your airways relax and narrow. This affects air pressure within your airways and causes the tissue to vibrate. This can also occur if your airways are partially blocked – for example, if you have a cold.

Your chances of snoring can also be increased by factors such as being overweight, drinking excessive amounts of alcohol, and smoking.

Read more about the causes of snoring.

Treating snoring

Treatment can improve snoring in some cases, but a complete cure isn't always possible.

Lifestyle changes, such as losing weight, are usually recommended first.

Anti-snoring devices, such as mouth guards or nasal strips, may help prevent snoring.

Surgery may be an option if anti-snoring devices don't help. This often involves removing the soft tissue that causes snoring, or preventing the tissue from vibrating by causing it to tighten.

Surgery for snoring is usually regarded as a treatment of last resort. It's important to be aware that surgery can often have a limited effect that doesn't last longer than one or two years. It can also cause unpleasant side effects or complications.

Read more about treatments for snoring.

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Symptoms

Snoring is when you make a noticeable sound when you breathe in during sleep.

The sound is caused by soft tissue at the back of your mouth, nose or throat vibrating. The exact sound you make will depend on the type of soft tissue that's vibrating.

For example, if the soft tissue at the back of your nose vibrates when you snore, you'll produce a pinched nasal sound that's not particularly loud.

If the tissues at the top of your mouth (soft palate) and the back of your throat (uvula) vibrate, you'll produce a louder, more guttural ("throaty") sound.

In most cases, snoring is caused by a combination of areas that are vibrating or blocked.

People tend to snore most during the deepest stages of sleep, around 90 minutes after falling asleep. Most people tend to snore loudest when sleeping on their back.

Snoring grades

Healthcare professionals use a grading system to assess the severity of a person’s snoring. There are three grades of snoring, described below.

Grade one snoring

Grade one snoring, also known as simple snoring, is where a person snores infrequently and the sound they make isn't particularly loud.

If your snoring is classed as grade one, your breathing will be unaffected. This means you won't experience any significant health problems related to your symptoms.

However, your snoring may cause personal problems or issues if it's irritating or upsetting your partner.

Grade two snoring

Grade two snoring is where you snore on a regular basis (more than three days a week).

Some people with grade two snoring may experience mild to moderate breathing difficulties during sleep. This can affect sleep quality, making you feel tired and sleepy during the day.

Grade three snoring

Grade three snoring is where you snore every night, so loudly it can be heard outside your room.

Many people with grade three snoring have a related condition called obstructive sleep apnoea. This is where the airways become partially or totally blocked for about 10 seconds.

The lack of oxygen triggers your brain to take you out of deep sleep into a lighter state of sleep, or to wake you up for a short period to restore normal breathing.

Repeated episodes of snoring and waking can occur throughout the night, causing you to feel very sleepy the next day. This may have an adverse impact on your day-to-day activities.

When to seek medical advice

See your GP if you feel excessively tired during the day. It may be caused by your snoring affecting your breathing while you sleep.

The most common sign of excessive tiredness is when you find yourself falling asleep during the day.

You should also see your GP if you think a lack of sleep is affecting your day-to-day activities and causing symptoms, such as:

  • poor memory and concentration
  • headaches (particularly in the morning)
  • irritability and a short temper
  • anxiety
  • depression
  • lack of interest in sex

You should also visit your GP if your snoring is causing problems for your partner, such as keeping them awake at night or waking them up.

If your child snores, take them to see a GP. It may be caused by an underlying problem with their airways, such as enlarged tonsils. This will require further investigation and possibly treatment.

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Causes

Snoring is caused by the vibration of the soft tissue in your head and neck as you breathe in.

It can affect the:

  • nasal passages
  • soft palate – a soft layer of tissue at the back of the roof of the mouth
  • base of the tongue
  • tonsils – two small glands above the tongue where the mouth meets the throat
  • uvula – a small cone-shaped section of tissue that hangs from the soft palate between the tonsils

While you're asleep, the airways in your head and neck relax and narrow. It's thought that the narrowing of the airways increases the speed you breathe out and changes air pressure in your airways. This causes the soft tissue to vibrate by sucking the sides of the airways in.

The same effect can also be the result of partially blocked airways, which may be caused by conditions such as enlarged tonsils and colds.

Evidence suggests that snoring will get worse over time if left untreated. The vibrations that occur during snoring appear to damage blood vessels that supply muscles in the head and neck. Over many years, this causes the muscles to weaken.

If your head and neck muscles are weakened, it will affect their ability to keep your airways open, making you more likely to snore frequently and loudly.

