Tag: Sleep

What is Snoring? – An Introduction

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Causes, Science

What is Snoring? – An Introduction

Partial airway obstruction causes soft tissue to vibrate and make noise.

Nearly everyone snores at some point. Snoring can affect young and old, men and women, and people of all shapes and sizes. Roughly 40% of men and 20% of women snore – that’s over 2 billion inhabitants of planet Earth.

This habit is often shrugged off as annoying and embarrassing but otherwise nothing to be worried about. In reality, snoring can affect so much of life, having physical, mental and social repercussions.

But what is a snore?

Q. What is a snoring sound?

A. Vibrating soft tissue

Snoring is the sound of the soft palate and other soft tissue in the upper airway vibrating. This can include the uvula, tonsils, adenoids, nasal turbinates and other surrounding tissue.

These vibrations happen when air can’t move freely through your airway which causes the floppy soft tissue to flap and make noise.

Q. Why does snoring only happen during sleep?

A. Relaxation

When we fall asleep, many muscles in our body relax. This is true of the muscles in our airway.

Being still in our sleep prevents us from doing damage to ourselves and others by acting out our dreams or walking around when not fully conscious. Therefore our muscles – including those in our upper airway – are paralysed when we sleep.

Because we are lying down while we sleep, gravity compounds this relaxation to set up snoring – whether it’s your jaw falling open, your tongue falling back or your throat giving way to the weight around it.

All of us relax when we sleep – so why doesn’t everyone snore? Snoring occurs when this normal relaxation is added to abnormal airway obstruction.

Q. Why doesn’t air flow freely?

A. Obstruction at various places in the airway

Airflow becomes turbulent when there is an obstruction in the airway causing a partial blockage.

The obstruction can be in several areas in the upper airway, sometimes concurrently [1]:

Tongue. When this falls back, it can block your airway.

Soft palate. This is the soft tissue behind the harder roof of your mouth. Excess floppy tissue here stops air flowing freely.

Nose. The nose is the more efficient way of breathing, and when dysfunctional, mouth breathing ensues and heightens the risk of snoring. Breathing through a partially blocked nose can also create whistling and popping sounds, or even cause suction that collapses your airway.

Knowing your obstruction is the starting point in identifying what causes your snoring.

If you are lucky, there is one cause for your snoring. You can tackle this and sleep quietly. More often than not, multiple factors accumulate to cause your obstruction.

Q. What causes airway obstruction?

A. Many different factors can influence snoring

Understanding what causes your airway obstruction is vital for matching snoring solutions to you. This is what we strive to help with at SnoreLab.

The reasons for snoring are made of lifestyle factors that you can control PLUS physical traits that are beyond your influence.

Factors that you CAN control

Many lifestyle factors need scrutinising if you want to identify the causes of your snoring:

Bodyweight. The heavier you are, the more likely you are to snore as excess weight compresses your airway.

Sleeping position. Sleeping on your back is a big risk factor for snoring. This position allows gravity to compress your airway more than when you sleep on your side.

Allergies. Allergic reactions cause nasal blockage and airway inflammation. Allergy sufferers have trouble breathing through their nose and therefore have to switch to noisier mouth-breathing.

Alcohol. Depressant drugs like alcohol make muscles relax. Relaxed airway muscles are more prone to disrupting airflow.

Smoking. Cigarette smoke irritates the airways, causing inflammation which can lead to obstruction.

Common cold. Similar to allergies, colds mean stuffy noses and mouth-breathing.

Medication. Certain drugs used to control blood pressure, sleeping pills and even some medicated nasal sprays can increase nasal congestion and relax airway muscles.

Factors that you CAN’T control

Unfortunately, in some cases, the obstruction is simply a part of your anatomy and genes.

Certain face shapes predispose people to snoring. For example, those with a pronounced overbite have a recessed jaw which pushes the tongue further back into the airway, making it more prone to falling back and causing a blockage.

Age. Older people are more at risk of snoring. This is because as we age we lose muscle tone in much of our body – this includes the muscles of the airway.

Sex. Men are more likely to snore than women. This is due to several reasons including how fat is differently distributed, contrasts in male and female airway anatomy and hormones.

Hormonal balance. Some hormones are protective against snoring, whereas others confer heightened risk. Menopause is a time in many women’s lives where snoring starts for the first time. This is because of a decrease in hormones that help to prevent snoring.

Thankfully, these uncontrollable elements are usually associated with heightened risk but not a direct cause.

Conclusion

By understanding the basis of snoring you can gain better insight into what makes you snore. Just as snoring impacts upon your life, your lifestyle impacts upon your snoring.

