How to stop snoring

Introduction
Snoring is a sound produced by the vibration of the soft tissues of the upper airway during sleep. It usually occurs during inspiration, but can also occur during expiration. Snoring is common, occurring in 44 percent of males and 28 percent of females who are between 30 and 60 years of age in the general population.

Snoring is indicative of increased resistance and partial closure of the upper airways.

Snoring, particularly if loud and habitual, may indicate the presence of obstructive sleep apnea (OSA), a sleep disorder characterized by chocking and a drop of the oxygen saturation during sleep which usually leads to sleep disturbance and daytime sleepiness.

Although snoring is indicative of increased upper airway narrowing, its absence does not exclude the presence of obstructive sleep apnoea. This is especially true among women.

Potential Consequences
Studies suggested that snoring may be indicative of the presence of obstructive sleep apnoea. It is well established that sleep apnoea is directly related to high blood pressure, increased risk of heart attacks and strokes.

Evaluation
It is useful to include the bed partner or a family member when evaluating a patient who snores because they may have greater insight into the problem than the patient. The patient, bed partner, and/or family member should be asked about symptoms or signs of sleep apnoea, including frequency and intensity of snoring, episodes of breathing cessation, periods of silence terminated by loud resuscitative snoring, restless sleep, and awakening with a sensation of choking, gasping, or smothering.

Excessive daytime sleepiness, moodiness, poor concentration, and morning headaches may also be present.

Symptoms and signs of conditions associated with increased upper airway resistance other than sleep apnoea should also be sought. Nasal congestion or a history of allergies, sinusitis, or sinus surgery may warrant further investigation since inadequately treated nasal or sinus disease is a potential cause of snoring. Frequent sore throats or mouth breathing may indicate enlargement of the tonsils or the adenoids, especially among young patients.

Diagnostic testing
The primary purpose of diagnostic testing in a patient who snores is to confirm or exclude the presence of sleep apnoea since it is associated with significant clinical consequences and requires long-term therapy.

Treatment
In the absence of obstructive sleep apnea (OSA), treatment of snoring is indicated for patients who want to minimize disruption to their bed partner’s sleep or to relieve themselves of any embarrassment caused by the snoring.

Conservative approaches
Weight loss:
Is recommended for obese patients who snore since it may improve snoring and has additional health benefits
Tobacco and alcohol: Smoking cessation is recommended for all patients. Elimination of alcohol consumption, especially during the several hours prior to bedtime, is recommended for patients who snore. Both interventions may reduce snoring and have numerous other potential health benefits.

Sleep position:
Sleeping in the lateral position is a low-risk intervention that warrants a trial in most patients who snore.
Nasal patency: Conditions that partially obstruct the already narrow airway can contribute to snoring. The use of nasal decongestants or nasal steroid sprays can reduce snoring. However, topical decongestant use should be limited to two to three days because more prolonged use can induce rebound nasal congestion and nasal passage inflammation.

Nasal dilators: Nasal dilators are devices that attempt to dilate the anterior nasal valve. Given the low risk and burden of the intervention, a trial of using an external dilator is reasonable for most individuals who have snoring that is not associated with sleep apnoea.

Oral appliances:
Oral appliances increase the size of the upper airway during sleep, which decreases snoring. They typically work by advancing the mandible, changing the position of the soft palate, retracting the tongue, or a combination of these mechanisms.

Surgical approaches: The data to support the benefit of surgery for the treatment of snoring is limits. surgical treatment of snoring should only be considered in patients who have tried and failed the conservative approaches

Nasal surgery: Surgical procedures to improve nasal patency have been tried in an effort to treat snoring, but supporting data are sparse and inconsistent.
Uvulopalatopharyngoplasty : (UPPP) involves surgically removing tissue from the soft palate and tonsillar pillars. It can be done through traditional surgical techniques or laser-assisted, which allows for outpatient therapy.
Radiofrequency palate surgery: Radiofrequency palate surgery, or somnoplasty, involves temperature-controlled radiofrequency tissue volume reduction of the palate.

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