Category: Science

Surgery for Snoring and Sleep Apnea

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Science, Sleep Apnea, Solutions

Surgery for Snoring and Sleep Apnea

Surgery is perhaps the most drastic snoring remedy available and has the potential to be very effective for some people. There are a number of surgical interventions to reduce snoring and sleep apnea.

In this article, we summarise the different types of surgery for snoring and sleep apnea, as well as exploring some of the important considerations to be made before opting for surgery.

Jump to the different types of anti-snoring surgery:

Some important considerations

Surgery should be a last resort

Surgical intervention should only be considered if other methods you have tried have failed.

Surgery is invasive and sometimes irreversible, so careful consideration should be given as to whether alternatives have been pursued to their full capacity.

Though it will usually be discussed in any consultation prior to surgery, some of the most effective methods of treating snoring are non-surgical and always worth mentioning. These include:

Surgery types vary and what is most suitable depends on YOU

There are several different types of surgery that can reduce snoring. Like non-surgical snoring remedies, there is no one solution that will work for everybody.

The most effective type of surgery depends on your snoring and what is causing it in the first place.

Your suitability will need to be assessed with a physical examination

For surgery to be effective to treat snoring, there must be a clear physical cause of snoring. This means you’ll need to undergo a thorough examination by an ENT (ear, nose and throat) specialist to identify the source of the snoring.

Initial examinations will include basic observations of your nose, tongue and throat. The procedure is also likely to involve flexible endoscopy.

Here, a flexible tube with a fibre optic camera is inserted into the nose and down the back of the throat to look for structural abnormalities.

Whilst this tube is in place, the examiner may ask you to recreate a snoring sound to help identify the tissue that is producing the noise.

You may have to undergo a sleep study first

It is important to distinguish between primary snoring and obstructive sleep apnea. This is because certain types of surgery are not recommended for obstructive sleep apnea (OSA) sufferers.

For that reason, if OSA cannot be ruled out after a physical examination, you may have to undergo a sleep study. This can be done either in a specialist sleep clinic or at home.

 

SnoreLab’s article on what to expect from a sleep study

Read

The benefits may not be permanent

The body has a remarkable way of adapting to change, and unfortunately this isn’t always a good thing.

Snoring surgery that addresses soft tissue works by causing intentional scarring to certain parts of the airway to stiffen them. Your body will automatically work to heal these scars, therefore whilst the snoring is reduced in the short term, you may find that it returns in the long term.

You could experience side effects

Whilst the side effect profile depends on the type of surgery you have, surgery will always involve breaking tissue which carries risks.

It is common for patients to experience some mild pain after surgical interventions.

Availability varies depending on where you live

Every country’s health system is different, and for that reason what is recommended, available and suitable in one location may not be so in another.

For example, pillar implants are considered suitable to treat mild-moderate obstructive sleep apnea in the USA but not in the UK [1].

The healthcare system in your location may also affect whether or not you are eligible for snoring surgery. Because snoring is usually considered a trivial condition (though those that live with it would argue otherwise), state funded medical systems are reluctant to fund snoring surgery. Further, snoring surgeries may not be covered by certain insurance policies.

The different types of surgery

There are three main categories of surgery that can help to directly reduce snoring:

  1. Soft Tissue surgery.
  2. Maxillofacial surgery.
  3. Neural stimulation.

1. Soft tissue surgery

The least invasive option, this involves making changes to the soft noisemakers themselves.

Soft tissue surgery aims to remove or stiffen the flappy parts of the airway which vibrate and cause the snoring noise.

Other soft tissue procedures involve making changes to structures in the nose that can cause “downstream” snoring via nasal blockage.

Most types of soft tissue surgery are not recommended for OSA sufferers, though this does vary.

Usually, these procedures can be performed in an outpatient clinic under local anaesthetic (i.e. you are awake but cannot feel pain in that region).

Uvulopalatopharyngoplasty

Also known as UPPP or UP3, this surgery aims to open the upper airway by removing tissue from the uvula, soft palate and pharynx. If they are still present, it can also involve removal of the tonsils and adenoids (the latter usually disappearing in adolescence).

It is the most invasive form of soft palate surgery and must therefore be performed under general anaesthetic (i.e. you are unconscious).

Whilst UPPP is one of the few soft tissue procedures recommended for OSA, it is performed less often than it used to be. This is because less invasive techniques with lower side effect profiles have emerged. It has also fallen out of favour because UPPP can reduce the effectiveness of CPAP.

Laser-assisted uvulopalatoplasty

Using a similar principle to UPPP, as the name suggests, laser-assisted uvulopalatoplasty (LAUP) uses carbon dioxide lasers to stiffen and remove tissue from the soft palate and uvula to widen the airway [2].

Because of the enhanced precision of lasers, it is considered a safer alternative to UPPP.

This procedure is usually done under local anaesthetic in a clinic and is done over three to four separate sessions.

Despite it being said that LAUP is suitable to treat mild to moderate OSA, studies have not demonstrated consistent improvements for these patients [3].

Radio frequency ablation

Also known as “somnoplasty”, this type of snoring surgery uses radiofrequency energy to generate heat for creating controlled lesions in soft tissue. The basis here is that the lesions become scarred and retract, reducing the amount of flappy tissue and stiffening what remains.

This can be performed on different parts of the airway depending on where the blockage is, including the turbinates of the nose (folds of tissue in the nasal cavities), the soft palate and the base of the tongue.

A minimally invasive technique, it is performed under local anaesthetic in an outpatient setting [2].

Injection snoreplasty

In this snoring surgery, no tissue is removed. Instead, sodium tetradecyl sulphate, a chemical used to treat varicose veins, is injected into the soft palate in order to scar it.

Whilst there are advantages here in that it is minimally invasive and doesn’t involve the removal of tissue, this is a fringe therapy and won’t be recommended by many clinicians. This is because the evidence to support its effectiveness is somewhat lacking, with only a few studies with small sample sizes.

Pillar procedure

This popular outpatient procedure performed under local anaesthetic involves inserting three or four small polyester implants into the soft palate to increase its stiffness and reduce vibration.

The pillar procedure has shown to reduce snoring for many patients. However, studies indicate that their effectiveness starts to decline after they have been in place for more than one year [4].

Septoplasty

A slightly different procedure, this surgery involves straightening the nasal septum – the cartilage which separates the two nasal cavities.

A deviated septum is where this cartilage is bent. It is therefore more difficult to breathe through your nose. This causes you to make a switch to mouth breathing which is known to increase the risk of snoring.

A septoplasty is usually performed in an outpatient setting and has very few/rare complications and side effects.

2. Maxillofacial surgery

Maxillofacial surgery makes structural changes to the bones of the face, jaws and neck. This aims to increase the space in the upper airway.

They are quite serious procedures which need to be done under general anaesthetic and will involve a hospital stay.

hese procedures are further reaching that soft tissue surgery. As a result, maxillofacial surgery can have life-changing benefits for patients with severe obstructive sleep apnea.

Maxilla/Mandible Advancement

This simply refers to repositioning the bones of the jaw. It usually involves moving the lower jaw (mandible) forward. This is done by cutting the bone and holding it in a more advanced position with metal plates and screws.

A receded lower jaw reduces the airway space behind your tongue; moving it forward widens this space and makes obstruction less likely.

This surgery can be likened to a permanent version of what an anti-snoring mouthpiece is designed to do.

If necessary, surgery can also be performed to move both the upper (maxilla) and lower (mandible) jaws forward.

Whilst this surgical option is quite drastic and will involve a period of recovery, it is the only procedure that is considered curative for severe obstructive sleep apnea. In multiple published trials over the years, patients consistently show a decreased AHI and reduced sleepiness.

Because of the changes to the bones of the face, this surgery will often cause irreversible changes to your appearance (often, patients report, for the better).

Hyoid suspension

The hyoid bone rests in the upper part of your neck. It is the only bone in the body that doesn’t connect to any other bone (and is therefore referred to as a “floating bone”).

