The Definitive Causes Of Snoring
It is said that snoring is often the result of overindulgence in one or a few of life's pleasures. The following reasons are the principal causes of snoring and by controlling them, you can become quieter, calmer and healthier at night.
Overeating / Lack of Exercise
Overeating and/or lack of exercise leads to an increase in fat around the throat. If you have a collar size of 16½ inches or greater, you may not have the muscle tone needed to keep the airway open sufficiently at night to allow normal breathing, and the narrow airway is more likely to vibrate. A person with a short fat neck is at an increased risk of snoring. Excess body fat seems to be more of a problem for men than women. Men tend to get fat around their necks and waists, whereas women seem to put on weight around the thighs. In women, the cross sectional area of the upper airway is greater and the airway walls may be more rigid and therefore less prone to yield to pressure. As a result, collapse of the airway is resisted when muscle tone falls during sleep. This means that women are less likely to snore than men. However, this situation very often changes for women following the menopause. Like men, as women get older their muscle tone tends to diminish and they put on more weight. By the time women have reached the age of 70 they are just as likely to be snorers as men of the same age.
Being overweight by just a few kilograms can be the cause of your snoring. If you have fatty tissue around your neck you will find that during sleep it squeezes the airway and prevents air from flowing in and out freely.
Weight loss with accompanying fat reduction will certainly help to alleviate snoring. However, weight loss cannot be achieved by diet alone, it must be accompanied by a sensible exercise programme.
Alcohol and Sleeping Pills
Alcohol travels to all areas of the body and slows the brain's responses, causing the muscles to relax even more than during a normal night's sleep. Alcohol also acts as a depressant. The added relaxation of the musculature causes the oropharynx to collapse more readily causing further snoring. Additionally alcohol can induce obstructive sleep apnoea (where breathing stops for short periods during sleep) in individuals who are otherwise just snorers. This does not mean that you have 'clinically recognised sleep apnoea' but, when you have been drinking alcohol and your sleep is interrupted by periods of not breathing, you should be aware that if you do not modify your lifestyle, this condition will worsen. It is very much more difficult to treat sleep apnoea than it is to treat simple snoring.
Alcohol also causes nasal airway irritation and congestion that increases the airway resistance when breathing. The consumption of alcohol affects every organ and system in the body. It can damage heart tissue and elevate blood pressure. It also has a high calorie content, and people who are heavy drinkers are often overweight.
If you cannot stop drinking you can modify the effects by having your last drink at least 4 hours before you go to bed. This will give your body sufficient time to reduce the effects of the alcohol and help you to sleep without snoring.
Whilst most people have sufficient muscle tone to prevent the airway from collapsing during sleep this situation may alter if you are taking sedatives. So, if you are taking any medication that has a sedating effect, ask your doctor for a non-sedating alternative. Naturally, you should never stop taking prescribed medicines without your doctor's consent.
Smoking and Snoring
Cigarette smoke irritates the lining of the nasal cavity and throat causing swelling and catarrh. If the nasal passages become congested it is difficult to breathe through your nose because the airflow is decreased. The likelihood of snoring increases as more cigarettes are smoked per day because the congestion increases with each cigarette. Even passive smoking can cause inflammation of the nose and throat passages, thus increasing the risk of snoring. Children of parents who smoke are more likely to be affected by snoring than children of non smoking parents. If you cannot stop smoking you can modify the effects by having your last cigarette at least 4 hours before you go to bed. This will give your body sufficient time to reduce the effects of the cigarette smoke and help you to sleep without snoring.
Body position plays an important role during sleep and can often make the difference between having a good night's sleep or not. For snorers and individuals who suffer from obstructive sleep apnoea (OSA), this is a particular problem as several studies have found that individuals who sleep in the supine position (on the back) are more likely to snore or have increased apnoeas than those who sleep in the lateral position (on the side).
