Dr John Eloff - Treatment of Snoring, Mild Sleep Apnea and Invisalign

Why is Snoring a problem?

 

Snoring sometimes can be the only sign of a more serious problem. People who snore should be evaluated to be certain that other problems such as sleep apnea, other sleeping problems, or other sleep related breathing problems.

If the snorer sleeps and breathes normally, then snoring is only a problem for the snorer’s bed partner or family members. In fact, snoring often disrupts the sleep of family members and partners more than it affects the snorer. Frequently, partners of snorers report leaving the bedroom (or making the snorer leave the bedroom) many nights per week. Snoring may not be a medical problem, but it can become a significant social problem for the snorer and sleep problem for the bed partner.

What is the clinical importance of snoring?

It is important to determine if snoring is related to an underlying medical condition or is an isolated (primary) problem (not associated with any underlying disease).

More specifically, primary snoring is not associated with obstructive sleep apnea, upper airway resistance, insomnia, or other sleep disorders. This distinction is important because of the associated link between the underlying conditions and other adverse health effects.

For example, obstructive sleep apnea (OSA) is associated with higher risks of cardiovascular disease such as heart attacks and strokes. This association is thought to exist because of higher prevalence of high blood pressure (hypertension) in individuals with obstructive sleep apnea. On the other hand, studies have shown that people with primary snoring did not have higher rates of elevated blood pressure compared to the general public. Despite this, there is increasing evidence of a relationship between snoring and other significant health problems. However, the exact relationship remains unclear.

How do medications and alcohol affect snoring?

The root cause of snoring is vibration of the tissues while breathing. Some medications as well as alcohol can lead to enhanced relaxation of muscles during sleep. As the muscles of the palate, tongue, neck, and pharynx relax more, the airway collapses more. This leads to a smaller airway and greater tissue vibration. Some medications encourage a deeper level of sleep, which also can worsen snoring.

What are different levels of snoring?

Mild resistance to airflow for any of the above reasons in the upper airways may result in some snoring that is not associated with any sleep disturbance.

If resistance to airflow increases, the efforts to maintain adequate ventilation and breathing may cause transient arousal from sleep that is typically not severe enough to cause the level of oxygen in the blood to decrease (hypoxia). This is called the respiratory effort related arousal (RERA).

When the resistance increases even further, the ventilatory efforts cannot keep up with the degree of resistance to maintain adequate levels of oxygen, and airflow decreases or stops. This often leads to a decrease in the level of oxygen in the blood. As a result, sleep becomes more fragmented and arousals more frequent. The events are referred to as obstructive hypopneas or apneas, and the condition is termed obstructive sleep apnea-hypopnea syndrome.

How should someone with snoring be evaluated?

To thoroughly evaluate someone with a snoring problem, it is important to also talk to that person’s bed partner or family members. A complete history and physical examination is often performed.

In addition, more detail about their snoring and sleep problems needs to be obtained. The patients may be asked about their sleep pattern and sleep hygiene, daytime symptoms of sleepiness, daytime napping, and frequency of awakening at night.

A thorough physical examination may also be performed including assessing the patient’s body weight and body mass index (BMI), assessment of the neck circumference (area around the neck), and visualization of the throat, nasal, and oral cavities to determine how narrow the oral and nasal passages are.

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