Anti-snoring surgery can be performed on the ligaments that hold the hyoid bone in place. This helps to move the base of the tongue forward to create more space in the airway.

3. Neural stimulation

This is an exciting, new type of surgery which involves electrical stimulation of the tongue muscles to keep the airway open. It is only ever performed on patients with obstructive sleep apnea.

The system usually consists of three small parts:

  • An electrode wrapped around one of the key nerves that stimulates the tongue to move forward.
  • A generator which creates the electrical impulse. This is implanted in the chest and can be switched off in the morning wirelessly via a remote.
  • A sensor which helps to synchronise the neural stimulation with inward breaths. This is implanted in muscles of the ribs but isn’t always included.

To be considered for neural stimulation surgery, you’ll need a diagnosis of obstructive sleep apnea with an AHI of 20-50 (i.e. moderate to severe) [5].

It is usually recommended only if CPAP has failed. As this is an emerging therapy with restricted approval and a limited number of surgeons trained to perform it, it is not an option available everywhere.

Conclusion

Surgery can be a very effective solution for some snorers and sleep apnea sufferers. However, like all snoring remedies, it isn’t suitable for everybody.

For surgery to work, there needs to be a clear physical abnormality that can be corrected.

Surgery should be a last resort only when other techniques to manage your snoring or sleep apnea have failed.

This article aims to give you insight into all of the different types of surgery available: the established techniques, the emerging procedures and those falling out of favour. It is important to note that what may be offered for you will depend on your symptoms, snoring causes, anatomy and the medical facilities where you live.

What is Sleep Apnea?

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Science, Sleep Apnea

What is Sleep Apnea?

It is normal for a snorer to wonder what sleep apnea is and if they are at risk.

Apnea simply means “no breathing”. Sleep apnea is a serious condition where your airway repeatedly closes during sleep, depriving you of oxygen until you gasp awake.

It is a common misconception that all loud snorers have sleep apnea, but if you think you do, ask yourself or your partner if you have any of the following:

  • Loud snoring with periodic silence and choking/gasping
  • Sore throat or headaches in the morning
  • Excessive sleepiness in the daytime
  • Lack of concentration
  • Behavioural changes and mood swings

Snoring, especially loud snoring, puts you at risk of developing sleep apnea later on – as good a reason as any to address your snoring now.

Side note: obstructive vs. central sleep apnea

Sleep apnea comes in two forms; the obstructive condition is linked to snoring as there is an airway blockage. The other type, central sleep apnea, is due to a fault in the brain’s regulation of breathing – this type is not linked to snoring. All subsequent references to sleep apnea refer to the obstructive form.

How does sleep apnea differ from normal snoring?

The key difference between snoring and sleep apnea is whether or not you are breathing.

When you produce a snoring sound, you are breathing; air must be travelling through your airways and into your lungs, albeit a bit bumpily. Noise from snoring is bothersome but the more worrying event is when the sound suddenly stops – now you aren’t breathing.

Here, snoring has made the serious transition to obstructive sleep apnea.

 

“Is it snoring or sleep apnea?”

Read the full article

Thankfully your body has a mechanism to kick-start breathing again. When it stops for too long, the amount of oxygen in the blood drops and carbon dioxide rises; your brain recognizes this dangerous situation. A fizz of brain activity briefly wakes your body up, often with a gasp or snort. Muscles in your neck open the airways so air can get back into the lungs.

Sadly, when you go back to sleep, this process of obstruction, low oxygen and awakening repeats itself again and again.

Why is sleep apnea dangerous?

Sleep apnea is harmful because repeated oxygen debt and fitful sleep every night takes its toll on your body [1]. During the low oxygen events, your heart is having to work harder. This increases blood pressure which damages your arteries, thickening their walls and increasing the likelihood of:

  • Heart problems including angina, heart failure and heart attacks
  • Stroke
  • Diabetes
  • Impotence

These physical problems are only made worse by disturbed sleep. A lack of sleep also has detrimental effects on your day-to-day mental functioning. Many people experience:

  • Low energy
  • Daytime sleepiness
  • Worsened reaction times
  • Poor memory

Beyond the sufferer, sleep apnea impacts upon society too. At work, persistent tiredness shrinks productivity and means more days taken off sick [2].

On the road, studies have found that people with sleep apnea are twelve times more likely to be involved in road traffic accidents. Some countries now make it mandatory to inform the driver registration authorities if you are diagnosed with sleep apnea [3].

What can put you at risk of sleep apnea?

Snorers are not necessarily suffering from sleep apnea, but the risks associated with each are closely aligned. The things that make you more likely to develop sleep apnea mirror the risk factors for snoring:

Identifying potential sleep apnea

There are some important things to watch out for if you suspect you have sleep apnea:

  • Very loud snoring, with periodic silence and gasping
  • Headaches or a sore throat in the morning
  • Being excessively sleepy in the day
  • Lack of concentration
  • Mood swings and behavioral changes

Despite continuously waking during the night, sufferers don’t usually realize it themselves. Many people assume that the fatigue they are experiencing is a symptom of age so fail to seek help. Instead, partners of those with the condition are more likely to spot their sleep apnea.

How does sleep apnea severity vary?

The severity of your condition can be assessed by counting how many times you experience low-oxygen events. This helps to generate an AHI score, the apnea-hypopnea index. This measures the apnea or hypopnea episodes per hour of sleep:

  • Apnea episode – complete airflow blockage for at least ten seconds
  • Hypopnea episode – at least 50% reduction in airflow for at least ten seconds

Your AHI score relates to the severity of sleep apnea:

  • 0-5 events per hour – normal
  • 5-15 events per hour – mild sleep apnea
  • 15-30 events per hour – moderate sleep apnea
  • 30+ events per hour – severe sleep apnea

Your score is very important when deciding on the best way to treat your sleep apnea. Mild to moderate cases can be addressed with normal snoring reduction techniques and consumer remedies. If you have a severe case, continuous positive airway pressure devices (CPAP) are the most effective form of treatment.

Conclusion

It is important to know that relatively benign snoring can make a dangerous transition to obstructive sleep apnea. This is a serious condition where your airway repeatedly closes during sleep, briefly depriving you of oxygen until you gasp awake.

Low oxygen events and continuous poor sleep can have serious repercussions on both your physical and mental wellbeing.

The same things that cause snoring put you at risk of sleep apnea. Some people even consider loud snoring to be the first stage of “sub-clinical” sleep apnea. Importantly, up to 95% of people with sleep apnea snore [4], but not everyone who snores has the condition. Understand your risk and know how to spot the signs so you don’t make the switch.

Mouth Exercises for Snoring

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Diet & Lifestyle, Science, Solutions

Mouth Exercises for Snoring

Anti-snoring mouth exercises can be of massive benefit to almost all snorers.

We know that getting some exercise can help us lose weight which is a great way to tackle snoring. Increasingly, we are seeing that exercise to help snoring needn’t involve running, cycling or swimming, or even breaking a sweat.

More people are turning to mouth, tongue and throat exercises to take control of their snoring and are seeing amazing results.

 

Five anti-snoring exercises that really work

Jump

How do these exercises work?

Snoring is caused by slack tissue in your airway increasing resistance to air passing through [1]. Anti-snoring exercises aim to tone up this slackened tissue, treating the root cause of snoring.

Low muscle tone causes snoring

Our tongues and muscles in the thoat naturally relax when we sleep. Snoring happens when this relaxation becomes too much and the tissues start to flap, or when the tongue falls back and its base obstructs airflow.

When these muscles are weak, the chance of snoring is much higher. Muscle tone diminishes with age which explains why older people are more likely to snore.

Exercises vs. snoring aids

Wearing various remedies can tighten this tissue or hold things in place. But to keep snoring away, you’ll always rely on these appliances.

Anti-snoring exercises tone these tissues, stop them collapsing and prevent them from flapping.

