Snoring

Snoring occurs when a person makes a snorting or rattling noise when they breathe during sleep.

Introduction

Snoring occurs when a person makes a snorting or rattling noise when they breathe during sleep. The noise comes from vibration of the soft palate and tissue in the mouth, nose or throat.

Some people snore infrequently and the sound they make is not particularly loud, while others may snore every night, loud enough to be heard in the next room.

Healthcare professionals use grading systems to assess a person’s snoring. The higher the grade, the more severe the snoring is.

Read more about the symptoms of snoring.

When to see your doctor

You should see a doctor if your snoring is affecting aspects of your life, such as causing excessive tiredness and poor concentration or relationship problems with your partner.

Excessive daytime sleepiness is particularly important because it increases the risk of a road traffic accident. The Department of Transport estimates that one in five road traffic accidents are the result of excessive sleepiness. It can also cause accidents with the use of machinery and things such as cranes and forklift trucks.

Snoring can sometimes indicate a more serious related condition called obstructive sleep apnoea (OSA), where a person’s airways repeatedly become partially or totally blocked for about 10 seconds throughout the night. See your doctor if you wake up gasping or choking during the night.

Read more about diagnosing snoring.

If your child snores you should also speak to your doctor.

Why does snoring happen?

Snoring is caused by the vibration of soft tissue in your head and neck as you breathe in and out during sleep. This includes the nasal passages, the soft palate in the roof of your mouth, and your tonsils.

While you sleep your airways relax and narrow. This affects air pressure within your airways, which causes the tissue to vibrate. This can also happen if your airways are partially blocked, for example if you have a cold.

Your chances of snoring can be increased by factors such as being overweight, alcohol, and smoking.

Read more about the causes of snoring.

How is snoring treated?

Treatment can improve snoring in some cases, but a complete cure is not always possible.

Lifestyle changes, such as losing weight, are usually recommended first.

There are also anti-snoring devices, such as mouth guards or nasal strips that may help prevent snoring.

If anti-snoring devices don't help, then surgery may be an option. This often involves removing soft tissue that causes the snoring, or preventing the tissue from vibrating by causing it to tighten.

However, surgery for snoring is usually regarded as a last resort. It is important to be aware that surgery can often have a limited effect that doesn't last longer than one or two years and can cause unpleasant side effects or complications.

Read more about treatments for snoring.

Symptoms

Snoring is where you make a noticeable sound when you breathe in during sleep.

The sound is caused by soft tissue at the back of your mouth, nose or throat vibrating. The exact sound you make will depend on the type of soft tissue that is vibrating.

For example, if the soft tissue at the back of your nose vibrates when you snore, it is likely you will produce a pinched nasal sound that is not particularly loud. Whereas if the tissues at the top of your mouth (the soft palate) and the back of your throat (the uvula) vibrate, you will produce a louder, more guttural ("throaty") sound. In most cases, snoring is caused by a combination of areas that are vibrating or blocked.

People tend to snore most when they are in the deepest stages of sleep, around 90 minutes after falling asleep. Most people also tend to snore loudest when sleeping on their back (supine).

Snoring grades

Healthcare professionals use a grading system to assess the severity of a person’s snoring. There are three grades of snoring, described below.

Grade one snoring

Grade one snoring, also known as simple snoring, is where a person snores infrequently and the sound they make is not particularly loud.

In grade one snoring, a person’s breathing is unaffected. This means they will not experience any significant health problems related to their symptoms. However, their snoring may cause problems or issues on a personal level if it is irritating or upsetting their partner.

Grade two snoring

Grade two snoring is where a person snores on a regular basis – more than three days a week. Some people with grade two snoring may experience mild to moderate breathing difficulties during sleep. The breathing difficulties can affect the quality of a person’s sleep, which can make them feel tired and sleepy during the day.

Grade three snoring

Grade three snoring is where a person snores every night, so loudly it can be heard outside their room.

Many people with grade three snoring have a related condition called obstructive sleep apnoea (OSA). This is where the airways become partially or totally blocked for about 10 seconds.

The lack of oxygen causes the person to come out of deep sleep and into a lighter state of sleep, or to wake up for a short period, in order to restore normal breathing.

Repeated episodes of snoring and waking can occur throughout the night leading to a person feeling very sleepy the following day. This may have an adverse impact on their day-to-day activities.