Increased risk

Some things that can increase your risk of habitual snoring include:

  • obesity – particularly if you have a large amount of fat around your neck; people with a neck circumference of more than 43cm (17 inches) usually snore a lot
  • drinking alcohol – alcohol relaxes your muscles when you sleep, which increases the narrowing of your airways
  • sedatives and some types of antidepressants – in some people, these medications can have a similar effect to alcohol on the muscles
  • smoking – tobacco smoke can cause your airways to become inflamed, which causes greater narrowing of the airways
  • allergic rhinitis – where the inside of your nose becomes swollen and inflamed as a result of an allergic reaction to substances such as dust or pollen

People with severe snoring may have obstructive sleep apnoea, a condition where the airways become temporarily blocked during sleep.

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Diagnosis

You may want to see your GP if you snore regularly.

They'll ask you some questions about your snoring, such as:

  • How often do you snore?
  • Is your snoring loud enough to wake others?
  • Is your snoring worse when you're lying in any particular position, such as on your back?
  • Are there underlying factors that may be contributing to your snoring, such as alcohol, smoking or medication?
  • Do you feel properly refreshed after sleeping, or do you still feel sleepy the following day?
  • Have others noticed you make snorting or gasping noises between snores?

If you answer yes to the last two questions, it may be a sign that you have obstructive sleep apnoea (OSA) – see below.

Your GP may weigh and measure you to assess your body mass index (BMI), and they may also measure the circumference of your neck. They may also examine your mouth and throat in case an abnormality, such as swollen tonsils or a non-cancerous growth, is contributing to your snoring.

Further tests are usually only required if your symptoms suggest you have OSA. This may involve referring you to a specialist sleep centre so you can be monitored while you sleep. Alternatively, you may be given a monitoring device to wear at night while you sleep at home. This is known as a home sleep study.

The Epworth Sleepiness Scale is also often used to help identify people at risk of developing OSA. It's a questionnaire that has eight questions, each with a score from zero to three, depending on how likely it is for you to fall asleep in certain situations, such as while watching television or reading.

Read more about how sleep apnoea is diagnosed.

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Treatment

It's sometimes possible to treat snoring by making lifestyle changes. Further treatment is also available if this doesn't help.

Lifestyle changes

Lifestyle changes are usually advised by your GP as a first step to treat snoring. These include:

  • losing weight if you're overweight
  • not drinking alcohol – particularly a few hours before you go to bed
  • giving up smoking if you smoke
  • exercising regularly – this can help strengthen neck muscles, which may help prevent the airways narrowing

Talk to your GP if you feel your medication may be contributing to your snoring, as they may be able to prescribe alternatives. However, don't stop taking prescribed medication without first consulting your GP.

If your snoring is worse when you're sleeping on your back, you may find sleeping on your side beneficial. Wearing a top with a pocket stitched between the shoulder blades and putting a tennis or golf ball in the pocket can help keep you off your back when you sleep.

Ear plugs

If your snoring isn't causing you health problems but is affecting your partner, asking them to wear ear plugs during the night may be a cheap and effective way of resolving the issue.

Anti-snoring devices

If lifestyle changes don't help, there are a number of anti-snoring devices you can try that can help prevent snoring. These devices aren't usually available on the NHS, but they can be bought at many larger pharmacies.

The different types of anti-snoring devices are described below.

Nasal devices

If your snoring is mainly coming from your nose, you may benefit from using nasal strips or nasal dilators.

Nasal strips are small pieces of self-adhesive tape similar in appearance to sticking plasters. Before you go to sleep, place the nasal strip on the outside of your nose. The strip pulls your nostrils apart, which can help stop them narrowing during sleep.

A nasal dilator is a plastic or metal device that looks a bit like a nose ring. You place it inside your nose before you go to sleep and it pushes your nostrils apart while you're asleep.

There hasn't been much research comparing the effectiveness of each type of nasal device in treating snoring. For most people, their choice of device is based on personal preference.

Oral devices

If your snoring is mainly coming from your mouth, you may benefit from chin strips or a vestibular shield. Chin strips are strips of tape placed under your chin, which help stop your mouth falling open while you sleep.

A vestibular shield is a plastic device that looks similar to a gum shield. It fits inside your mouth and blocks the flow of air. This forces you to breathe through your nose, which may prevent you from opening your mouth and snoring.

As with nasal devices, there's limited evidence on which type of oral device is more effective, so the choice will be down to your personal preference.

Mandibular advancement device (MAD)

If your snoring is mainly due to the base of your tongue vibrating, a mandibular advancement device (MAD) may be recommended.

A MAD is similar to a vestibular shield, but it's designed to push your jaw and tongue forward. This increases the space at the back of your throat and reduces the narrowing of your airway that's causing your tongue to vibrate, resulting in snoring.

You can buy a MAD for around £30-50, which is suitable for most cases of simple snoring (snoring that doesn't cause any breathing difficulties).

However, if your snoring is associated with breathing difficulties, such as obstructive sleep apnoea, it's recommended that you have a MAD made specifically for you by a dental specialist (orthodontist) using impressions of your teeth and jaw.

The cost of a custom-made MAD will depend on the complexity of the device and materials used, and can range from several hundred pounds to several thousand pounds. It's unlikely that you'll be able to obtain a custom-made MAD free of charge on the NHS.

