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Why do we snore and how can I stop snoring at night?

Irish Examiner logo Irish Examiner 30/09/2022 Sharon Ní Chonchúir
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I sleep with a snorer. Or should I say that I try to sleep with a snorer?

Snoring is often downplayed as a joke but let me tell you that sleeping with a snorer can be torture. There have been countless nights when the noise has driven me from my bed in search of peace in the spare room.

Nor is snoring a joke for snorers themselves. “There’s this idea that snoring is benign and more troublesome for the partner of the snorer than the snorer,” says Ken O’Halloran, professor of physiology at UCC. “But it can be indicative of health issues or the cause of problems.”

Being woken by snoring can have a cumulative negative impact on health. A 2010 Japanese review found sleep deprivation was associated with high blood pressure, coronary heart disease, and diabetes.

So, why do we snore?

“It happens when there isn’t enough space in the nose and throat to allow the smooth flow of air during breathing,” says Dr Brian Kent, a consultant respiratory physician at St James’ Hospital in Dublin.

“This causes vibrations of soft tissue within the airway, particularly the soft palate at the roof of the mouth, which leads to that characteristic snoring sound we all know.”

It only happens when we sleep because that is when our muscles relax.

“This includes our throat muscles, which keep our airway open,” says O’Halloran. “When we sleep, the throat muscles relax and the airway narrows.”

According to Kent, up to 50% of men and 25% of women are habitual snorers. Various factors influence whether you’re likely to be one of them. Your genes, for example, determine the size and shape of your jaw, tongue, and nose.

“Traits such as a shorter lower jaw or an enlarged tongue increase the risk of airway collapse during sleep,” says O’Halloran.

Body weight is another factor, as having fat around the neck can squeeze the airway and cause narrowing.

“Your sleep position plays a role too,” says O’Halloran. “When we sleep on our backs, the gravitational force can close the airway.”

Allergies cause congestion, making us more likely to snore. Also, smokers are more prone to snoring.

“Alcohol is a factor too,” says O’Halloran. “It relaxes our muscles, including those in our throat and even people who do not habitually snore will often do so after consuming alcohol.”

Men snore more

Men are also more likely to snore than women — Kent attributes this to hormones. “The female hormones progesterone and oestrogen provide some protection against breathing disturbances during sleep in pre-menopausal women,” he says. “But after menopause, women begin to catch up in relation to snoring and in their risk of developing sleep apnoea.”

A 2022 Norwegian study found that lower levels of these hormones meant that sleep apnoea was more common in post-menopausal women. It also found that the lower a post-menopausal woman’s oestrogen and progesterone levels were, the more likely they were to snore.

Sleep apnoea is considerably more serious.

“Snoring happens when there’s insufficient space in the upper airway to allow for quiet airflow, but sleep apnoea is when there isn’t enough space to allow air to flow through at all,” says Kent.

You can hear the difference if you share a bed with someone with sleep apnoea.

“Silence will be followed by abrupt snoring, spluttering and movement,” says O’Halloran. “People often wake feeling as if they’re choking and when they fall back to sleep, the problem presents again.”

This broken sleep can significantly impact a person’s life. “They can be so tired during the day that they nod off while driving,” says Kent.

There is also a health toll.

“If it’s untreated and severe, it puts people at increased risk of high blood pressure, diabetes, cardiac disease and stroke,” says Kent.

Can we take steps to stop snoring and minimise our risk of sleep apnoea? Breathing instructor Patrick McKeown reassures us that there are. He says there are two categories of snoring.

“Mouth snoring happens when people breathe through their mouths. If you’re waking with a dry mouth in the morning, you’re breathing through your mouth ... if you’re snoring, an easy way to fix it is to tape your mouth shut using a light, easy-to-wear bio-tape that is widely available.” (A 2020 Taiwanese study found that mouth breathing significantly increased the likelihood of snoring.)

The other category is nasal snoring. McKeown, the author of two bestselling books The Oxygen Advantage and The Breathing Cure, recommends simple breathing exercises known as the Buteyko Breathing Method for this form of snoring.

“It’s all about retraining the brain to breathe slightly and calmly through the nose,” he says. “These exercises decongest the nose, normalise the flow of breathing, and reduce snoring.”