When to seek medical advice

Visit your doctor if you feel excessively tired during the day, as it may be caused by your snoring affecting your breathing while you sleep.

The most common sign of excessive tiredness is when you find yourself falling asleep during the day.

You should also see your doctor if you suspect a lack of sleep is affecting your day-to-day activities and causing symptoms such as:

  • poor memory and concentration
  • headaches (particularly in the morning)
  • irritability and a short temper
  • anxiety
  • depression
  • lack of interest in sex

Also visit your doctor if your snoring is causing relationship problems with your partner, such as keeping them awake at night or waking them up.

Snoring in children should be investigated by a doctor as it is often caused by an underlying problem with their airways, such as enlarged tonsils, which may require further investigation and treatment.

Causes

Snoring is caused by the vibration of the soft tissue in your head and neck as you breathe in.

Tissue that can be affected includes:

  • nasal passages
  • soft palate – a soft layer of tissue at the back of the roof of your mouth
  • base of your tongue
  • tonsils – the two small glands that sit above the tongue at the junction of the mouth and pharynx (the pharynx is the upper section of the throat)
  • uvula – a small cone-shaped section of tissue that hangs from the soft palate between your tonsils

While you are asleep, the airways in your neck and head relax and narrow. It is thought the narrowing of the airways increases the speed at which you are breathing out and changes air pressure in your airways. This causes the soft tissue to vibrate by sucking the sides of the airways in.

The same effect can also be the result of partially blocked airways, which may be caused by conditions such as enlarged tonsils and colds.

Evidence suggests snoring will get worse over time if left untreated. Vibrations that occur during snoring appear to damage blood vessels that supply muscles in the head and neck. This may, over many years, cause the muscles to weaken.

If the muscles in your head and neck become weakened, their ability to keep your airways open will be affected, making you more likely to snore frequently and loudly.

Increased risk

Some things that can increase your risk of habitual snoring include:

  • obesity – particularly if you have a large amount of fat around your neck, people with a neck circumference of more than 43cm (17 inches) usually snore a lot
  • drinking alcohol – alcohol relaxes your muscles when you sleep, which increases the narrowing of your airways
  • sedatives and some types of antidepressants – in some people, these medications can have a similar effect to alcohol on the muscles
  • smoking – tobacco smoke can cause your airways to become inflamed, which increases the narrowing of the airways
  • allergic rhinitis – a condition where the inside of your nose becomes swollen and inflamed due to an allergic reaction to substances such as dust or pollen

People with severe snoring may haveobstructive sleep apnoea (OSA), a condition where the airways become temporarily blocked during sleep.

Diagnosis

If you regularly snore, you may want to visit your doctor for a consultation.

Your doctor will ask questions about your snoring which may include:

  • How often do you snore?
  • Is your snoring loud enough to wake others?
  • Is your snoring worse when you are lying in any particular position, such as on your back?
  • Are there underlying factors that may be contributing to your snoring, such as alcohol, smoking or medication?
  • Do you feel properly refreshed after sleeping or do you still feel sleepy the following day?
  • Have others noticed you make snorting or gasping noises between snores?

If you answer yes to the last two questions, it may be a sign you have obstructive sleep apnoea (OSA).

Your doctor may weigh and measure you to assess your body mass index (BMI) and may also measure the circumference of your neck.

They may also examine your mouth and throat in case an abnormality, such as swollen tonsils or a non-cancerous growth, is contributing to your snoring.

Further tests are usually only required if your symptoms suggest you have OSA. This may involve referring you to a specialist sleep centre so you can be monitored while you sleep. Or you may be given a monitoring device to wear at night while you sleep at home. This is known as a home sleep study.

Read more about diagnosing obstructive sleep apnoea.

Treatment

It is sometimes possible to treat snoring with lifestyle changes, but further treatment is also available if these don't help.

Lifestyle changes

Lifestyle changes are usually advised by your doctor as a first step to treat snoring. These include:

If you feel your medication may be contributing to your snoring, talk to your doctor. They may be able to prescribe alternatives. However, do not stop taking prescribed medication without first consulting your doctor.

