Some 45 percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a tennis ball on the pajama back – to force the snorer to sleep on his side. (Snoring is often worse when the person sleeps on his back.)
Chin and head straps, neck collars, and devices inserted into the mouth are usually disappointing as snoring cures. Many electrical devices have been designed to produce painful or unpleasant stimuli when the patient snores. The presumption was that a person could be trained or conditioned not to snore. Unfortunately, snoring is not under the person’s control whatsoever; and if these devices work it is probably because they keep the snorer awake.
What Causes Snoring?
The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.
What is Sleep Apnea?
Sleep apnea is a condition in which breathing stops and starts during sleep. It is usually associated with snoring. Snoring is just a sign that the upper airway caliber has narrowed to a critical degree. Much like water that flows through a narrowing (i.e. a canyon) speeds up creating turbulence and noise, so too does air that has to flow through a narrowed upper airway at night. If the narrowing becomes too severe it promotes closure of the airway resulting in an apnea. An apnea is arbitrarily defined as a cessation of airflow that lasts at least ten seconds. A hypopnea is defined as a significant reduction in airflow lasting at least ten seconds and usually associated with a decline in a person’s oxygen level.
Apneas and hypopneas are generally classified into three types, central, obstructive, and mixed with the latter two being much more common. Central sleep apnea occurs when the brain neglects to send impulses to the chest muscles so that a breathing effort is not initiated. Obstructive sleep apnea (OSA) occurs when a breathing effort is initiated but air can not enter the lungs because the upper air passage has collapsed. The upper air passage extends from the nasopharynx (hard palate) to the larynx. Mixed apneas occur when initially there is no inspiratory effort but subsequently when efforts are initiated the apnea persists because the upper airway is collapsed.
People are generally considered to have sleep apnea if they have more than 10 apneas + hypopneas per hour of sleep (commonly referred to as the apnea-hypopnea index or AHI). The sleep apnea syndrome refers to people with sleep apnea at night who also have excessive daytime somnolence.
Obstructive sleep apnea can affect anyone but tends to be more common in men and in people who are overweight. Almost all obstructive sleep apnea patients are regular snorers. It is probably more common in people as they get older. There are some studies demonstrating that sleep apnea is more common in relatives of sleep apnea patients. The exact reason for this has not been completely established.
Sleep apnea (depending on how it is defined) is believed to affect up to 5% of women and 15% of men who are 30 to 60 years old. Of those people who snore every night, 19% of females and 34% of males have sleep apnea. The sleep apnea syndrome (sleep apnea plus daytime somnolence) is believed to affect 2% and 4% of adult females and males respectively. This makes it one of the most common medical disorders that the adult population suffers from.
There is no way to be certain without detailed testing to know whether someone has sleep apnea. However, the following types of symptoms and signs or a combination of these should alert a person and their physician to the possibility:
- Unusually sleepy during the day, and snore a lot at night.
- Told by a spouse or partner that their snoring is interrupted by periods when they don’t breathe properly.
- A small or recessed jaw (retrognathia).
- Despite an adequate number of hours of sleep, feeling unrefreshed in the morning.
- Wake up several times at night for no particular reason, especially if a spouse or partner describes gasping or snorting respirations during the night.
- Unexplained heart (especially right-sided) or respiratory failure.
- Memory or concentration problems that are not easily explained.
- Excessive daytime fatigue.