You can train yourself into sleeping more quietly without having to wear an anti-snoring appliance ever again!

There are snoring aids on the market with very little science to back them up. The same is not true for anti-snoring exercises. There’s plenty of evidence and it all looks rather encouraging [2].

The evidence – music lessons

In 2000, researchers investigated whether you could reduce snoring with singing. A drama therapist from the University of Exeter in the UK developed a series of singing exercises for a group of twenty snorers [3].

The group sung these songs for twenty minutes a day for three months. The singing they did wasn’t your typical tune you might hum to yourself, but focused more on projecting strong vowel sounds with big exaggerated mouth movements.

It sounds more like yodeling, is rather bizarre, but it works. Comparing the participants’ snoring recordings before and after the study, the researchers saw a big drop in snoring.

In a different study six years later, twenty-five patients with moderate obstructive sleep apnea were signed up for didgeridoo lessons. Fourteen received tuition and did practice at home every day for four months. The other eleven – the control group – were put on a waiting list and carried on as normal.

Playing the didgeridoo is hard and requires strong mouth, tongue and throat muscles. At the end of the four months, the group who played the instrument showed some promising results improvements to their snoring [4]:

  • They were less sleepy throughout the day.
  • Their sleep apnea episodes reduced. Patients had a lower apnea/hypopnea index, 6.2 points fewer than the control group.
  • Their partners reported feeling less disturbed at night.

The evidence – targeted exercises

Didgeridoos and didgeridoo teachers are not easy to come by, and not everybody wants to walk around yodeling. Researchers took the concepts of these practices and created a series of exercises that target the snoring muscles of the tongue, soft palate and throat.

Guimaraes et al

In 2009, a group of scientists in Brazil performed the largest snoring exercise study to date [5]. The study design was robust, randomizing thirty-one different patients with moderate obstructive sleep apnea into two groups.

Each group was under the impression that they were receiving an amazing new anti-snoring therapy (important to ensure that any improvements are not due to the “placebo effect”), but only 16 were given the anti-snoring exercises. The other fifteen were a control group, given “sham therapy” which entailed a series of breathing exercises.

Each group attended supervised sessions for thirty minutes once a week and were told to do their exercises every day at home too.

Whilst the control group did ineffectual deep breathing, the test group followed an exercise regime involving the tongue, soft palate and walls of the throat. Exercises involved sucking, swallowing, chewing, breathing and speaking.

After three months, those doing the exercises had markedly improved their sleep apnea. They:

  • Reduced the severity of their sleep apnea. AHI on average dropped by 39% compared to no change in the control group.
  • Snored less frequently and less loudly
  • Had better sleep quality
  • Experienced less sleepiness during the daytime
  • Had improved oxygen saturation during sleep apnea episodes

Other studies

Further studies highlighted that thirty minute sessions are long and realistically people were unlikely to do this under their own steam. Merely brushing our teeth twice a day for two minutes is something that one in four of us struggle with [6]!

Researchers started to focus on shorter regimes, using similar exercises but done in short sessions several times per day. These patients still significantly decreased their snoring volume by 60%, improved their sleep quality and made their partners feel less disturbed [7].

Overall, the studies have strongly shown that [2]:

  • Anti-snoring exercise therapy reduces sleep apnea severity by 50%.
  • Exercises also reduce normal snoring, both objectively and subjectively. Snorers’ partners feel less disturbed and both the frequency and volume of snoring is decreased.
  • Sleepiness improves with consistent anti-snoring exercises.
  • Exercise regimes needn’t be long. As little as forty minutes per week can have a positive impact.

 

Detailed summary of the research into oropharyngeal exercises for snoring

Read

Five anti-snoring exercises that really work

One doctor, a massive advocate of anti-snoring exercises and the professed “patron saint of snorers” describes these exercises as yoga for your mouth with a focus on stretching and positional training [1].

The exercises favor quicker, sharp repetitions as opposed to long holds, which can instead add muscular bulk and make matters worse.

Different studies have used different techniques, but here are five of the key exercises that appear in most experiments and can really make a difference:

  1. Tongue curlers. With your mouth open, slide the tip of your tongue backwards along your hard palate as far back as it will go. Repeat 20 times.
  2. With an open mouth, press your tongue flat against the roof of your mouth and suck it upwards. Hold for 2 seconds and repeat 20 times.
  3. Force the back of your tongue against the floor of your mouth whilst the tip remains in contact with your lower front teeth. Again, you should do this with an open mouth.
  4. Pull your cheek out with your finger, use your cheek/mouth muscles to pull the finger back in.
  5. Elevate the back of your throat by sounding “aahh”. Once you get better at this exercise, you should be able to raise your uvula (the dangling part in the back of your throat) without making a sound.

You are unlikely to see instant results. These exercises are most effective when performed daily and stuck to over a period of time. Remember, you don’t need to spend ages on your routine, as little as eight minutes has shown to still be very effective [7].

To give yourself the best chance of success, set aside a time in the day to do these exercises. Also try to do them in private as you may look and feel a little strange. With some practice you will get better at the exercises and will start to notice the difference.

What Happens in a Sleep Study?

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Science, Sleep, Sleep Apnea, Solutions

What Happens in a Sleep Study?

If you snore and are worried about sleep apnea, to get a diagnosis you’ll need to undergo polysomnography in a sleep study.

In this guide to sleep studies, we explore:

At SnoreLab, we often get asked “Can the app detect sleep apnea?” Some users have found tell-tale signs of sleep apnea in their SnoreLab recordings, but importantly, these don’t reliably tell you that you have sleep apnea. The only way to robustly diagnose sleep apnea is with a sleep study.

Some estimates put the rate of sleep apnea amongst people aged 30-60 at 16.5%, but the vast majority of these people are undiagnosed [1]. This is because there is a lot of anxiety, unawareness and misinformation surrounding sleep studies.

This article aims to demystify sleep studies so you know what to expect if you want to make a positive step towards understanding and treating sleep apnea.

What does a sleep study do?

A sleep study does exactly what the name suggests, it studies your sleep. This is done via a process called polysomnography (PSG) which literally translates to “many sleep measurements”.

Sleep apnea cannot be diagnosed with your snoring sounds on their own, therefore other measurements are necessary. As well as capturing your sounds with a microphone, PSG will also measure:

  • Blood oxygen levels – blood oxygen drops during apnea episodes.
  • Brain activity – to detect the microarousals that accompany apnea events and assess sleep stage.
  • Muscle activity
  • Heart rate
  • Breathing rate and effort – to provide evidence of breathing interruptions.
  • Eye movement – helps to determine what stage of sleep you are in.
  • Sleeping position – gives some insight into what triggers sleep apnea.

PSG can also be used to study other conditions such as narcolepsy, restless leg syndrome, periodic limb movement disorder, insomnia, sleepwalking and night terrors.

How do I get a sleep study?

Medical referral

If you think you might have sleep apnea, first assess your risk with some questionnaires. Scoring high on screening questionnaires such as the STOP-Bang questionnaire and the Epworth Sleepiness Scale can be useful in persuading clinicians that a sleep study is necessary.

You can then see your doctor to request further investigation into your sleep breathing problems.

As well as your screening questionnaire results, SnoreLab can often be very helpful in giving your doctor some evidence of your loud snoring or maybe even some apnea episodes.

If seeing a general practitioner for your initial consultation, you may first be referred to a sleep specialist or an ear, nose and throat (ENT) clinician before being offered a sleep study.

Requesting a home study online

In some countries, there are online companies that conduct home sleep studies without you ever having to attend a medical consultation. After filling out an online assessment form and paying a fee, these companies will post your study equipment to you with instructions.

Which type of study is best for me?

If your specialist deems you to be at risk of sleep apnea, you should be offered a sleep study to confirm this suspicion.

There are two types of study, one done at a specialist sleep lab, the other in your home.