An MAD lasts about 18 months before it needs to be replaced.

Surgery

Several surgical techniques can also be used to correct snoring. However, surgery for snoring is usually only available free of charge on the NHS if:

  • there's evidence that snoring is having an adverse effect on your health or quality of life, and
  • you've tried all other recommended treatments without success

Surgery for snoring is usually regarded as a last resort, when all other treatment options have been tried and haven't worked.

Surgery also isn't suitable for most cases of snoring.

Surgery isn't usually recommended for people with sleep apnoea because there are more effective treatments available, such as using breathing devices to help with breathing.

Read more about treating sleep apnoea.

In cases where there are obvious anatomical problems contributing towards snoring, such as having large tonsils, surgery to remove the tonsils may be recommended.

Otherwise, there are four main types of surgery that are used to treat snoring:

  • uvulopalatopharyngoplasty (UPPP)
  • uvulopalatoplasty (UP)
  • palate implants
  • radiofrequency ablation (RFA) of the soft palate

These procedures aren't usually available on the NHS.

Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is used when it's been confirmed that soft tissue in your mouth (excluding your tongue) is responsible for your snoring.

During UPPP the surgeon will remove:

  • your uvula – the piece of tissue that hangs from the roof of your mouth
  • some of your soft palate
  • some excess tissue around the base of your throat

In some cases, your tonsils and adenoids may also be removed. Adenoids are small lumps of tissue at the back of the nose, behind the palate.

UPPP is carried out under general anaesthetic, which means you'll be asleep during surgery and unable to feel any pain or discomfort during the procedure. However, UPPP can cause considerable pain afterwards, which can sometimes persist for up to three weeks.

Removing your uvula can affect your ability to pronounce certain sounds, but it won't affect your ability to speak English. This is because the English language doesn't make use of any of the sounds made with the uvula (known as uvular consonants). However, you may find that your pronunciation of some words in other languages is affected by the operation.

UPPP completely cures snoring in about half of all people who have the procedure. Serious complications occur in an estimated 1% of cases. They include:

Uvulopalatoplasty (UP)

Uvulopalatoplasty (UP), sometimes called laser-assisted uvulopalatoplasty (LAUP), is increasingly used as an alternative technique to UPPP because it carries a lower risk.

However, evidence suggests that UP may not be as effective as UPPP in the long term. UP can also cause considerable post-operative pain that lasts up to two weeks.

During UP, lasers or high-energy radio waves are used to burn away the uvular and some of the soft palate.

Soft palate implants

Soft palate implants can be used to treat snoring that doesn't cause breathing difficulties if it has been confirmed that the vibration of the soft palate is causing it.

During the procedure, a local anaesthetic injection is used to numb the roof of your mouth. Several implants made out of synthetic (man-made) material are injected into your palate, causing it to stiffen. This should help prevent to the soft palate vibrating while you sleep.

In 2007, the National Institute for Health and Care Excellence (NICE) published guidance about soft palate implants. It stated that there are no safety concerns over the use of implants, but people considering using them should be aware that there's limited evidence about whether they're an effective long-term treatment.

For more information, see the NICE guidance about soft-palate implants for simple snoring (PDF, 89kb)

Radiofrequency ablation

Radiofrequency ablation (RFA) of the soft palate is an alternative treatment to soft palate implants. It's used to treat cases where vibrations of the soft palate are responsible for snoring, and aims to stiffen the soft palate.

The procedure is carried out on an outpatient basis, which means you won't need to stay in hospital overnight. The roof of your mouth is numbed with a local anaesthetic and an electrode is implanted in the tissue of your soft palate, which delivers high-energy radio waves that shrink and harden the tissue. This makes it less likely to vibrate when you're asleep.

NICE guidance published in 2014 reported on a number of small studies that assessed the effectiveness of RFA. The researchers concluded that following the procedure there was an improvement in snoring and upper airway obstruction, which led to a lack of daytime sleepiness. The quality of life for both those affected and their partners also improved.

The guidance also states that there are no major safety concerns relating to RFA of the soft palate for snoring. However, evidence as to its long-term effectiveness is limited.

For more information, see the NICE guidance about radiofrequency ablation of the soft palate for snoring (PDF, 126kb)

Medication

Medication can't directly treat the symptoms of snoring, but it can be used to help treat some of the underlying causes.

For example, if allergic rhinitis (nasal irritation and swelling) is causing your snoring, an antihistamine nasal spray may help relieve your symptoms. Antihistamines are a type of medication that are very effective in treating allergic reactions.

Alternatively, if your snoring is particularly troublesome as a result of having a blocked nose, a short course of nasal decongestants may help. However, never use nasal decongestants for more than seven days in a row because it can make your symptoms worse.

Your GP can advise you on whether medication will help your snoring.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 21/01/2015 10:05:28

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