Snoring

What is snoring?

Snoring, medically known as rhonchopathy, refers to involuntary noises that occur during sleep when breathing in and out. This is because the muscles relax as a whole during sleep, which also relaxes the upper airways and relaxes the palate muscles. Not only does this narrow the upper airway, but the relaxed soft palate and uvula flutter back and forth with every breath. Constriction plus vibration of the structures triggers the disturbing noises.

With increasing age, almost every second person snores, more men than women. As a rule, this is so-called primary or habitual snoring; synonyms are benign or harmless snoring or non-apnoeic snoring. This form of snoring is not a disease, but can be extremely stressful for the person sleeping in the same room. Because an undisturbed night’s sleep is then out of the question. Four important criteria for primary, harmless snoring:

1. Phases of quiet breathing and snoring can alternate, but there are no breathing interruptions.
2. Circulation and oxygen levels in the blood are right.
3. Measurements of the brain waves show that sleep is continuous and that there are no breathing interruptions with resulting short-term waking.
4. Because sleep is so continuous, there is hardly any tiredness, microsleep or concentration problems during the day.

These dangerous side effects of snoring – waking up at night due to breathing interruptions, daytime sleepiness – are typical in the context of sleep apnea, medically known as obstructive sleep apnea syndrome (OSAS). The breathing interruptions lead to a lack of oxygen, which in turn triggers the wake-up reaction in the brain. However, these nocturnal breathing interruptions with brief awakenings occur unconsciously and the person affected is unaware of them the next day. Sleep apnea also harbors a number of other serious health risks: The breathing interruptions promote high blood pressure and therefore also arteriosclerosis as well as strokes and heart attacks. Cardiac arrhythmias can also occur in connection with sleep apnea.

It is therefore important for every snorer to know whether it is a primary, harmless nocturnal noise that “only” disturbs their partner or whether it is sleep apnea, which is associated with massive health risks if it is not treated.

Snoring: Causes and risk factors

It is not only the muscles that slacken during sleep and the resulting narrowing of the upper airways that cause snoring. The sleeping position can also promote snoring: If you lie on your back, your lower jaw often folds downwards, causing your tongue to slide a little more towards your throat and making this passageway even smaller. Other risk factors for snoring:

• Male gender – in women, the risk of snoring usually only increases after the menopause, so female hormones could indirectly offer some protection.
• Age – the muscles become flabbier with age, including in the neck area.
• Overweight – fat deposits are not only found on the stomach and hips, but also in other areas of the body, including the throat. Because it is already narrow anyway, even small amounts of fat can significantly narrow it.
• Alcohol, but also medication that promotes falling asleep
• Adenoids or enlarged tonsils
• Congenital changes, such as a curvature of the nasal septum, but also a large tongue and a small lower jaw promote snoring

Symptoms: In addition to the familiar noises, there are also signs in the morning

Snoring can be expressed as growling, rattling or humming, the variations are manifold, as is the volume. It can reach 20 decibels, comparable to the quiet rustling of leaves, or in extreme cases 80 decibels, which corresponds to the noise level of a jackhammer. However, such high volumes only occur for a short time. However, almost all of them have a disturbing effect on your partner. If you sleep alone, you will usually hardly know whether you snore or not. However, there are two symptoms that are only noticed after waking up and may indicate harmless nocturnal snoring. These are:

• Dry mouth in the morning
• Hoarseness that disappears in the course of the morning

However, if the snoring is caused by sleep apnea, i.e. the dangerous nocturnal pauses in breathing, the following symptoms typically occur:

• Headache
• constant tiredness during the day, whereby you may even doze off from time to time, the so-called microsleep. It is particularly dangerous and can have dramatic consequences when driving a car, for example.
• Concentration disorders

Overall, these are the typical symptoms that occur due to a lack of sleep, in this case due to constantly interrupted sleep.

Snoring: Diagnosis with us

We are your contact partner. We also offer special consultation hours for snoring. The most important thing in the diagnosis and examinations: a clear distinction between

• it is harmless snoring, but it may cause distress to your partner and therefore needs to be remedied, or
• you have sleep apnea, which should definitely be treated.

The doctor will first ask you a whole series of questions or give you a questionnaire. Common questions include:

• Are there certain situations that cause you to snore (such as drinking alcohol)?
• Do you eat late and a lot in the evening?
• On a scale of one to ten, how much do you snore (with most of them referring to your partner’s statement)?
• Do you have trouble falling asleep?
• Can you sleep through the night?
• How do you wake up in the morning – refreshed or rather tired?
• Are you often tired during the day or have you nodded off?

This is followed by a physical examination of the head and neck – are there any restrictions in the airways, such as adenoids, enlarged tonsils, is the nasal wall not straight? The size, shape and position of the lower jaw are also revealing.

If these examinations have shown that there are no abnormalities and no sleep apnea, this is primary snoring. In this case, no further tests are usually necessary and we will discuss measures to combat the annoying snoring together with the person concerned. However, if sleep apnea is suspected, the causes are investigated. Imaging procedures such as computed tomography (CT) and magnetic resonance imaging (MRI) are suitable for this purpose.

An outpatient sleep endoscopy also provides information. Under sedation, a tiny camera is inserted into the upper airways. We can use it to check the soft palate, tonsils, uvula, the entire palate and throat to see if there are any constrictions.

A polysomnography examination in the sleep laboratory then provides the final certainty. So you spend a night in the sleep laboratory, where a wide variety of parameters are checked and recorded while you sleep – such as brain wave measurements to identify deep sleep phases, monitoring of oxygen saturation, heart rate, breathing, but also changing sleeping positions. From this we can determine whether sleep apnea is present, what the causes could be and develop a treatment plan on this basis.

Snoring: Prevention, early detection, prognosis

Prevention of snoring is limited to five points:

1. One of the most effective ways to prevent snoring is to avoid being overweight. This prevents fat deposits from narrowing the upper airways.
2. It is best to avoid alcohol completely in the evening. And if you (have to) take sleeping pills, ask us whether the medicine is really essential for you.
3. It is best to sleep on your side or stomach and don’t get into the habit of sleeping on your back.
4. Refrain from smoking.
5. Ensure a consistent sleep-wake rhythm and appropriate sleep hygiene.

Progression and prognosis of snoring

Even if it is only harmless snoring: Consider the five tips that will also help to reduce existing snoring. Make sure that your snoring does not increase. Experts warn that around 50 percent of heavy snorers develop sleep apnea sooner or later.

So have snoring checked by a doctor, also to make sure that it is not the dangerous breathing stops. If you already have sleep apnea, please have this condition treated. As listed, sleep apnea promotes a whole range of secondary diseases that can ultimately even be life-threatening – such as strokes and heart attacks.

Snoring: Conservative treatment or surgery

Harmless snoring can often be stopped by the simple five behavioral changes mentioned above. They are therefore both prevention and self-treatment. However, the measures do not work for everyone. And some of the risk factors, such as age, cannot be influenced at all.