Studies done at sleep labs:

  • Give more reliable insight into what is happening to your body during sleep
  • Use more attachments and measurements; can detect a wider variety of conditions
  • Are usually more expensive
  • Often have less availability meaning longer waits

Whereas studies performed at home:

  • Are more comfortable due to the familiar settings, therefore can give better quality sleep
  • Still give reliable results, particularly if your symptoms are quite severe
  • Are usually less expensive
  • Are more convenient
  • Can be prone to error if not fitted correctly

Often, your specialist will recommend the most suitable type of study for you and will make you aware of the relative merits of each.

Sleep lab studies – what to expect

Sleep studies conducted at specialist labs are more comfortable than many people think. The word “lab” conjures images of cold indifference; people in white coats and unfriendly, clinical surroundings. Most bedrooms in specialist sleep clinics are comfortable and sympathetically decorated, with a real bed as opposed to a hospital trolley – some say akin to a three-star hotel.

Before your study

To ensure good sleep and reliable data, there are a few things to do in the lead up to your study:

  • Maintain a normal and healthy sleep routine on the nights leading up to the study.
  • Avoid napping on the day of the study.
  • Limit caffeine consumption and avoid alcohol altogether.
  • You may also need to adjust your medications (ask the referring specialist beforehand).

What to bring

Make sure to bring:

  • Suitable night clothing
  • A change of clothing for the next day
  • Toiletries
  • Something to keep you occupied before going to sleep. There will likely be a period of winding down before the study starts, so a book or puzzle to keep you occupied (without excessive stimulation) is a good idea.
  • Any medication you take routinely, both to maintain that routine and to show to the staff, as this can provide some insight into your sleep symptoms.
  • Any necessary documentation

Getting wired up

Because PSG measures many different things, there are lots of attachments that need to be made. Ultimately, you need to be relaxed enough to sleep properly, so the technician should take time to make sure the attachments are secure yet comfortable. This will take anywhere from thirty minutes to an hour, so you should use this time to ask any questions you have.

Different labs will vary, but typically you will have these various attachments on a number of places on your body:

  • Head – electrodes taped on to measure your brain activity.
  • Side of your eyes – these measure the movement of your eyes to help determine your sleep stage.
  • Chin – electrodes here assess the muscular tension in your jaw.
  • Nose – a nasal cannula rests two small tubes into your nostrils to measure breathing rate.
  • Chest – a strap here monitors your breathing effort. This part may also include a small box where other channels are connected to.
  • Finger – a small clamp usually on your index finger measures blood oxygen levels by shining infra-red light through your finger nail.

Once all of these attachments are in place, your technician may ask you to blink or make some snoring noises to test the connections.

You are likely to then be given some time to wind down before going to sleep.

Depending on the time of your study and the individual practices of different labs, you may be provided with a meal.

Getting to sleep

As more and more pieces of wire are attached to you, you’ll probably feel that it’s less and less likely that you’re going to be able to sleep in this strange environment.

People often start to worry that they won’t sleep or get accurate results. In reality, only a tiny proportion of sleep tests fail due to inadequate sleep data. It may take a little longer to fall asleep, but usually, you’ll get plenty of sleep which will give the clinicians lots of data to work with.

Throughout the night

Typically, you are given six to seven hours to sleep. A technician will monitor you overnight. If you need to urinate in the middle of the night, simply let the technician know and they will come to disconnect the relevant attachments properly.

In the morning

Don’t be surprised if you wake up to a different technician. Sleep studies last about ten hours from initial arrival so it’s likely that the staff will change over.

Once you have been given time to change and freshen up, you might be asked to complete some questionnaires about your sleep and symptoms. Everything is usually done by 7am.

Home studies – what to expect

Typically, you will have your home sleep study about four weeks after your initial referral.

Attaching the equipment

If you have booked your home study through a clinic, you will probably have to attend that clinic on the day of your study. This is your chance to get as much information as you can and ask any questions if you have them. There are two possible set-up methods, you will either:

  1. Collect the equipment and attach the components yourself once at home. Here, you will be given the home study equipment with a set of instructions. These types tend to have fewer pieces and therefore give less detail
  2. Get the main components attached by a technician with just a few connections for you to do once home before you go to sleep. Having a specialist fit the components allows use of more connections giving more measurements.

If you have mobility issues, it may be possible for a sleep technician to deliver and fit the study equipment in your home.

Home sleep studies tend to be less involved than those conducted in specialist labs, so there are likely to be fewer attachments. You will have a minimum of:

  • Nasal cannula – rests two small tubes in your nostrils to assess your airflow.
  • Finger clamp – this is a pulse oximeter: a device that measures the amount of oxygen in your blood.
  • Chest strap – this measures your breathing efforts as well as containing a box where the other wires connect.
  • Heart rate monitor.

This is the minimum. Some home studies, particularly those where a specialist gets you fitted at the clinic beforehand, have more attachments that can also measure brain, eye and muscular activity; much like a lab study.

Getting to sleep

Once wired up, despite being in the comfort of your own bed, you are likely to take a little longer to get to sleep. Most people report that the attachments feel a little strange but not uncomfortable. The set-up should allow you to sleep in whatever position you like.

If you worry that you aren’t sleeping enough, remember that only a tiny handful of sleep studies fail due to inadequate sleep data. Though you may feel you haven’t slept particularly well, chances are, you slept much more than you think you did.

In the morning

Most equipment is quite easy to disconnect. Clinics don’t usually require the parts to be bundled up neatly and often supply a simple plastic bag or box for you to simply stuff the parts into. Usually, the cannula is disposable.

Some units will have a little light that shines either green or red in the morning to indicate whether the test has sufficient data. You’ll be given instructions before as to what to do if the light is red.

You then need to return the study to the clinic for them to generate the results.

To better understand what happens in a home sleep study, read Susan’s story, a SnoreLab user’s first-hand account of getting a sleep apnea diagnosis through a home sleep study.

Understanding your results

Getting your sleep study results back can take days to weeks. If you have had a home study and your results are unclear, your specialist may refer you for a lab study instead.

You will get a document that gives many details about what was recorded during your study. Here is a breakdown of what usually gets measured and what it all means …

Sleep physician/technician’s report

This is a summary of the findings. They will say whether your sleep and the data obtained was adequate as well as an overview of the findings including: sleep position, sleep stages and apnea episodes.

Calculated variables

These are your apnea measurements:

  • Total AHI – the average number of times per hour, you experienced an apnea or hypopnea event (total or >50% breathing cessation for 10 seconds or more).
  • NREM AHI – the AHI during the non-REM stage of sleep.
  • REM AHI – the AHI during the REM stage of sleep.
  • Minimum oxygen saturation – the lowest level of oxygen detected in your blood.
  • Longest apnea – the duration in seconds of your longest period of complete breathing cessation.
  • Longest hypopnea – the duration in seconds of your longest period of partial (>50%) breathing restriction.
  • Mean apnea/hypopnea duration – the average time in seconds of each episode.
  • Arousal index – the number of times per hour you aroused from sleep.
  • Apneas experienced in different positions

Conclusion

This identifies if you have sleep apnea and its relative severity:

  • Normal: AHI = 0-5. This will sometimes just be called “primary snoring”.
  • Mild obstructive sleep apnea: AHI = 5-15
  • Moderate obstructive sleep apnea: AHI = 15-30
  • Severe obstructive sleep apnea: AHI = 30+

Sleep statistics

These are the measurements of your sleep, the relative times spent in each sleep stage and how long you took to fall asleep:

  • Time available for sleep – i.e. when the lights were off.
  • Total sleep time
  • Sleep efficiency – this is the percentage of time spent asleep during the time that the lights were off
  • Sleep latency – the time taken to fall asleep
  • REM sleep time
  • NREM sleep time
  • Sleep in supine position – time spent sleeping on your back.

Different sleep stages with SnoreLab’s insights into the Architecture of Sleep.

Learn more.