The physiological mechanism for this is most probably due to the effects of gravity on the upper airway. When sleeping in the supine position, gravitational forces increase the tendency for the tongue and soft palate to fall back into the throat. This creates a narrowing of the airway and the likelihood of airway obstruction that leads to a number of breathing abnormalities. The airway tends to be more stable in the lateral position and less likely to collapse.
Individuals who suffer 'retrognathia' (receding chin) tend to snore when sleeping on their back. The unusually shaped jaw pushes the structures of the upper airway towards the back of the throat, narrowing the airway so that snoring occurs.
Snoring and apnoea events seem to be more numerous and more severe in the supine position than in the lateral position. One study demonstrated that more than half of their OSA patients had twice as many apnoeas in the supine position than in the lateral position. Interestingly, lateral positional OSA patients are reported to be thinner and have less severe apnoea than supine positional patients. Similarly, lateral snorers are reported to have less severe snoring than those who sleep on their back.
The clinical evidence, regardless of opinion, is unanimous in suggesting that both sleeping position and sleep stage have a considerable impact on both snoring, sleep apnoea and other sleep disorders. Although it would seem desirable to prevent snorers from sleeping on their back, in practice this is rarely achieved. Most studies have confirmed that positional therapy is ineffective and therefore physical therapy such as Mandibular Advancement Therapy will have more beneficial effects.
Sleep stage seems to have more of an effect on snoring independent of body position. Sleep stage affects snoring time and intensity. However, there are differing opinions as to what stage of sleep is of more significance. Some studies report snoring and apnoeas are more prominent in SWS (slow wave sleep), followed by Stage 2 and least in Stages 1 and REM (rapid eye movement). Other studies report snoring and apnoeas are more prevalent during REM sleep. One study reported a higher prevalence of continuous snoring in SWS than in REM and concluded that this could be due to a higher airway resistance in SWS or to the regularity of the breathing pattern. During Stages 1 and 2 of sleep, breathing is frequently periodic and in REM it is irregular with more pauses. Consequently, during light and REM sleep, the incidence of respiratory arrhythmias (changes in breathing pattern) would be high but continuous snoring would be unlikely.
It is thought that sleep position may also have an effect on individuals who suffer sleep bruxism (teeth grinding). In one study, patients were found to have averaged 19 clenches per hour in the supine position as opposed to 15 clenches in the lateral position. This study also found that clenching was associated with sleep stage. Patients who slept in the lateral position had a decrease in the amount of Stage 2 sleep (and an increase in SWS & REM) that resulted in less clenching activity.
Allergies and in particular allergic rhinitis are increasing in prevalence and currently affect between 10-25% of the population. The most common symptoms include: nasal congestion, rhinorrhoea, itching, postnasal drip and sneezing. However, daytime sleepiness, disrupted sleep at night, fatigue, headache, decreased cognitive performance and malaise can also be the consequence of allergic rhinitis but these symptoms are not always recognised as being associated with allergy.
Impaired sleep not only causes daytime somnolence and fatigue but can decrease our productivity, increase our risk of accidents, alter our mood and affect our quality of life. Until now, it has not been easy to prove a direct cause and effect relationship between rhinitis and impaired sleep. However, a recent study by Fisher et al (2005) comparing allergic rhinitis patients with controls, found statistical evidence suggesting that daytime sleepiness and quality of life correlated with the severity of rhinosinusitis. The research also found that for those individuals who suffered allergic rhinitis when sleeping in the supine position (on the back), the congestion in their nasal airway increased. This was particularly evident during the early hours of the morning, which affected their circadian rhythms and consequently their sleep quality.
Congestion in the nasal airway can lead to sleep disordered breathing and snoring. From a questionnaire based study of 5000 subjects who frequently suffered rhinitis symptoms, it was found that they were significantly more likely to be snorers, have non-restorative sleep and excessive daytime sleepiness. The study also found that subjects with nasal congestion were almost twice as likely to have moderate to severe sleep disordered breathing than normal subjects. Statistical findings similar to the previous study found that both nasal congestion and rhinitis were significant factors in sleep disruption, especially when sleeping on the back, with all symptoms being worse in the early morning hours.