If your snoring is worse when you are sleeping on your back, you may find sleeping on your side beneficial. Wearing a top with a pocket stitched between the shoulder blades and a putting a tennis or golf ball in the pocket can help to keep you off your back as you sleep.

Ear plugs

If your snoring is not causing you health problems but is affecting your partner, asking them to wear ear plugs during the night may be a cheap and effective way of resolving the issue.

Anti-snoring devices

If lifestyle changes don't help, there are anti-snoring devices that can help prevent snoring. These devices can be bought at many larger pharmacies.

The different types of anti-snoring devices are described below.

Nasal devices

If your snoring is mainly coming from your nose, you may benefit from using nasal strips or nasal dilators.

Nasal strips are small pieces of self-adhesive tape similar in appearance to sticking plasters. Before you go to sleep, you place the nasal strip on the outside of your nose. The strip pulls your nostrils apart, which can help prevent them narrowing during sleep.

A nasal dilator is a plastic or metal device that looks a bit like a nose ring. You place the dilator inside your nose before going to sleep and it pushes your nostrils apart while you are asleep.

Currently, there has not been much research to compare the effectiveness of each type of nasal device in treating snoring. For most people, the choice of which device to use is based on personal preference.

Oral devices

If your snoring is mainly coming from your mouth, you may benefit from chin strips or a vestibular shield. Chin strips are strips of tape placed under your chin. The strips help stop your mouth falling open while you sleep.

A vestibular shield is a plastic device similar in appearance to a gum shield. It fits inside your mouth, blocking the flow of air into your mouth. This forces you to breathe through your nose which may prevent you from opening your mouth and snoring.

As with nasal devices, there is limited evidence regarding which type of oral device is more effective, so the choice will be down to your personal preference.

Mandibular repositioning splint (MRS)

If your snoring is mainly due to the base of your tongue vibrating, a mandibular repositioning splint (MRS) (also known as a mandibular advancement device or MAD) may be recommended.

An MRS is similar to a vestibular shield, but designed to push your jaw and tongue forward. This will increase the space at the back of your throat and reduce the narrowing of your airway that is causing your tongue to vibrate, resulting in snoring.

However, if your snoring is associated with breathing difficulties, such as sleep apnoea, it is recommended that a MRS is made specifically for you by a dental specialist (orthodontist) using impressions of your teeth and jaw.

The cost of a custom MRS will depend on the complexity of the device and the materials used, and can range from several hundred pounds to several thousand pounds. It is unlikely you will be able to obtain a custom-made MRS free of charge on the NHS.

An MRS lasts about 18 months before it needs to be replaced.

Surgery

Several surgical techniques can also be used to correct snoring. However, surgery for snoring is usually only available free of charge on the NHS if both of the following apply to you:

  • There is evidence that snoring is having an adverse effect on your health or quality of life.
  • You have tried all other recommended treatments without success.

Surgery for snoring is usually regarded as a last resort, when all other treatment options have been tried and proven ineffective. Surgery is also not suitable for most cases of snoring. For example, it has limited effectiveness in treating nasal snoring.

Surgery is not usually recommended for people with sleep apnoea because there are more effective treatments available, such as using breathing devices to help with breathing. Read more about treating sleep apnoea.

In cases where there are obvious anatomical problems contributing towards snoring, such as having large tonsils, the recommended surgical option may be to correct the problem by removing the tonsils.

Otherwise, there are four main types of surgery used in treating snoring. These are:

  • uvulopalatopharyngoplasty (UPPP)
  • uvulopalatoplasty (UP)
  • palate implants
  • radiofrequency ablation (RFA) of the soft palate

They are described below.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is used when it has been confirmed that soft tissue in your mouth (excluding your tongue) is responsible for your snoring.

During UPPP the surgeon will remove:

  • your uvula – the piece of tissue that hangs from the roof of your mouth
  • some of your soft palate
  • some excess tissue around the base of your throat
  • in some cases, your tonsils and your adenoids (small lumps of tissue that are located at the back of the throat, above your tonsils)

UPPP is carried out under general anaesthetic, which means you will be asleep during surgery and unable to feel pain or discomfort.

However, UPPP can cause considerable pain afterwards, which can sometimes persist for up to three weeks.

Removing your uvula can affect your ability to pronounce certain sounds. However, this will not affect your ability to speak English because the English language does not make use of any of the sounds made with the uvula (known as uvular consonants). However, you may find your pronunciation of some words in other languages is affected by the operation.