The next steps

Your results report may also include some recommendations. If your results show little to worry about (i.e. normal primary snoring) you’ll get some general advice that takes into account both the study results and your general health.

If sleep apnea has been detected and you had your study through a referral process, you will then have some follow up appointments to discuss treatment options.

Mild to moderate sleep apnea can often be improved with consumer anti-snoring remedies and positive lifestyle changes. Usually, severe sleep apnea requires treatment with CPAP.

See SnoreLab’s guides to the different types of CPAP mask and how to fix common problems with CPAP.

This article gives an overview of the general processes in most laboratory and home sleep studies. Individual practices may vary.

Age and Snoring

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Causes, Science

Age and Snoring

Snoring can worsen with age, but there are things you can do to reduce your risk. It’s also important to remember that young people snore too.

“Snoring is an old person’s problem”. This statement is both true, and very false. There’s no shortage of changes that take place as we age, and a propensity for snoring is one of them.

Whilst age is a significant risk factor for snoring and sleep apnea, increasing numbers of young people and even children find themselves snoring, or even gasping and choking through the night.

Snoring’s association with age is exactly that, an association, not an inevitability. If you’ve found your snoring worsening with age, there are a few things that you can do to. Additionally, if you feel you’re too young to be snoring all the time, you’re not alone. It may be time to carefully consider its possible causes.

In this article, we explore:

Why do we snore more as we age?

Our sleep changes as we age. We find it harder to fall asleep and stay there, get less sleep in general, and crucially, we’re likely to snore more. Some sources show that fewer than 10% of 17-29 year olds say they frequently snore, whilst more than 40% of over 50s do [1].

When it comes to the more dangerous prospect of sleep apnea, some 18% of people aged 65 and over are having at least 10 apneic episodes per night compared to only 3% of under 45s [2].

But why is this? Aging is inevitable, but snoring doesn’t have to be. Age-related snoring has direct and indirect causes …

Direct reason – weakened airway

Weak airway muscles are the main reason for snoring more with age.

Snoring happens when the tissue in our airways start to vibrate because it is too loose. Just as skin loses tension with age and muscles in our bodies become weaker and less toned, so does the airway. This loss of tone is particularly true of the soft palate, one of the main sources of snoring noise [2].

Throughout earlier life, women tend to snore less than men. This gap is narrowed once women reach the menopause as various physiological changes make you more likely to snore.

Indirect reasons

With age comes a few other factors that make snoring more likely:

  • Easier to gain weight. A slowed metabolism and overall decrease in physical activity make weight gain go hand in hand with age. Weight gained on the neck and midriff heighten the risk of snoring.
  • More medication. Drugs to treat high blood pressure, heart conditions and even simple pain relief medication can lead to a congested nose which makes snoring more likely. Sedatives also contribute to enhanced relaxation of the soft tissue of the throat.
  • Reduced immunity. Lots of snoring can be caused by a blocked nose; blocked noses are often the result of a cold, something you might be more vulnerable to as you age [3].

What can be done to combat age-related snoring?

Remember, snoring isn’t inevitable as you age. There are things you can do:

  • Mouth exercises. The best way to get tone back to those weakened muscles in the throat is to exercise them. Check out our guide to anti-snoring mouth exercises, an anti-snoring tactic which can be particularly helpful for older snorers.
  • Mouthpieces. Another way of tightening that loose tissue is to use a mouthpiece which brings your jaw or tongue forward. Find out more about the right sort of mouthpiece for you with our buying guide to anti-snoring mouthpieces.
  • Treat your blocked nose. Your nose can be blocked for a number of reasons, so there are a multitude of solutions. See our guide to snoring and nasal blockage to see what’s stuffing you up and what you can do about it.
  • Lose some weight. Easier said than done, yes. Impossible once you reach a certain age, no. Often, effective weight loss and retention needn’t involve a hard-to-maintain crash diet. The cumulative effect of many small, sustainable and positive lifestyle and diet changes can make a big difference. Have a look at our SMART strategy for weight loss.

Snoring is not just an “old people problem”

Despite the evidence for snoring increasing with age, we and many SnoreLab users testify that snoring is not a problem confined to older people. Yes, fewer young people snore when compared to the older population, but this “fewer” still constitutes thousands upon thousands of people [1].

Snoring has many causes and we are increasingly seeing that snoring and sleep apnea is a problem for not only adults, but adolescents and children too …

Young adults and snoring

How common is it?

There seems to be some conflicting numbers when it comes to young adults snoring. One thing however is certain: snoring is not an “old people problem”.

A survey of 12,000 high school students in Korea revealed that a startling 22.8% of them snored, with just over 1,000 even reporting experiencing sleep apnea [4].

The prevalence of snoring in university-age young adults is higher than many think. One study asked 2,200 California university students aged 18-25 about their snoring. 30% reported snoring [5].

Even anecdotally, whilst scrolling through SnoreLab’s Twitter feed at the start of the university semester in October, we see many unhappy students lament the snoring capabilities of their new roommate!

Snoring in young adults often goes unnoticed. This is due to several reasons:

  • A misconception that snoring is only a problem for older people
  • Social stigma around snoring
  • Lack of understanding of the risks, therefore a reluctance to seek help or information
  • Younger people usually sleep alone so aren’t identified as problematic snorers.

Why is it a problem?

Snoring and sleep apnea present problems for younger people just as they do for older people. As well as the risks to your physical health that sleep apnea poses (which can present more of a problem in young people), snoring amongst young adults has shown to have a negative impact on other facets of life such as mood regulation, driving safety and even academic performance [6].

One study assessed the likelihood of medical students to fail their exams based on whether or not they snored. Non-snorers had a failure rate of 13%, whereas 42% of the frequent snorers failed their exams [7].

What can be done to help?

Of course, the best treatment for snoring depends entirely on its causes, of which there are many. That said, anti-snoring product companies are putting more emphasis on the importance of snoring in younger people.

Good Morning Snore Solution have recently introduced a tongue retainer for young adults aged 16-25, based on an assumed difference in facial shape and size. Tongue retainers work by preventing your tongue falling back and blocking your airway whilst also tightening the slackened tissue in your throat.

Whilst many will be skeptical about how the mouthpiece is actually tailored specifically to this group of people, it is great to see companies in the anti-snoring marketplace taking snoring in young people seriously.

If you don’t know where to begin with your snoring, have a look at our 7 ways to stop snoring naturally and our 7 recommended snoring aids.

Children and snoring

How common is it?

Studies estimate that around one in ten children snore. On top of that, 1-4% experience obstructive sleep apnea [8], a condition all too frequently associated with older people.

Snoring in children can be relatively normal, but if they are snoring consistently throughout the night for four or more nights a week, it needs to be taken seriously [9].

Why is it a problem?

Sleep deprivation is the biggest problem for children with sleep disordered breathing. Children need lots of healthy sleep to develop well. Studies have linked sleep fragmentation with ADHD, and adolescents presenting to mental health services show a high prevalence of sleep disturbance [10].

What can be done to help?

Children have slightly different airway anatomy to adults. A common culprit for snoring in children is the adenoids – glands located near the soft palate which usually shrink and disappear later in life along with the snoring itself [9].

For that reason, surgically removing these glands is often an effective treatment method for children with obstructive sleep apnea. Some research indicates that children’s stunted mental capabilities, often attributed to the sleep disturbance that accompanies sleep apnea, reverses completely 3 to 10 months after surgical removal of the adenoids [11].

Not all children will show an improvement after this type of surgery. Much like in adults, snoring can be caused by other factors. For example, obese children and children with certain craniofacial abnormalities, show less improvement [8].

Conclusion

Age can indeed make you snore more, but snoring is not just an “old people problem”. Sleep patterns change with age but one thing remains constant: good sleep is important. If your snoring is impacting upon your sleep or health in any way, at any age, it needs addressing. Understanding and treating snoring earlier in life puts you in a better position to not snore further down the line.