Respiratory allergy is the result of nasal hypersensitivity or hyperactivity. The lining of the nose and throat swells which prevents correct breathing through the nasal airway and is often worse at night. Symptoms are typically the same as those of allergic rhinitis and can have similar devastating effects on quality of life.
Known causes of allergic rhinitis and respiratory allergy include: dust particles, tobacco smoke (including passive smoking), feather pillows & bedding, dung of house dust mite, pet hair, indoor plants & flowers, perfumes, some household cleaners and paint smells.
There are many treatments for allergic symptoms and the best treatment of all is to prevent or avoid the offending allergy. For example, barrier bedding is readily available in high street shops and will prevent house dust mites from entering your pillows and bedding. Tobacco smoke is a common allergen and can affect not only the smoker but all those who inhale it. It has long been established that children of smoking parents are twice as likely to snore as those from non-smoking families.
The anti-inflammatory and astringent properties of herbal sprays such as Rhynil will help reduce the symptoms of nasal congestion and can be used on a long-term basis. But what if you don't know what is causing your allergy? It may be worth trying a simple home test allergy kit to determine the cause.
Nasal stuffiness is another common reason for mouth breathing, because we tend to breathe with our mouths open to compensate for not being able to breathe through our noses. It is essential that you find out what is causing the nasal stuffiness and treat it. Using Rhynil, which is safe for long-term use, can reduce nasal congestion and catarrh.
You may also like to try steam inhalation. This traditional remedy is very worthwhile. Alternatively, if your nasal stuffiness persists you may find antihistamines can be very useful. Ask your GP or pharmacist for advice.
Rhynil Herbal Spray
Rhynil is made from the plant known as Euphrasia Oficinalis or Eyebright. This plant was originally used as a treatment for eye problems but in recent years it has been widely used in the treatment of conditions such as catarrh, infectious and allergic conditions affecting the sinuses and nasal passages, hay fever and upper respiratory tract infections.
Individuals who suffer any condition that affects the nasal passages will find it difficult to breathe at night. This encourages mouth breathing and snoring as a consequence. The properties of Eyebright help relieve nasal congestion and related symptoms making nasal breathing easier.
Although there is very little published clinical data on the efficacy of Eyebright in reducing snoring, BSSAA has undertaken a total of 4 trials on its efficacy. The results of the trials concluded that 70% of subjects found a very definite improvement in reducing snoring, 20% found no improvement and 5% stopped the trial due to ill effects (2 subjects reported epistaxis (nose bleed), 1 reported vivid dreams, although these conditions cannot necessarily be attributed to the treatment).
Rhynil is recommended for individuals whose snoring originates from the soft palate, mouth breathing or nasal congestion.
Rhynil is currently our Best Selling Snoring Product
If you are a 'mouth breather' and sleep with your mouth open you will probably snore. When we breathe in through the nose the air passes over the curved part of the soft palate in a gentle flow into the throat without creating unnecessary turbulence. When we breathe in through the mouth however, the air hits the back of the throat 'head on' and can create enormous vibrations in the soft tissue.
You can promote nasal breathing and eliminate bad breath with our range of Mouth Breathing Devices
Small or Collapsing Nostrils
We probably do not think about 'how' we breathe as it is a natural function and happens anyway. However, how we breathe is important especially at night.
During sleep we are designed to breathe through the nose. If for any reason nasal breathing is not possible our body's self-preservation mechanism forces us to breathe through the mouth. There are several reasons as to why some people find it difficult to breathe through the nose during sleep.
