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Snoring

Overview

Snoring is a hoarse or unpleasant sound that results from irregular breathing or obstruction in normal breathing patterns. It causes vibrations within the chest cavity which get released in the form of audible noises. It occurs during sleep, and in the majority of the cases, the person who is snoring is not aware of it. It gets addressed when a partner, kid, or family member complains. It is mostly an involuntary response, although some people can produce snoring sounds by voluntary action.

Causes

The primary mechanism which explains snoring is the relaxation of the soft tissues in the back of your mouth. These include uvula and soft palate. Relaxations of these tissues to a level where it partially obstructs the airway passage results in audible snoring sounds. Multiple factors are attributed to snoring. Some of the common factors include mouth breathing, infectious diseases of the upper respiratory tract, allergies, pharyngitis or tonsillitis, nasal obstruction, smoking, alcohol intake, obesity, sleeping on the back for a long time, swelling of the tongue, traumatic injury, weakness of throat muscles, jaw abnormalities, deviated nasal septum, sleep apnea, etc. Snoring is also considered a strong genetic predisposition and age-related factor. Any acute or chronic diseases that can cause irritation or obstruction of the respiratory tract can result in snoring. Irregular sleep or lack of sleep can also be a causative factor.

Risk Factors And Epidemiology

Risk factors of snoring are linked to its causes. If you have a genetic history of family members
who snore loud, there is a high chance that you may be snoring in your sleep as well. This risk is increased by external factors such as smoking, excessive alcohol intake, or obesity. The risk of respiratory diseases also increases the risk of snoring. If you have any jaw abnormality, malpositioning of jaws, or nasal deformity, that can also lead to snoring activity during sleep. Sleeping on the back for long durations causes the tongue to move back into the throat, leading to partial airway blockage. Therefore the habit of sleeping on the back is another risk factor.
Snoring can affect individuals of any age and gender. However, research work has indicated that elders over the age of 50 have a higher tendency to develop snoring compared to young adults. It is more prevalent among males than females due to physiological or external factors such as smoking or alcohol use.

Signs And Symptoms

The signs and symptoms of snoring are not noticed by the snorers themselves in the majority of the cases. A partner or roommate describes the presence of loud or unpleasant audible noises which the affected person produces during sleep. Suppose snoring is caused due to an infection of the respiratory tract. In that case, it may be accompanied by coughing, sneezing, runny nose, sore throat, tonsils enlargement, shortness of breath, nasal congestion, etc., depending on the pathogenic organism.

Diagnosis

Diagnosis of snoring is based on the history explained by a partner or roommate, history of smoking or alcohol intake, history of other medical diseases, and a clinical examination. Nasal passages and throat are observed for any signs of infection or allergy. A stethoscope checks the breathing rate and sounds to rule out other respiratory tract diseases. Nasal or throat culture, PCR, or other suitable tests may be necessary if an infection is suspected. Imaging, including x-rays, CT scan, and MRIs, are only indicated if your doctor suspects any other abnormality with the respiratory system. Some cases may require polysomnography in which an individual’s vitals and other neurological activity are observed while they sleep.

Differential Diagnosis

Snoring may be present or confused with another disorder known as obstructive sleep apnea. There is a significant pause in breathing during sleep that can last up to a few seconds in this condition. It is necessary to get examined by a doctor before any complication develops.

Treatment

Treatment of snoring depends upon its cause. Appropriate medications and treatment measures are necessary to clear the airway passage and allow a regular breathing pattern if it occurs due to any respiratory tract infection. Lifestyle modifications such as less smoking, reducing alcohol intake, and exercise is recommended in case of obesity. Sleeping on your side and using higher pillows is also suggested. Some patients require using nasal clips or oral appliances to widen the opening of airway passage and allow a steady flow of air. Tongue and oropharyngeal exercises have proven beneficial for snoring. If snoring is associated with sleep apnea, a continuous positive airway pressure (CPAP) machine facilitates normal breathing. Surgical options for treatment are generally not recommended. They may be insisted upon by a person himself due to social factors. Minimal surgery of the uvula, palate, and pharynx may be done in such cases to widen the airway passage.

Medications

Snoring due to physiological factors does not require any medications. Medicines are only necessary if a viral or bacterial infection obstructs the airway. Suitable antivirals, antibiotics, corticosteroids, or analgesics may be prescribed by your doctor depending on the cause of the infection.

Prognosis

Snoring can be treated wholly or partially with home remedies and supportive care. Chronic diseases of the respiratory tract may result in long-term snoring. Snoring associated with sleep apnea should be addressed immediately to avoid major complications.

Prevention

Snoring can be prevented by understanding the causative factors and managing them. Smoking and alcohol usage should be limited, especially if you have a family history of snoring. These two factors weaken the throat muscles and may be involved in irritation of the respiratory passage. All other precautionary measures necessary to avoid air-borne infections (wearing a mask, washing hands frequently, using sanitizer) should be taken. Sleeping on the side and using higher pillows is recommended to prevent snoring. Exercise and dietary modifications are recommended for obese individuals because excessive fat deposition around the throat can also lead to snoring and airway obstruction.