Weird Anti-Snoring Ideas of the Past

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Science

Weird Anti-Snoring Ideas of the Past

Type “snoring remedies” into a search engine and you’ll see the usual suspects: mouthpieces, nasal dilators and special pillows amongst a few others.

We dug deeper into the history of anti-snoring devices and found some unusual contraptions we thought we’d share …

Tongue holding mouthpiece – 1962

Mouthpieces and tongue retainers are effective and popular devices for treating snoring. Combining the two was never a good idea and was always doomed to failure.

This patent, filed in 1962, has the right idea for preventing snoring: hold the base of the tongue clear from the airway to leave the passage of air unobstructed. The problem was how it went about doing so.

The mouthpiece uses a tray to fit onto your top teeth. From the back of the mouthpiece, a paddle protrudes backwards and downwards to push your tongue base forward. Surely, there wasn’t a single user who didn’t vomit or gag uncontrollably when attempting to use this device.

Anti-snoring shock collars – 1967

This is something we are more used to seeing on dogs to stop them barking, but back in the 1960s there were several patents filed for anti-snoring shock collars.

The idea was that when snoring was detected by the internal microphone, the collar would deliver an electric shock to the user and train them to stop snoring.

Good sleep and frequent electrocution aren’t exactly happy bedfellows, so needless to say, the idea didn’t catch on.

Open mouth alarm – 1960

Many people snore because they breathe through their mouth instead of their nose.

With this contraption from 1960, if your mouth inadvertently falls open at night the bulky unit under your chin detects this and sounds a buzzer, telling you to shut your mouth and go back to sleep.

As you then struggle to get back to sleep, fearing the next imminent buzz, you wonder why you didn’t just get a chin strap.

This is another device that has the right idea but implements it very strangely.

Check out SomniFix for a more feasible alternative.

Gag-less mouthpiece – 2004

Gag-less can be interpreted two ways: either it doesn’t involve gagging, just like wireless doesn’t involve wires; or it makes you gag less than alternatives, but can still most definitely make you gag. Looking at this device, we’d say the latter is more likely.

This compressed tube fits inside your mouth to keep your tongue in check with its “saw-like” ridges. Anything described as “saw-like” surely has no place in your mouth.

Snoring deconditioning system – 1975

Many inventors loved the idea that you can use behavioral conditioning techniques to banish snoring.

This device from 1975 treats you like a lab rat with a combination of negative and positive reinforcement to make you “learn” to stop snoring.

When snoring is detected, the device activates a set of unpleasant prompts: light, sound, touch and pain. A buzzer under the pillow, flashing lights above the bed, and vibrations or electric shocks to the arm wake the user when they snore. The only way to turn off these intrusions is to press a “Stop” button on the central controller (number 30 in the above image).

Once you have flicked the switch and learnt from this negative conditioning, positive reinforcement comes in the form of an M&M via the reward chute! Users soon found out that the biggest reward was flicking the “OFF” switch instead!

 

SnoreLab’s full article about snore alarms

Read

Head-moving snore alarm – 1962

Continuing along the behavioral conditioning theme, this device from 1962 simply named “Snore Alarm” listens out for snoring and then violently jolts your head to wake you up.

The microphone placed at the top of the bed is connected to an amplifier, which when activated:

“[…] deliver[s] a sharp upward impulse of force to the hinged board [under the pillow]. This shakes or jars the sleeper, causing the sleeper to awaken. When the sleeper is thus awakened, he becomes aware of the fact that he is snoring.”

It seems bizarre, but one of our favorite anti-snoring products available today doesn’t look too dissimilar to this device. Smart Nora listens for snoring and then moves the head to stop it. Importantly, Smart Nora’s actions are gentle and don’t intend to wake the snorer but instead bring back some muscular tone to the airway.

 

More about Smart Nora

Read

Not yet in the past, there’s still some hope for …

Silent Partner

Silent Partner is an eye mask that aims to use active noise cancellation to get rid of snoring sounds.

The idea is good: a non-invasive sleep mask with small inbuilt microphone(s) and loudspeaker(s) to both detect the snoring sound and produce a “counter-sound” to cancel it out. This concept is much like that of noise cancelling headphones, but with a few additional challenges. These challenges have so far proved difficult to overcome.

First, there’s the size of the loudspeakers. Snoring sound is made up of a mix of frequencies (or pitches), with more towards the low to mid range. Speakers small enough to fit in a sleep mask find it hard to produce the tones that can successfully cancel out these lower frequencies in snoring.

Second, there’s the cancellation zone. Silent Partner’s promotional video demonstrates a snoring user with a bubble of silence around the their head. Creating such an optimal bubble is extremely challenging (i.e. impossible) and will always involve a compromise (i.e. won’t work).

Third is the nature of snoring itself. Snoring is a non-stationary noise; its energy fluctuates. Noise cancellation works very well on stationary sounds such as the gentle hum of an air conditioning unit or an aeroplane, but struggles to adjust to constantly changing sounds.

If Silent Partner were somehow able to navigate these pitfalls, the distorted low-frequency sound that would ensue would probably be more annoying than natural snoring.

After acquiring $1.6m from crowdfunding, the company hasn’t yet produced anything. The website has ceased to exist and the comments on its crowdfunding page don’t make for easy reading.

Okay, so what does work for snoring?

Hopefully, after seeing the bizarre array of anti-snoring techniques confined to history, you have a new found appreciation for the anti-snoring products available today.

Check out our SnoreLab’s 7 most effective snoring aids to see what could work for you – no electric shocks necessary!

Snoring Due to a Blocked Nose?

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Causes, Science

Snoring Due to a Blocked Nose?

A blocked, congested or stuffy nose is one of the leading causes of snoring.

Many snorers will notice that they cannot breathe well through their nose and instead have to breathe via their mouths.

Unblocking your nose can drastically reduce snoring, but which way is best? Nasal obstruction has many causes so there are several different solutions.

Here, we explore the different causes of a blocked nose that could be the root of your snoring:

What could be blocking your nose?

Just as there is no single cause of snoring, many things can cause a blocked nose. Multiple factors can often working in sync with each other to aggravate snoring.

Check to see if you fit the profile for any of these …

1. A cold/illness

The common cold is brought on by a range of viruses that attack the upper respiratory tract. This invasion coupled with your body’s own defense mechanisms cause your nose to swell and become blocked.

Remedy your cold-induced snoring with:

2. Allergy

A leading cause of nasal obstruction and indeed snoring is allergies – particularly dust allergies or the pollen allergy better known as hay fever. This is where your body launches into infection-fighting mode in reaction to harmless things.

As allergens get into the body mainly through the nose, this is the area that is most affected. Heightened blood flow and release of inflammatory molecules make your nose become stuffy.

Snoring related to allergies can be effectively managed using:

  • Neti pots. These use salt water to flush out allergens and soothe inflamed tissue.
  • Air purifiers remove allergens from the air before they get to your nose.
  • Nasal sprays can be medicated or non-medicated. Both aim to reduce inflammation. Mast cell inhibitor sprays are a good preventative measure for hay fever sufferers.
  • Anti-histamines are a type of anti-inflammatory medication commonly used by allergy sufferers.

Read the story of SnoreLab user Jenny, who effectively banished her snoring after treating her dust allergies.

… I recorded my snoring and scored 199 with 70% of my snoring at the epic level. We cleaned, vacuumed and aired the room. I had some allergy medication from the doctor, settled down and WOW! I didn’t snore! …

3. Environmental factors

Fumes from noxious chemicals, smoke (tobacco or otherwise), perfumes and even changes in temperature are some causes of non-allergic rhinitis (rhin = nose, itis = inflammation).

This type of nasal blockage can be chronic, meaning it lingers for a long time and persistently recurs.

If you are exposed to these irritants on a daily basis, you may have lived with a stuffy nose for so long that you don’t even realize it anymore. Perhaps you don’t even factor it in as a cause of your snoring. Think about your day to day life and the things you are exposed to, as certain occupations carry more risk of exposure to these harmful irritants.