There are many snoring remedies and solutions available, including products that enthusiastically tell you that this will stop you snoring. Many of them do work very effectively, but only if they are well matched to you and your snoring.

Understanding how your snoring works and finding your specific causes is the first step towards healthier, quieter nights.

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].

Why Good Sleep is Important

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Science, Sleep

Why Good Sleep is Important

The partner of a chronic snorer loses over an hour of sleep every night [1]. Good sleep can be hard to come by for all parties in a bedroom polluted with snoring, particularly if snoring transitions to sleep apnea.

But why does this matter?

Sleep can seem like a real waste of one third of your life; time spent doing apparently nothing when there’s so much else you could be doing. A lack of sleep however, spells a shortened life and one where your waking hours are severely blunted.

By staying awake and spurning sleep, more time is lost than is gained. We must accept that sleep is vital for health and survival.

Good sleep is healthy

Sleep seems to be a pretty inactive period. On the surface, our sincere lack of movement or responsiveness would indicate that our body is dormant. This isn’t so. It’s very active, just in a different way. During sleep, our bodies and brains are busily repairing, refreshing and rewiring.

If sleep were a miracle drug, everyone would pay a fortune for it as the list of benefits are nothing short of astounding. Sleep:

  • Reduces your risk of chronic physical, neurological and mental disorders
  • Enhances your defenses to infection
  • Diminishes food cravings helping to regulate weight
  • Forms new memories

Good sleep can even make you look better. Cortisol – a stress hormone – increases when we lose sleep and in turn decreases the production of collagen, a protein that gives your skin smoothness.

A study in Sweden asked volunteers to rate the attractiveness of people who had 8 hours sleep against those who had experienced 31 hours sleep deprivation. The sleep deprived people were perceived as less healthy and less attractive [2].

Bad sleep is damaging

The inverse of the advantages of good sleep is the damage that can be done with sleep deprivation. Indeed, multiple studies have shown that getting less than six hours of sleep per night significantly increases the likelihood of an early death [3].

In the short-term, the mental impairment from moderate sleep deprivation equates to the effects mild alcohol intoxication [4]. Extreme sleep deprivation has even been shown to cause hallucinations.

Over a longer period, chronic sleep debt can do irreversible damage to the brain and rest of the body. Importantly, this increases the likelihood of a host of maladies:

  • Stroke
  • Anxiety and depression
  • Dementia
  • Weight gain
  • Heart disease
  • Reduced immunity
  • Cancer

Conclusion

Poor sleep is the underdog of public health. Problems like obesity, cancer and dementia are far more prominent in the public consciousness than problematic sleep is. If you consider that bad sleep has a hand in all of these conditions, you’ll appreciate the importance of getting a good night [5].

If snoring is having an impact upon the sleep quality of you or your partner, these nighttime noises definitely need addressing.

Sleeping Position and Snoring

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Causes

Sleeping Position and Snoring

Sleeping on your back makes you more likely to snore or experience sleep apnea.

Side sleeping is the best sleep position for snoring. This is because side sleeping reduces the compression of your airways.

Back-sleepers can try a variety of techniques to prompt themselves to sleep in healthier, quieter positions …

How to improve your sleeping position

If you find yourself sleeping on your back and snoring, it’s time for some “positional therapy”. Simply put: try sleeping on your side!

Making this basic change, without the need for any invasive techniques, complicated devices or significant expenditure could have a huge impact on your snoring or sleep apnea.

Side note: a history of side-sleeping

It has long been known that side-sleeping prevents snoring. Soldiers in the American War of Independence and in the First World War were advised to wear their rucksacks filled with bulky things whilst they slept. This was to stop them rolling onto their backs and snoring, giving their position away to the enemy [1].

Your sleeping position is an ingrained habit, so can be hard to change. That said, there are techniques that can make a huge difference.

You can try to change your sleeping position with hacks you engineer at home, specially designed pillows or even vibrating training devices that tell your subconscious mind that it’s time to turn over.

1. Homemade hacks

Before you buy something to help you sleep on your side, give some of these free tactics a go:

  • Tennis ball therapy. Tape one or sew a pocket for one to the back of your pajamas to make sleeping on your back difficult.
  • Inflatable pillow prop. Stuff a fully inflated camping pillow into an empty pillowcase. Lie on the empty portion of the pillowcase with your back resting on the inflated pillow. We learnt this trick from SnoreLab user Michael …

“I use a small inflatable camping pillow, about half the size of my normal pillow. I blow it up to just short of its maximum so it is very firm and difficult to roll on to and push this inside a normal pillow case all the way to the end which leaves a tail. Sleeping on this tail stops the camping pillow from rolling away whilst propping me up and stopping me from rolling onto my side. If I want to get onto my back it’s quite a struggle and doesn’t happen by accident.”

