Snoring
If there is partial obstruction at any level of the upper respiratory tract, from the nose down to the larynx, then during sleep, when the muscular wall of the throat relax, the inspiring air flows through the narrow passage and produces the sound of snoring.
Snoring is disturbing for the spouse, but is not always related to a severe pathology. Most adults snore when sleeping in supine position, if they go to sleep immediately after a heavy meal, or if they smoke and drink a lot of alcohol and then go straight to bed.
Sleep Apnoea
Sleep Apnoea
When snoring is loud, it may be a symptom of a severe condition, called sleep apnoea. In this condition, the respiratory path is obstructed completely and the body cannot get the required oxygen. The heart makes a great effort to send oxygen to the periphery (increased heart rate or tachycardia) and the blood pressure raises (hypertension). The carbon dioxide in the blood raises, and when it reaches a certain level, the brain centres responsible for sleep, wake us up. The muscles of the throat contract, the breathing pathway opens up and oxygen intake increases. Immediately after that, we fall asleep again, and and the same procedure is initiated, which will lead to another awakening and so on. This can happen several times during sleep, often more than 500 times in a five hour sleep, meaning that the patient with sleep apnoea never gets enough sleep to have a satisfactory rest. So, they feel sleepy in the morning and tired and droopy all day through. This interferes with their daily activities, disturbs work and can be dangerous when driving or handling machinery. Furthermore, the daily distress of the heart and vessels may lead to heart disease and hypertension.
What is the role of increased body weight
Obesity leads to accumulation of fat under the mucosa of the throat and in the tongue mass, which further narrows the respiratory pathway and worsens snoring and apnoea. This is why, the management plan offered to overweight or obese patients must include a nutrition programme, in addition to any surgical or conservative treatment.
Diagnosis
In every case of snoring, a full ear, nose and throat examination is mandatory. Examination of the nose and throat will reveal possible points of obstruction, and surgical intervention will be offered, when appropriate. A deviated nasal septum or hypertrophic turbinates will need surgical correction. If the tonsils are large, the uvula is too long or the palate is hypertrophic, the surgeon will offer an operation to the throat, named pharyngoplasty.
Sleep Study
When snoring is associated with morning fatigue and daytime sleepiness, a special test is needed, which monitors several body parameters during sleep and will exclude or confirm Sleep Apnoea. If the diagnosis of sleep apnoea comes up from the sleep study, then in co-operation with the Pneumonologists, a positive pressure breathing apparatus is prescribed, known as C-PAP.
What one should expect from treatment
Careful diagnostic workup, probably with involvement of more than one medical specialties, will lead to the suggestion of an individualized management plan. It is important to remember that common surgical interventions to the nose and pharynx, as the ones mentioned above, address simple snoring and not severe sleep apnoea. While they often improve snoring by more than 70%, over a significant period of at least five years, they have small, if any, impact on the parameters of apnoea. This being said, an apnoeic patient with huge tonsils or completely obstructed nose will definitely benefit from surgical correction of these abnormalities, so the possible role of surgery on every case is discussed with the patient, taking into account the available scientific evidence, as well as common sense. It should be made clear, however, that, regardless any significant improvement in snoring, an apnoeic patient may still need to use the C-PAP, after a successful septum operation or pharyngoplasty.
This website aims at providing simplified scientific information and not medical advice on specific conditions or individual cases. In this respect, it cannot replace the consultation and documented opinion of a specialist physician.