The natural environment can also influence snoring. Use SnoreLab to make notes on any stark changes in the weather, as this can certainly play a role in nasal blockage and snoring

Snoring caused by breathing bad air can be improved with the use of:

4. Hormones

Hormones are the body’s chemical messengers. Because they travel in the blood they are capable of reaching everywhere in the body, including the nose.

Hormonal fluctuations are particularly prominent during the menopause, menstruation and pregnancy.

There’s no shortage of changes that take place in the body during pregnancy, and though it may be low on your list of priorities, changes do take place in the nose. With increased blood supply to many parts of the body, up to 42% of pregnant women in their third trimester experience nasal blockage and as many as 49% snore (as opposed to 20% of the general female population) [1].

If hormonal fluctuations are responsible for your blocked nose and snoring, consider using:

5. Alcohol

An alcoholic drink before bed isn’t a great idea for restful or quiet sleep. Snoring is the result of over-relaxed muscles obstructing the airway. As a depressant, alcohol only makes this worse. Additionally, the breakdown of alcohol in the blood produces some transitional chemicals that, before being expelled as waste, can cause nasal congestion [2].

6. Nasal sprays

Using nasal decongestant sprays has proven effective in reducing nasal blockage and in turn, snoring. Whilst some types of nasal spray recommend daily use, the decongestant type (which works by constricting nasal blood vessels) can start to have the opposite effect if overused causing a “rebound effect” [3].

If you are using a nasal spray to treat your allergies, always check what type it is and read the instructions.

7. Medication

A blocked nose can also be triggered by prescription drugs that you may be taking regularly to treat other conditions.

Medication for high blood pressure (ACE inhibitors), heart conditions (beta blockers) and simple over-the-counter pain relief (NSAIDs) can all contribute to stuffing you up.

Have a check in your medicine cupboard if you suspect that your nose is worsening your snoring. This can often be remedied with a non-medicated approach such as a nasal dilator.

8. Physical abnormalities

If inflammation in the nose persists, the nasal folds become damaged and cause a blockage in their own right. Small, benign tissue growths called nasal polyps can develop alongside long-standing allergies, recurring infection or bad reactions to drugs such as aspirin.

The structure of your nose is also important. People with a deviated septum are likely to suffer from nasal blockage. This is where the cartilage separating your nasal cavities is asymmetric, meaning one cavity is larger than the other, with the smaller chamber having the propensity to become blocked.

A deviated septum is often due to facial trauma, though is also associated with certain genetic disorders of connective tissue and birth defects.

Sometimes, a simple nasal dilator can be very effective at relieving snoring caused by nasal tissue abnormalities. See which ones are most suitable for you with our guide to nasal dilators.

The science bit – how does nasal obstruction cause snoring?

Your nose is great, and when it’s working correctly you are unlikely to appreciate the important work it does. Whilst adding warmth and moisture to incoming air, it also uses mucus to trap harmful invaders and channels air through your upper airway efficiently and silently.

Snoring with a partially blocked nose

Trying to breathe through a blocked nose is uncomfortable. If you can just about manage it, the whistling or popping noise you get, whilst not the textbook definition of a snore, is still incredibly bothersome and would benefit from some attention.

A typical snore is still possible with a closed mouth. If you breathe through partially blocked nose, greater suction forces are created that can cause your throat to collapse and bring on snoring where your uvula and soft palate start to flap [4].

Snoring with a fully blocked nose

Usually, with a stuffy nose you simply aren’t getting enough air into your lungs through this narrowed space. This is when you need to go to breathing plan B, through the mouth.

Unfortunately, mouth breathing is a leading cause of snoring.

Opening your mouth whilst you sleep results in some changes to the shape of your airways, particularly the soft tissue “noise makers” that are responsible for snoring. Sleeping with your mouth dangling open is known to aggravate snoring for numerous reasons [5]:

  • An open mouth causes your throat to compress
  • Your tongue falls further back into your mouth
  • The open space behind your tongue and soft palate is reduced
  • Directly inhaled air vibrates the soft tissues at the back of your mouth
  • Your throat dries out from breathing in non-humidified air
  • Mouth breathing doesn’t filter allergens and bugs.

Conclusion

For some, a blocked nose is the sole cause of snoring, for others, the picture is bigger. Understanding what role your nose has in snoring and identifying the cause can set you well on your way to tailoring the correct remedies to your snoring and achieving quieter nights.

For more information about the best snoring remedies for a blocked nose, read our full article.

Is Snoring Genetic?

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Science

Is Snoring Genetic?

Is snoring genetic? Questions in life rarely have a definitive answer, and this is no exception. Here, the answer is an unsatisfying “yes and no”. There is a genetic connection, but not a direct cause.

Your DNA can increase the risk of snoring but won’t condemn you to a certain life of nocturnal noises.

My family snores. Am I doomed?

Multiple studies have found that coming from a family of snorers confers a 3-fold increased risk of snoring yourself [1]. This is due to a number of different inherited features but there is no such thing as a “snoring gene”.

There is also some research to suggest that an increased risk of obstructive sleep apnea can be inherited [2].

But fear not – if your whole family snores, whilst you may have to work a little harder to make sure that you don’t, you are far from doomed!

What heritable traits can make you snore?

Cranio-facial features

A predisposition for snoring can come from certain structural features in your face and airways.

Physical characteristics like your eye colour, height and skin tone are inherited from your parents. The same is true of the features that can make you snore.

The usual anatomical culprits for snoring are:

  • Small nostrils
  • Receded chin (known as retrognathia)
  • Small jaw (known as micrognathia)
  • Narrow airway
  • Large tongue
  • Large soft palate

All of these factors decrease the size of your airway and disrupt airflow therefore making snoring more likely.

If your snoring can be attributed to a distinct anatomical feature, it can usually be helped with standard anti-snoring remedies. Sometimes, if the abnormality is particularly pronounced, corrective surgery could be a solution.

Weight

Obesity is a key risk factor in snoring and obstructive sleep apnea.

Basically, the heavier you are, the more likely you are to snore.

Less clear is how much your genes are to blame. In some cases, yes, being overweight does seem to run in families, but it is the subject of much debate as to whether this is the result of nature or nurture.

The likely answer is, again, probably somewhere in the middle …

Physiological factors that dictate weight can indeed be inherited genetically. Appetite is regulated by a system of hormones and signals in the body which are ultimately controlled by a series of underlying genes.

On the other hand, attitudes to food, diet and weight are learned from the behaviours and views of the people around us. This can include our family or simply the society and culture we live in.

Conclusion

There are lots of factors that influence snoring, and it would appear that your DNA is one of them. It’s important to remember that this is only an influence and not a sentence to an eternity of snoring.

So if your mum and dad compete for the best (or worst) Snore Score, you need not worry. You can’t control your genes, but you can control a lot of other factors that contribute to your snoring. Try to understand your triggers and the solutions that work for you.

If you don’t know where to start, have a look at our 7 recommended lifestyle factors that can make huge differences to your snoring.

The Architecture of Sleep

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Science, Sleep

The Architecture of Sleep

If you have ever been suddenly woken up, deep into the night, you’ll know it’s a very disorientating experience. When you wake up naturally, you rouse gently in a less confused state. This is because in these separate instances you have woken up in different stages of sleep.

Sleep has two main states, these are crudely defined by the movement of our eyes (but actually have a lot more important qualities and differences):

  • Non-rapid eye movement (NREM)
  • Rapid eye movement (REM)

Having the correct proportions of each of these types is important to getting good and restful sleep.

The Sleep Cycle

Going from being awake to sleeping isn’t like flicking a simple on/off switch. Sleep has different stages and depths where your brain and body go through specific motions.