UPP is successful in completely curing snoring in about half of all people who have the procedure. Serious complications occur in an estimated 1% of cases. They include:

Uvulopalatoplasty (UP)

Uvulopalatoplasty (UP), sometimes called laser-assisted uvulopalatoplasty (LAUP), is increasingly used as an alternative technique to UPPP because it carries a lower risk.

However, evidence suggests that UP may not be as effective as UPPP in the long term. UP can also cause considerable post-operative pain that lasts up to two weeks.

During UP, lasers or high-energy radio waves are used to burn away the uvular and some of the soft palate.

Soft palate implants

Soft palate implants can be used to treat snoring that does not cause breathing difficulties if it has been confirmed that the vibration of the soft palate is causing it.

During the procedure, a local anaesthetic injection is used to numb the roof of your mouth. Several implants made out of synthetic material are then injected into your palate, causing it to stiffen. This should help prevent the soft palate vibrating while you sleep.

Radiofrequency ablation

Radiofrequency ablation (RFA) of the soft palate is an alternative type of treatment to soft palate implants. It is used to treat cases where vibrations of the soft palate are responsible for snoring.

During radiofrequency ablation, the roof of your mouth is numbed with local anaesthetic and an electrode is implanted in the tissue of your soft palate. The electrode is then used to deliver high-energy radio waves that shrink and harden the tissue of the soft palate. This should help to make it less likely to vibrate when you are asleep.

NICE guidance states there are no obvious safety concerns about the procedure, but there is currently limited evidence as to the long-term effectiveness of the treatment.

Medication

Medication cannot directly treat symptoms of snoring, but can help treat some of the underlying causes.

For example, if allergic rhinitis (nasal irritation and swelling) is responsible for your snoring, an antihistamine nasal spray may help relieve your symptoms. Antihistamines are a type of medication that have proved very effective in treating allergic reactions.

Alternatively, if your snoring becomes particularly troublesome as the result of having a blocked nose, a short course of nasal decongestants may help. However, never use nasal decongestants for more than seven days in a row because it can make your symptoms worse.

Your doctor can advise about whether medication will help with your snoring.

Stephanie's story

Stephanie Chewter says her snoring is so loud she wakes up herself, her partner and their two children.

It has become a lot worse in the past year, which she blames on her weight gain.

“I’ve put on a lot of weight in the last year,” says Stephanie, 35, from Weston-super-Mare. “I’ve gone from 14 to 20 stone.”

Living with her partner and two teenage boys means her snoring isn’t affecting just her own quality of life. “My snoring drives everyone mad,” she says. “I’ve got two kids and it wakes them up as well."

There are around 15 million people in the UK who snore and it's a condition that can ruin friendships, marriages and lives.

Stephanie is studying archaeology and says her disruptive nights can leave her feeling flat in the day, which affects her concentration.

Her doctor explained to her that snoring was caused by the narrowing of the airway during sleep. The noise associated with snoring is caused by parts of the nose and throat, in particular the soft palate, vibrating as you breathe in and out.

At night, muscles that help keep your airway open become relaxed, the airway narrows and vibrates more, making snoring more likely.

Anything which makes your airway relax will make the snoring worse, including alcohol and sleeping tablets.

Other factors such as smoking, a blocked nose, allergies and nasal polyps can also increase the likelihood of snoring.

Being overweight by just a few kilograms can also cause snoring. Build-up of fatty tissue around the neck squeezes the airway and prevents air from flowing in and out freely, causing vibration.

Stephanie has tried sleeping aids such as nasal strips and nasal sprays, but neither have had any noticeable effect.

She finds sleeping head-to-toe with her partner causes less disruption. “It’s probably because my snoring doesn’t seem as loud to him,” she says.

But when the decibels rise too much, Stephanie is forced to sleep elswhere. “I have to sleep downstairs on a two-seater settee and then the only person I wake up is myself.”

Stephanie says she is either going to have to invest in a larger sofa or find a cure for her snoring because sleeping on the settee has given her back pain.

She knows her snoring will diminish if she loses weight. “I will lose weight eventually but I’m not ready,” she says. “I just haven’t got the willpower at the moment.”

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