- Size of nostrils
- Nasal collapse (alar collapse)
- Nocturnal nasal congestion (rhinitis)
- Nasal obstruction (anatomic abnormalities)
These features increase nasal resistance, commonly known simply as 'nasal resistance'. Nasal resistance may be a contributing factor in the occurrence of sleep disordered breathing, upper airway resistance syndrome (UARS), snoring and obstructive sleep apnoea (OSA). Madronio et al (2004) studied a group of 43 subjects and reported that those who were nocturnal 'mouth breathers' tended to experience more apnoea events than those with predominantly nasal breathing. They also concluded that mouth breathing may increase the risk of upper airway collapse as the respiratory muscles are 'route dependent' and mouth breathing interferes with the normal passage of air passing into the lungs. If oxygen is unable to be delivered around the body and in particular to the brain during sleep, sleep quality is affected and may lead to the condition known as excessive daytime sleepiness (EDS).
This relationship between nasal resistance and sleep disordered breathing was first noted in the 1800's when it was concluded that by dilating the nostrils these undesirable effects could be relieved (Rappai M 2003). Since then many studies have concluded that the use of nasal dilators can improve both nocturnal breathing and sleep quality for individuals who are affected by nasal resistance.
The scientific principle behind nasal dilation is based on physiology and physics and the effect is to dilate the air passage of the nose and to stiffen the nasal wall. Both mechanisms reduce nasal resistance and allow higher flow of air.
In 1988 Professor Petruson of Sweden invented a simple nasal dilator called Nozovent. Over the years it has proved to be one of the most popular and easy to use devices to enhance nasal breathing. This device is not just for snorers but can be used by anybody who suffers from nasal resistance.
The vibrations produced by prolonged and heavy snoring injure the airways and affect the upper airway muscles (pharyngeal, laryngeal, tongue and soft palate). Vibrations induced by snoring may also damage the nerves of these muscles and interfere with blood supply. In normal individuals these muscles support the airway and prevent it from collapsing, but due to the damage caused by snoring it is thought that the upper airway muscles are more likely to suffer from fatigue in snorers and are more prone to collapse.
If you are a 'tongue base snorer', this means that you snore because your airway is liable to vibrate at the base of the tongue. Turbulent air is trying to get into your lungs through this restricted airway and in doing so it vibrates the tissues of the tongue. The tongue may partially or completely block the airway preventing you from breathing. This is termed apnoea which means 'without breath'.
By using a Mandibular Advancement Device (MAD) you can gently bring your lower jaw forward and keep your tongue away from the back of your throat, thus preventing the obstruction.
Clinical studies consistently show that MADs are an acceptable form of treatment in the long term for patients with tongue base snoring and mild/moderate sleep apnoea. Patients from one study categorized the device as fair or good after 10 years of wear. Seventy percent of these patients were wearing the device every night for 6 hours.
Controlling snoring with a MAD will not only reduce snoring but will also improve general health and wellbeing. One study reported significant changes to snoring, breathing pauses, daytime sleepiness, concentration, night time sleep quality, work efficiency, tiredness, general health and mental status, following MAD treatment. Similar improvements in health and wellbeing were also reported by bed partners.
Many snorers using a MAD for the first time believe that it will interfere with their sleep. However, these fears are unfounded. Studies, in which sleep architecture has been monitored, clearly show an improvement in sleep quality and a significant decrease in sleep fragmentation.
Around 30% of patients using a MAD suffer minor side effects, although this does not appear to influence compliance. The majority of patients indicate that they find the device comfortable or only slightly uncomfortable. The most frequent side effects are excessive salivation, teeth discomfort and jaw discomfort. The frequency and severity of side effects are undoubtedly affected by the type of appliance, wear time, degree of protrusion and care taken in the fitting process.
It has recently been found that MADs are also suitable for individuals whose snoring originates from the soft palate. The researchers found that snoring originating from palatal flutter was significantly improved following MAD use. They concluded that not only does a MAD increase the airway dimension at the tongue base but also at the level of the soft palate.
You may find that your snoring is not confined to a single cause but is multi-factorial. For example, you may be snoring because you are sleeping with your mouth open. But the reason you habitually breathe with your mouth open may be because you have an allergy that is causing nasal stuffiness and preventing you from breathing through your nose. In this situation you will need to address both the nasal stuffiness and the mouth breathing in order to control your snoring.