Snoring really isn't a joke... it interrupts your sleep and your partner's and can lead to a string of serious health problems..... DR ADITI DESAI President of the British Society of Dental Sleep Medicine tells you why getting the right help is so important......
As many as one in four people in England are estimated to snore, more commonly affecting adults aged fourty- sixty. Snoring is twice as common in men than women.
'Snoring can either be occasional when you're tired or have overdone alcohol or had a heavy meal or habitual - snoring all night every night ,' says Dr Aditi Desai, a dental surgeon with a special interest in sleep medicine, at London Bridge Hospital and Harley Street, London.
'People still think snoring is a bit of a joke - but even benign snoring causes problems with sleep quality - it will cause micro arousals in the brain and this prevents you from getting the deep refreshing sleep the body needs at night to rest and repair itself.
'That's why it's important not to ignore it. There's evidence that if left untreated, snoring can get worse and can cause longer term health issues too.'
Although the stereotypical snorer is an overweight man, snoring affects both sexes .Being overweight increases the likelihood that you'll be a snorer, but snoring affects slim people too ,' says Dr Desai.'The root cause is some element of narrowing or obstruction of the airway, but there are many reasons for this' Possible causes of snoring include
• Anatomical causes: 'These include large tonsils, adenoids , a narrow jaw or an oversized tongue, which can all partially block the airway,' says Dr Desai.' It's also possible to be just born with a narrow or constricted airway.'
Being overweight: 'While a large belly will push up the diaphragm and reduce lung capacity,' explains Dr Desai. 'Having a thick neck is a major risk factor for snoring because the extra fat deposited around the neck and tongue compresses the airway causing it to collapse.'
• Lifestyle factors: 'Eating a heavy meal late at night, drinking lots of alcohol and taking sleeping pills or some antidepressants all relax muscles leading to the airway muscles being more susceptible to collapse,' explains Dr Desai.'Smoking can also cause snoring because toxins in tobacco lead to tissue inflammation which swells and affects the airflow.
• Sleeping on your back: This can cause your tongue to fall backwards and partially block your airway.
• Allergies or colds: Inflammation in the nasal passages due to an allergic reaction to dust or pollen is another cause of snoring. A cold can cause the tissue to swell, triggering problems breathing through the nose .The sufferer breathes through the mouth instead, which makes them more likely to snore. Nasal polyps, abnormal tissue growths in the nasal passages, caused by chronic inflammation due to asthma or allergies can also cause obstruction.
Is your snoring obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is the medical term for when your airway collapses and you momentarily stop breathing for a few seconds. This can happen repeatedly throughout the night leading to dips in your blood oxygen levels.'Estimates vary but at least four per cent of men over 40 and two per cent of women have severe OSA and it is rising - although women catch up with men after the menopause,' says Dr Desai.'When your airway collapses for 10 seconds or more for more than five times an hour , you are classed as having OSA; the higher the number of episodes the more severe the condition.'
OSA is linked to poor sleep, but can also increase your risk of developing cardiovascular disease, high blood pressure and stroke as well as Type 2 Diabetes and weight gain, as it affects the metabolic cycle. Recent studies have also shown an increased risk of developing dementia in patients with sleep apnoea.
'Unfortunately, it can lead to waking unrefreshed or with a headache and poor concentration during the day - as many as 50 per cent of road traffic accidents are related to people falling asleep at the wheel due to poor sleep,' says Dr Desai.
Diagnosing snoring and sleep apnoea
GPs and dentists can assess the impact your snoring has on your quality of life by getting you to fill out an Epworth Sleepiness questionnaire, a series of eight questions designed to assess your daytime sleepiness (anything above 9 out of a max score of 24 is considered abnormal).
'If the score is high you may be referred to a sleep centre or given a home sleep test to find out if you have OSA,'says Dr Desai. 'A home sleep test can vary but most consist of a cannula being applied to the nose which measures air flow and a sensor called an oximeter fitted to the finger to monitor oxygen levels, pulse and heart rate as well as a sensor that records sleep stages and if you are getting the deep sleep and REM sleep that is so essential for repair and memory consolidation. A sensor may also be attached to the chest to determine the position of the person while asleep.'
Patients undergo a test which measures how many times they stop breathing completely or partially in an hour. Scores above 6 are classed as OSA, the higher the score the more severe the OSA.
Treatments for non-OSA snoring
'If your score is lower though, your GP or dentist may manage your care -suggesting lifestyle changes such as losing weight, exercise , stopping smoking and avoiding heavy meals late at night , as well as positional therapy - where you wear body sensors at night encouraging you to sleep on your sides (or sew a tennis ball in the back of your pyjama jacket).
'Sometimes though you may need to have a mandibular device custom-made for you by your dentist to reposition your jaw while you sleep pulling the tongue away from blocking the upper airway. These keep the jaw in a forward position and keep the airway open and stable
'Some patients may need surgery to widen the airway or remove any blockage due to tonsils or nasal polyps for example,' says Dr Desai.
Other treatments for non-OSA snoring include using nasal sprays for allergies and nasal congestion and nasal strips to keep the nostrils open and reduce airway resistance, reducing snoring.
Treating obstructive sleep apnoea
If you've been diagnosed with sleep apnoea after a sleep test, the treatment your doctor is most likely to recommend is a C-PAP(continuous positive airway pressure) sleep mask. These work by pumping air through a machine connected through a tube to a mask worn over your face.
'The air pressure keeps your airway open all night and stops it collapsing,' explains Dr Desai.
'Unfortunately around 50 to 55 per cent of patients can't tolerate wearing a mask at night. Where this happens having a mandibular advancement device made to help keep your jaw protruded while you sleep can help stop your airway collapsing at night.
'The most effective mandibular advancement devices are custom made. They are best fitted by a trained dentist who will be able to assess your suitability for such a device. 'Over the counter or ‘boil and bite’ devices are available to buy and fit yourself, but these can be uncomfortable, unretentive and can lead of undesirable side effects such as tooth movement and jaw pain,' says Dr Desai.'The British Society of Dental Sleep Medicine does not recommend the use of such devices.'