snoring

Snoring is a very common problem that impacts quality of life and health. Besides being a annoying complaint to bed partners, snoring may represent significant blockage of airflow during sleep and be a symptom of Obstructive Sleep Apnea Syndrome. This is the most advanced stage of snoring and can cause profound cardiac, pulmonary, and behavioural problems. Apnea comes from the Greek term meaning "want of breath." Whereas snoring means partial obstruction of the airway, apnea means total obstruction. With this form of snoring the upper airway closes while asleep. The uvula and soft pallet collapses on the back wall of the upper airway. Then the tongue falls backward, forming a tight blockage and preventing any air from entering the lungs. The effort of the diaphragm, the chest and the abdomen, only cause the blockage to seal tighter. Eventually that action can become severe enough to cause an arousal, clearing the upper airway blockage, allowing the person to breathe. Then you go back to sleep and it happens all over again.

Although snoring may be common, it is not normal. It is always a sign of some degree of airway obstruction. Therefore, at what point should the snoring lead to concern about such an obstruction? Primary snoring, is unrelated to apneic episodes and is much more common than OSA-related variety. However, primary snoring may be an early analyst for patients who will eventually develop obstructive sleep apnea. This progression is more likely in patients who undergo a weight gain, and most often manifests at ages 35–40. True primary snoring is characterised by loud noises that disrupt the sleeper or sleep partners. Everybody probably snores at some time, due to nasal congestion, excess fatigue, central nervous system depressants, abnormal sleep positions, obesity, or for many other reasons. That said, snoring usually self-corrects. However, in people with persistent snoring and sleep apnea, the condition does not self-correct without arousal; therefore it is at this stage that individuals or their partners, should start to lose sleep (excuse the pun!)

The sounds of snoring originate in the collapsible part of the airway where there is no rigid support. That is, from the epiglottis to the choanae. It involves the soft palate, uvula, tonsils, tonsillar pillars, base of tongue, and pharyngeal muscles and mucosa. Snoring occurs during the inspiratory phase of respiration. As a person breathes during sleep, two opposing forces are at play. The walls of the oropharynx contain musculature, which functions to maintain an open airway. In contrast, as inspiration causes negative intrathoracic pressure, the airway lengthens and narrows due to suction. The dual effect of lengthening and narrowing weakens supporting musculature. Should the dilator muscles be unable to prevent collapse, the patient experiences partial or total airway obstruction. The soft palate and adjacent structures move back and forth as the person mouth-breathes through the collapsed airway, causing the characteristic noise of snoring.