Snoring: when should you see a doctor?

Snoring’s reputation for causing sleepless nights is well-known. It often leads to daytime tiredness and results in exasperation for anyone sharing the same room as the person snoring. Learn about snoring and its treatment from Mr Jonathan Hughes, an ENT (ear, nose and throat) specialist.

Is snoring something to worry about?

Snoring is very common; the majority of men and many women suffer snoring to some degree during their lives. The noise we associate with snoring happens when the flow of air in the nose and throat becomes blocked. As a consequence, the throat opens and closes in a way that causes vibrations and generates sound. There are generally two groups of patients that we see in the clinic:

• People who snore and it’s an inconvenience
• People who snore and have a significant medical problem (obstructive sleep apnoea)

For the vast majority, snoring is an inconvenience and can cause issues with anyone who sleeps in the same room, such as marital problems between partners. It can also result in mild daytime tiredness.

When is snoring dangerous?

Snoring becomes dangerous when you have obstructive sleep apnoea. This condition is associated with episodes at night in which a person stops breathing. When left untreated, it can cause high blood pressure, heart failure, heart attacks, stroke; as well as significant daytime tiredness and depression. As a result, it’s particularly dangerous for people who drive or operate heavy machinery.

If you’re experiencing significant daytime tiredness and someone has witnessed that you’ve had episodes of stopped breathing, I would recommend being seen by a specialist. Snoring is a nuisance generally, but the key thing is that snoring can be associated with a serious disease in the context of obstructive sleep apnoea. It’s often associated with people who are overweight and have high blood pressure (hypertension). If worried, get screened.

What are less-serious causes of snoring?

Less-serious causes are much more common than serious causes. Often, the less-serious causes are one or more of the following:

• Being overweight
• Drinking alcohol
• Taking sedatives at night
• Having problems with the nose and sinuses, that block the airflow through the nose
• Problems with the palate in the mouth
• The back of the tongue blocking the airflow in the throat

What about the serious causes of snoring?

The following causes are much less frequent:

• Obstructive sleep apnoea (as explained above)
• A tumour in the throat or voice box - but this is uncommon

Other potential symptoms of a tumour in the throat are problems with eating and drinking (dysphagia), a voice change or a lump in the neck.

What information will a specialist look out for?

Firstly, a full history of the patient's symptoms will be noted. This includes looking for the following complaints:

• Daytime tiredness
• Morning headaches
• Witnessed episodes of apnoea (episodes of stopped breathing) by a partner
• Other symptoms that are associated with the upper aero-digestive tract, such as voice changes and problems swallowing
• Nasal symptoms, from conditions like sinusitis and a deviated nasal septum
• Social problems as a result of snoring, with work and family
• Symptoms of cardio- and cerebrovascular disease caused by obstructive sleep apnoea

Then I look at their past medical history. In particular, asking about:

• High blood pressure
• Heart attacks
• Strokes
• Obesity
• Diabetes

Then I check if they are smokers or drink alcohol, and if they take any medication that could contribute to snoring.

What would a medical exam for snoring involve?

After gathering a detailed history, a physical examination would be performed. This is to assess the mouth to look for masses in the throat that could cause snoring and to check the palate and tongue. By looking at the front of the nose, ENT specialists can check for a deviated nasal septum. With a nasal endoscopy, the back of the nose can be examined to look for an obstruction in nasal airflow.

An examination also involves checking a patient’s Body Mass Index or BMI; this is because a higher BMI can be associated with snoring. We can also measure the diameter of a patient’s neck, those with thicker necks have a higher chance of snoring.

What are the treatment options?

There are various treatments and a specialist can advise you on the one most suitable for you. Generally, improving snoring requires a multifactorial approach.

Lifestyle changes

• Losing weight
• Reducing alcohol intake
• Stopping the use of night-time sedatives
• Wearing a mandibular advancement splint at night, which brings the jaw forward and reduces obstruction to improve airflow
• Wearing a positional sleep aid – these allow a person to stay in the optimal position while sleeping to reduce the likelihood of snoring

Radiofrequency/laser palatoplasty

This treatment makes the soft palate, at the back of the mouth, stiffer so that it’s less likely to vibrate and therefore, produce less noise.

CPAP machine

People with suspected obstructive sleep apnoea may be recommended to wear sleep monitor sensors, that record sleep and feed information to a monitor. If the results show moderate to severe sleep apnoea, they could be offered a Continuous Positive Airway Pressure (CPAP) machine. This is a mask that is worn over the nose (and sometimes over the mouth and nose) that is connected to a machine that keeps the airways open during sleep. It gives positive pressure into the airways so that they don’t collapse.

Some patients don’t cope well with a CPAP machine and in these cases, surgery may be offered.

Surgery

Surgeries for snoring are varied. The key is to address the individual anatomical problems. Drug-Induced Sleep Endoscopy (DISE) is a minor day-case procedure that aims to simulate sleep and snoring and it's performed in a hospital with an endoscope inside the upper airway to identify the areas of the throat that are blocking off and causing the snoring/obstructive sleep apnoea. With this information, specific treatments, including operations, addressing problems with the palate, tonsils, tongue or larynx can be considered in high confidence that the snoring will be improved.

Can snoring be completely silenced?

Patients need to be realistic about what kind of improvement can be achieved. Snoring can certainly be improved in most people and the volume lowered to a manageable level, but often, it’s not possible to completely silence snoring.

Start looking after your ear, nose and throat health with Mr Hughes by clicking here to get in touch.