Why do we snore?

In deep sleep the muscles of the tongue, throat and roof of mouth relax and allow the tongue and soft palate and uvula to fall backward. The heavier the person is, the more overweight, the more this backward fall can close the breathing passage. In a recent study it was shown that by correcting the nasal condition and shrinking the tonsils, even sleep apnea can be corrected.
Did you know there are doctors who specialize in snoring? And no wonder, snoring can destroy a relationship ! It can also change you from a pep and energy person to one who drags himself around all day half asleep.

Normal Sleep

Normally the person breathes openly and there is no alteration of sound such as snoring. If the nose is congested, if there is post-nasal drip or sinus or allergy, the reduced airway can produce sounds, which the partner doesn’t care for. However, a second change takes place. When there is drainage from the nose, this can affect the soft tissues of the throat. The tonsils may enlarge, there may be swelling of the back of the throat or the top of the throat too. Even the tongue may be affected. This enlargement acts as a stop valve to create the obstructive aspects of snoring called sleep apnea.

Social Snoring

Socially, snoring can be a true handicap. No question that snoring severely bothers the partner’s sleep, and earplugs may not be a sufficient answer. A separate bedroom is not a happy answer. Social snoring may be defined as loud noises made in sleep that doesn’t affect the flow of oxygen to the body.

Sleep Apnea

Sleep apnea is different than social snoring. There may be periods when no oxygen gets to the body and the all-important brain. This can be measured by Sleep Study Analysis where the oxygen level and brain activity is recorded during sleep.
With sleep apnea there are periods of low oxygen reaching the brain. The patient may actually stop breathing for a time! There is an index that tells the doctor how many of these periods without oxygen are occurring. If they are frequent and long, then brain damage can occur. With sleep apnea persons note tiredness on awakening, fatigue, and decrease in “pep.” Most serious is falling asleep during the day including while driving . Insurance companies now recognize that anyone who has had several accidents probably has sleep apnea. In Australia, Sleep Apnea is a reportable condition that may restrict a driver’s license.
Serious medical complications of sleep apnea include hypertension and obesity. Because of the tired feeling he eats candy, becomes more obese and the snoring becomes worse. In obesity the soft tissues of the throat enlarge and become heavier.

Preventing Snoring After Surgery

Only lately have doctors realized how important it is to correct nasal/sinus conditions in order to correct snoring. This is why so many persons have had the latest snoring surgery and months later they are back to snoring again because the same post-nasal drip or sinus condition is again causing the throat tissues to swell!
The recent article in Laryngoscope. 118(2):354-359, February 2008. showed that by correcting the nasal obstruction and reducing the size of the tonsils, patients with serious sleep apnea could be relieved.

THROAT and NASAL Treatment

If a patient shows a nasal/sinus condition, careful examination of the throat generally shows some puffiness or swelling of the throat tissues. This is because the bacterial drainage is picked up and filtered by the tissues of the throat including the tonsils.
Incidentally there are tonsils also located on the back of the tongue that can also swell and block breathing.
One approach that has worked for many snorers is to use pulsatile nasal irrigation for post-nasal drip or persistent sinus drainage and use the throat irrigation to irrigate the throat. Throat pulsatile irrigation is easy to do, takes about a minute and the throat feels fresh afterwards.
How throat irrigation works
Throat structures, like the tonsils, has tissue designed to catch bacteria and get rid of it. In a throat infection the tonsils enlarge in order to better fight invading bacteria. Any part of the throat can swell and make more tonsil like tissue for this purpose. With pulsatile irrigation, bacteria are removed, there is more good blood brought to the area by the massage of the pulsation, and there is increased lymphatic drainage to take away the bad stuff. Pulsatile throat irrigation is especially effective in removing ill-smelling white debris from the crypts or holes in the tonsil crypts.
How nasal/sinus irrigation works
In post-nasal drip, persistent sinus drainage, thick phlegm, you find that the nasal cilia designed to move bacteria out of the nose is moving too slow. With pulsatile irrigation, the speed of the vibration gets the cilia back to normal speed and helps the body to act normally again. In addition, pulsatile irrigation is the most effective way to rinse away bacteria, pollen and dust.

How to clear snoring

The actual method is to add one teaspoon of salt or a packet to 500 cc of warm water in the irrigator reservoir.
Attach the nasal tip. Adjust the stream so it is about one inch high – a low gentle pressure. Irrigate both sides until you reach the 200 cc mark.
Then remove the nasal attachment and put on the throat one that is included with the pulsatile irrigator. Lean gently over the sink. Slide the throat tip to the right side of the tongue to irrigate the right throat. Then flip it over and slide to the left tongue to irrigate the left throat and tonsil.
The amounts used for each irrigation can vary. For the throat irrigation you don’t need to use saline, you can use plain water or add any kind of mouth wash. What is important that the nasal irrigation must be done with saline.

That nose

If the tip of the nose droops down, try lifting it up. Does that open up the airway? If so your snoring cure may be to tape the tip of the nose up in that lifted condition when you sleep.
Your doctor may find that the nose has a badly deviated nasal septum that accounts for your snoring and may recommend correcting that deviation.

That jaw

Some persons have a dental situation that forces the tongue back in sleep. This may be corrected by a dental device that brings it forward in sleep.

The tennis cure

Since snoring occurs when you sleep on your back – the uvula, soft palate flop back and obstruct – sleeping on your side may be the answer. Take an old tennis ball and sew it onto the back of a T shirt. Wear this in sleep so that when you sleep on your back, you will prompted to turn to the side. This doesn’t bother REM sleep.

Surgery

Various means of reducing tissues of the throat have been developed including removing tonsils, uvula and parts of the soft palate, or reducing swollen tissue by radiofrequency, or inserting stiff “stays” so that the soft palate no longer vibrates. Sometimes these procedures fail because the post-nasal drainage that caused the throat swelling in the first place is still present, and can again cause swollen throat tissue. This is why at Tower ENT we recommend using the pulsatile nasal and throat irrigation to clear the nose and shrink the throat tissues. When that works we can then avoid a surgery and prevent snoring from reoccurring. Or after surgery we make sure that the nose stays clear and no longer effects the throat.

CPAP

CPAP refers to continuos flow of air under pressure delivered to your lungs under pressure. The patient wears a mask, the device delivers air under pressure which overcomes blockage of the throat. The relief may be immediate with increased rest, pep and feeling good again. Unfortunately many patients don’t tolerate this device well and must seek an alternative approach.

What’s Best for You

Obviously there are several approaches to snoring relief and the most important one is a correct diagnosis. Whether you are treated by sewing a tennis ball to your T shirt or by clearing nasal drainage or by surgery to remove obstructive tissue, the relief of this condition can significantly help your health and that of your partner.

Simple Steps for Snoring

• Nasal Moisturizer Nasal Gel at night
• Lifting the tip of the nose up with tape to open the airway.
• Proper pillow so the neck isn’t bent forward.
• Encourage sleeping on the side. A tennis ball on the back of a T shirt
• Pan of water to moisten the room and avoid dryness.
• Clearing nasal congestion by pulsatile irrigation
• Reducing swollen tonsils by pulsatile irrigation
• Head of bed elevated
• Weight control

Feel Good

If you or your partner snores, do look into methods of clearing this so you and your partner can enjoy better sleep and better health.
Signed, Murray Grossan, M.D.