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Snoring and Sleep Apnea

45% of normal adults snore at least occasionally and 25% are habitual snorers. Problem snoring is more frequent in males and overweight people and usually worsens with age. Snoring may be an indication of obstructed breathing and should not be taken lightly. An otolaryngologist can help you to determine where the anatomic source of your snoring may be and offer solutions for this noisy and often embarrassing behavior.

Snoring occurs when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Noise is made when these structures strike each other and vibrate during breathing.

In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist.

People who snore may suffer from:

  • Poor muscle tone in the tongue and throat.
  • Excessive bulkiness of throat tissue: Children with large tonsils and adenoids often snore. Overweight people have excess soft tissue in the neck that can lead to airway narrowing.
  • Long soft palate and/or uvula.
  • Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, resulting in snoring. Deformities of the nose or nasal septum, such as a deviated septum, can cause such an obstruction.

Snoring disturbs sleep patterns and deprives the snorer of adequate rest. It may be a sign of obstructive sleep apnea (OSA), which can lead to serious, long-term health problems. OSA is characterized by multiple episodes of breathing pauses greater than 10 seconds at a time. This results in lower amounts of oxygen in the blood which causes the heart to work harder. It also causes disruption of the natural sleep cycle which makes people feel poorly rested despite adequate time in bed. Untreated obstructive sleep apnea increases the risk of developing heart attacks, strokes, diabetes and other medical problems.

Heavy snorers should be evaluated to ensure that sleep apnea is not a problem. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction or enlargement of the tonsils and adenoids. A sleep study may be ordered to determine if the snoring is from sleep apnea.

Treatment depends on the diagnosis and level(s) of upper airway narrowing:

  • Obstructive sleep apnea is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is called CPAP; it is currently the initial treatment of choice for patients with OSA.
  • Uvulopalatopharyngoplasty (UPPP) is surgery for treating snoring and obstructive sleep apnea. It removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration. The size of the air passage may be further enlarged when a tonsillectomy is added to the procedure.
  • Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base, and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser, and radiofrequency. These procedures may be done in the operating room or during an office visit. Several treatments may be required.
  • Methods to increase the stiffness of the soft palate without removing tissue include injecting an irritating substance that causes stiffness in the injected area near the uvula. Another method is inserting stiffening rods (Pillar implants) into the soft palate.
  • Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
  • A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA.
  • In some patients, significant weight loss can also improve snoring and OSA.

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  • Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
  • Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
  • Establish regular sleeping patterns.
  • Sleep on your side rather than your back.
  • Elevate the head of your bed four inches.

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