How it develops
Snoring is a noise created by an obstruction within the upper airways whilst breathing during sleep and it can occur in both adults and children.
There are 2 distinct types:
Simple snoring. Socially disruptive but without breath-holding. This can either be treated conservatively or by intervening surgically.
Sleep apnoea. Snoring that is not only socially disruptive but also results in breath-holding. This is diagnosed by undertaking sleep studies in a sleep lab and is treated with a device called a CPAP machine.
Snoring can be caused by localized or general problems, the localized ones occuring anywhere from the nasal cavity along to the post nasal space (back of the nose) and then down to the soft palate and the base of the tongue. As a result, any of these areas can be targeted to reduce or stop the problem.
The generalized problems usually centre around weight gain which results in flabby airways with poor tone which, in turn, leads to vibration in a relaxed, sleepy state. Other generalized problems may be caused by smoking, excessive alcohol use or regular use of sedatives to help sleep.
Sometimes it is difficult to know where the source of the problem lies, particularly if the signs are subtle. To this end a sleep nasendoscopy can be performed where a small, bendy telescope can be passed down the nose under sedation to induce snoring, thus identifying the area that is problematic.
Treatment: Simple snoring
Improvement of the nasal airway.
. If the nose is congested then this must be treated depending on what the cause is e.g. allergies (sprays, antihistamines), infection (antibiotics).
. Breathe-right strips.
. Plastic nasal splint
Stop collapse of the tongue base.
. Dental splint. This looks like a gum guard and is designed to be worn at night to hold the teeth in position which, in turn, stops the jaw and tongue from collapsing back.
Weight loss. This is crucial for a successful treatment outcome, regardless of what type of snoring is being treated.
In children, if the adenoids and tonsils are grossly enlarged, they can be removed to open up the airway. This is extremely effective but news to be performed in a children’s hospital with appropriate nursing and medical facilities available.
Adults rarely have adenoids and they thus don’t affect the airway but if their tonsils are enlarged, they can be removed to open up the airway as well.
If the soft palate is very lax (floppy) it can be stiffened by trimming the uvula (dangly appendage of the soft palate) and scarring the central part of the soft palate to stiffen it. This can be carried out using a laser, diathermy or occasionally an ultrasonic device.
Both the tonsillectomy and palate surgery are painful but this is usually well tolerated and treated by paracetamol, codeine, anaesthetic gargles and anti-inflammatories. Eating and drinking is actively encouraged to stop infections or bleeding.
Candidates for surgery need to understand that up to 1/3 of operative cases may not reduce snoring and this makes careful patient selection all the more important.
Treatment: Sleep Apnoea
In children, this is usually caused by enlarged adenoids and tonsils which can be treated by performing an adenotonsillectomy. It is very rare for this to be caused by the brain switching off the breathing whilst sleeping (Ondines’ curse).
In adults, diagnosis with a non-invasive sleep study is important and, once confirmed, treatment involves the use of CPAP (Continuous Positive Airway Pressure). This is a machine that fits over the nose as a mask and is designed to keep the airways open whilst asleep, thus facilitating taking a breath when required. It can dry the airways out a little and it is thus important to regularly perform steam inhalations to prevent or reduce this.
I have good links with sleep centres in Brighton (Dr. Mark Jackson), Worthing (Dr. Kate Steele) and East Grinstead (Dr. Peter Venn) to help with this process.