Within the seven to eight hours that we should be sleeping, we cycle through these NREM and REM stages in ninety-minute blocks …

  • To start, we initially plunge quickly through the stages of NREM sleep and trundle along in deep sleep.
  • After a while, we climb back into lighter NREM, eventually spending some time in REM.
  • We then drop back into deep sleep again at the start of the next ninety-minute cycle.
  • For every cycle, an increasing amount of time is dedicated to REM sleep, creating an asymmetric pattern.

But what happens during these phases, and why are they necessary?

NREM vs. REM Sleep

NREM Sleep

Stage 1 – this is light sleep, the first destination after wakefulness with tiny dream-like thoughts and easy arousal back to being awake.

Stage 2 – here, breathing slows and body temperature drops.

Stages 3 and 4 –this is deep sleep. Any sound, touch or light from the outside world is tightly controlled, with entry to the brain blocked. This is why it is hard to rouse someone from deep sleep.

This is an important stage for growing and repairing the body, increasing blood flow to various tissues, releasing important hormones and re-energizing.

The brain is reviewing the information that it has received throughout the day. Without the mental chatter of consciousness, our brain waves are long, slow and coordinated.

This pattern allows effective communication between different brain regions. Information is selected and pruned to form memories; the important memories being retained by creation of pathways in the brain, whilst needless ones are discarded from our temporary and fragile short-term storage.

REM Sleep

REM sleep is our dreaming sleep. Despite being asleep, our brain activity is very similar to when we are awake – lots of action; short, sharp and cluttered waves of electrical activity.

The exact functions of REM sleep are still not fully understood, but it is thought to be important in memory formation and learning. The memories selected in NREM sleep are now played back to us, helping us contextualize, learn and integrate them into the real world.

Despite being close to waking, our bodies are completely still, a mechanism to prevent us from turning this pseudo-consciousness into potentially risky sleep-walking or acting out dreams.

When deprived of REM sleep, both mental and physical dysfunction ensues. Indeed, when falling asleep after a period of REM deprivation, our sleep cycle patterns shift to snatch back as much of it as possible, favoring longer periods of REM sleep [1].

Side note: Extreme sleep deprivation and REM

In 1959, radio presenter Peter Tripp staged a “Wakeathon” as a publicity stunt. He stayed awake and on-air for 200 hours straight. As he became more and more sleep deprived, his brain started to enter REM sleep whilst being awake – he was dreaming with his eyes open. Tripp started to think he was an imposter of himself. During a bathroom break he opened a drawer which spat out flames, and he thought his assistants were conspirators trying to frame him for a crime he didn’t commit.

Where does snoring come into this?

There are no definitive rules as to when snoring and sleep apnea occur during the sleep cycle, but studies have found certain trends. It is thought that regular snoring occurs more during NREM sleep. This would explain why snorers don’t wake themselves up with the sound of their own snoring.

Obstructive sleep apnea is commonly associated with REM sleep [2], despite this some studies have found just as many cases of worsened apnea during NREM sleep [3].

Snoring During Pregnancy

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Causes, Science

Snoring During Pregnancy

It is estimated that as many as 49% of pregnant women snore, many of them having never snored before [1].

This goes against the rule that women naturally snore less than men. In the general population, around 20% of women across all ages snore, with even fewer of child-bearing age doing so.

“At nine-months pregnant, I have been keeping my poor partner awake with my late-night nasal symphony.”

Amongst the medley of changes happening during pregnancy, your new-found snoring is probably low on your list of priorities. But if you are pregnant and have recently found yourself snoring, you may have questions and concerns: why is it happening, is it something to be worried about and what can you do to stop it? Let SnoreLab talk you through it …

Why does snoring increase during pregnancy?

It is perfectly normal to snore whilst pregnant. Swelling in your upper airway, weight gain and breathing for two all work together to make you more likely to snore …

Blood

By the third trimester, your blood plasma volume is 40-50% more than it was before you were pregnant. On average, that is another liter and a quarter [2], or roughly 2 pints!

This is necessary to meet the increased demands of growing a human. It is also to protect you from potential blood-loss in labor. In the meantime, this vast expansion in blood volume has some swelling effects on much of your body, including the areas responsible for snoring.

Your airway becomes increasingly engorged with blood which causes it to narrow. This means the air passing through has more resistance. Additionally, you may notice that your nose has become quite congested. 42% of women in their third trimester have pregnancy-rhinitis, or nasal swelling [3]. This can cause you to breathe through your mouth and snore as a result.

“I am nearly nine-months pregnant and for months I have been suffering with even more nasal congestion than usual.”

Weight

Weight gain during pregnancy changes the way you breathe. As your uterus expands, it pushes upwards as well as outwards, meaning your diaphragm is pushed up too. This creates a lower residual volume in the lungs which can predispose your throat to obstruction and snoring [1].

Breathing changes

When pregnant, not only are you eating for two, you are also breathing for two! Pregnancy induces some subtle changes in the way you breathe: increasing the respiratory drive and the amount of air you breathe in an out within a given time. This can create negative pressures which lead to snoring [1].

Should you be worried about snoring during pregnancy?

There is some research out there to suggest that pregnant snorers are at greater risk of complications compared to pregnant women who don’t snore. But don’t panic. These are links, not direct causes and can often be associated with issues other than normal pregnancy-onset snoring.

Two studies by a team of US scientists in 2012 [4] and 2013 [5] found that snoring expectant mothers were at greater risk of:

  • Pre-eclampsia – a condition characterized by high blood pressure and proteins in the urine.
  • Having labor complications that necessitated a Caesarean section.
  • Babies having a low birth weight.

The important thing to note here is that these studies talk about “chronic snorers”. This refers to women who snored a lot before they were pregnant. If you are new to the snoring game since becoming pregnant, you needn’t worry.

Pregnant women who snore shouldn’t be overly concerned about these findings. Every woman is different, and whilst these studies attempted to adjust their methods in order to look at snoring alone, other health factors are bound to have an effect.

Indeed, being obese before pregnancy, having chronic conditions of the upper airway and smoking heighten women’s risk of snoring when pregnant. If these factors are applicable to you and your snoring has got much worse since becoming pregnant, it might be advisable to seek some guidance.

If you are concerned about your snoring, experience excessive daytime tiredness or think you are having apneic events, consult your antenatal care provider.

What can you do to stop pregnancy-induced snoring?

The good news is that if you have started snoring since becoming pregnant, it is very likely that once you have given birth, the snoring will stop.

In the meantime, as you navigate though the complexity of pregnancy, to give yourself one less thing to worry about and reduce your snoring, you can try a few things …

  • Try nasal dilators – these are non-medicated so you needn’t worry about them being suitable for pregnant women. These simple devices either fit into your nostrils, or across the bridge of your nose. Here, they gently open your nasal passages and reduce snoring associated with a blocked nose.

“Pregnant ladies, these are your cure to breathing again until the baby comes!”

  • Sleep on your side – sleeping on your back is known to compress your airway and make snoring much worse. Regardless of snoring, side-sleeping is a good idea as you progress through pregnancy as it ensures adequate blood flow to your baby [6].
  • Eat properly – gaining weight during pregnancy is inevitable but it’s important to not gain weight excessively. Careful consideration of your diet during pregnancy ensures the health of your baby and can keep off the excess weight that can lead to snoring.
  • Use a humidifier – running a humidifier can reduce the congestion in your nasal passages, helping you breathe easier through your nose to reduce the likelihood of mouth breathing and snoring.

“I am pregnant and suffering from a dry nose so a humidifier has been a life-saver!”

Conclusion

The changes that happen during pregnancy can come thick and fast, and having the added annoyance of snoring seems a bit unfair. Thankfully, if you have started snoring only since being pregnant, you are extremely likely to stop once you have given birth.

Whilst there is some science to suggest an increased chance of complications, don’t be too concerned if you find yourself snoring whilst pregnant, particularly if you are new to snoring. Try a few of our tips and if your snoring still causes problems, consult your antenatal care provider.

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