A pilot study McKeown undertook in partnership with the University of Limerick and Limerick University Hospital in 2013 corroborates his recommendations. Patients who did his breathing exercises showed a 70% reduction in snoring at their three-month follow-up appointments.

Kent advises his patients to start with lifestyle changes.

“Relatively straightforward measures like cutting down on alcohol, avoiding sleeping on their backs and weight loss can help some people control their snoring,” he says.

Finding a solution

Specialised tongue exercises might benefit them too. A 2015 study found that daily tongue exercises reduced the frequency of snoring by 36% and snoring volume by 59%. 

Singing could be another option. A 2013 trial involving 120 people found that those who were given singing exercises to do reported better sleep and less snoring.

A mandibular advancement device can help people who snore due to issues with their lower jaw.

“These hold the lower jaw forward during sleep which increases the amount of space through which the air can flow at the back of the throat,” says Kent. “They have been proven to be effective for snoring and for people with mild to moderate sleep apnoea.”

A continuous positive airway pressure (CPAP) machine is often recommended for those with more severe symptoms.

“They use a hose connected to a mask or nosepiece to deliver constant air pressure to help you breathe while you sleep,” says O’Halloran. “But people can find them difficult to wear every night.”

If you’re a snorer and want to investigate the range of options available, it’s a good idea to first find out more about your snoring. Apps such as Snore Lab record you as you sleep, measuring snoring over time. It also tracks the lifestyle factors that can exacerbate snoring so that you can take steps to tackle those before resorting to more serious treatments.

It’s essential to pay attention to snoring, says Kent.

“If you snore and have other symptoms such as feeling tired during the day or your partner comments that it sounds funny, get it checked out as it could be sleep apnoea. Even if you don’t think it’s sleep apnoea but it’s domestically disruptive and often leads to one or other of you on the sofa, it’s worth checking it out too. People snore for all sorts of reasons and there are ways of treating most of them.”

We’re following his advice in our house. We’ve downloaded an app to see how bad this snoring is and to listen for the tell-tale sounds of sleep apnoea, and then proceed from there. Either way, the time has come to do something about it.

Snoring myths debunked

Snoring is such a common problem that countless weird and wonderful cures have been devised for it over the years. However, many are ineffective, and some may even be counterproductive. Here are some that work and some you should avoid.

1. Have a nightcap before bed. People used to think that a relaxing alcoholic drink before bed reduced the risk of snoring, but this is untrue. Alcohol is a relaxant, but it relaxes all of the body’s muscles, including those in your throat, making you more, not less, likely to snore.

2. Sleep on your back. Again, this is a fallacy. The muscles in our throat relax in our sleep whatever our sleep position but when we lie flat on our backs, there is also the additional gravitational effect of our tongue rolling back in our mouths and narrowing our airways even further. It’s more advisable to sleep on your side. This is why snorers used to be encouraged to sew tennis balls into the back of their pyjamas as it made sleeping on their backs so uncomfortable they were unlikely to do it for very long. A gentler approach might be to place a pillow against your back to encourage you to sleep on your side.

3. Take a sleeping pill. Don’t do this, says O’Halloran. Sleeping pills are likely to aggravate snoring and sleep apnoea. Like alcohol, they relax our muscles and increase the risk of airway obstruction ad the throat muscles cease to function.

4. Lose some weight. O’Halloran says that weight loss is a recognised strategy to combat sleep apnoea. Losing fat around your neck area is especially effective as it relieves the pressure on the airway, which can help to prevent snoring.

5. Have surgery to address issues such as a deviated septum. Kent advises that this should only be considered as a last resort and when lifestyle changes have been attempted first. “It’s rare that a deviated septum is the only cause of snoring or sleep apnoea, which means that surgery rarely solves the problem by itself,” he says. “Often the problem stems from reduced space at the back of the throat which requires extensive surgery such as the removal of tonsils, the uvula, or some of the soft palate. It’s uncommon that surgery would be a doctor’s only recommendation.” 

6. Try steroid nasal sprays and antihistamines. These treatments can help clear nasal congestion caused by allergies. Clearing your nose makes you less likely to breathe through your mouth and consequently less likely to snore.

7. Don’t smoke. This is always good advice and especially so for snorers. Smokers snore more than non-smokers so quit smoking if you can. If you can’t, try not to smoke in the hours before sleep.

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