  • Bed head elevation. For stubborn back sleepers – slot some books underneath the head end of your bed to create the couple of degrees of elevation that could make a real difference.

 

SnoreLab’s full article on homemade hacks to improve your sleeping position

Read

2. Specially designed pillows

Some pillows are designed to keep you in more favourable positions to stop your snoring:

  • Wedge pillow. For the stubborn back sleeper who simply can’t sleep on their side; wedge pillows elevate your head which lessens the effect of weight on your airway. Check out SnoreLab’s recommended memory foam wedge pillow.
  • Neck realignment pillow. If you find side-sleeping uncomfortable on your neck and back, try one of these. SnoreLab’s approved pillow has adjustable height and aligns your airway to reduce the chance of snoring.
  • Pillows to promote side sleeping. Some pillows make it difficult to sleep on your back either with ergonomically designed ridges or with arm holes to stop you turning in your sleep.

“I was recommended a wedge pillow to elevate my head. I saw on the app that this could let me still sleep on my back but in a more elevated position so I was drawn to this idea. I found the position comfortable as I could go back to my preferred sleeping position. It’s also quite firm so my head was nicely elevated which gave me instant success.” – Fiona, SnoreLab user.

 

SnoreLab’s full article on specialist anti-snoring pillows

Read

3. Vibrating training devices

These are devices that attach to your body and vibrate when they detect that you are sleeping on your back – the automated equivalent of a nudge in the ribs from your sleep-deprived bed partner.

The subtle vibration creates a subconscious prompt for you to roll onto your side. Evidence for their effectiveness is growing, with tests showing positive results for mild obstructive sleep apnea comparable to using a mouthpiece [2].

“The efficacy of sleep position training therapy was maintained over 12 months and was comparable to that of oral appliance therapy in patients with mild to moderate positional OSA.” [2]

The Snooor wearable trainer is a small and discreet device that sticks to your head or chest. We believe it has the potential to be one of the most effective snoring remedies available:

  • Non-invasive. Simply stick it to your forehead or breastbone. You’ll soon forget it’s there.
  • Easy to use. Simply press the button to turn on and then start feeling the vibrations after 20 minutes.
  • Lightweight and discrete. Measures only 40mm x 40mm.
  • Affordable. Unlike other positional trainers, the Snooor wearable doesn’t require a prescription and is far cheaper than alternatives.

Save 10% with code:

SNORELAB

The science bit – why does sleeping on your back worsen snoring?

When you sleep on your back, your mouth has a tendency to fall open. This changes the shape of your upper airway.

The effect of gravity on your face, head and neck starts to compress your airway; this is particularly poignant if you are overweight due to the excess fat on the neck.

Researchers have measured these altered airway dimensions meticulously: using MRI, radiography and infra-red analysis of the upper airway [3][4]. They found that when you sleep on your back:

  • Your jaw recedes, compressing the upper airway
  • Your tongue falls back
  • There is more oval shape of the upper airway

All of these factors combine to compress the airway, disturb airflow and cause vibration – i.e. snoring. In the worst-case scenario, they cause complete blockage and sleep apnea.

Sleep-breathing problems are often related to an unhealthy sleeping position. More than half of all obstructive sleep apnea cases are referred to as “position-induced” sleep apnea [5], where the severity of the condition is massively reduced when switching to side-sleeping.

Conclusion

If you think your sleeping position is influencing your snoring, it may be time to consider positional therapy to start to sleeping in quieter, healthier positions.

Of course, there are many people who sleep on their side and still snore. Snoring has many causes so it’s important to explore them all.

Remember to check out our guide to specialist snoring pillows and clever hacks to help you sleep on your side.

CPAP: A Guide to the Different Types of Mask

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Sleep Apnea, Solutions

CPAP: A Guide to the Different Types of Mask

If you’ve been recommended CPAP to treat your snoring and sleep apnea, you might have a few questions:

What is CPAP?

CPAP stands for “continuous positive airway pressure”. A CPAP device uses a mask to force air into your nose or mouth to keep your airway open. It is very effective in treating sleep apnea, a condition where the airway repeatedly closes during sleep.

Contrary to popular belief, CPAP does not give you more oxygen, it simply establishes a current of normal air that props open your upper airway to prevent it from collapsing.

Normal breathing works via negative pressure, where expansion of the chest creates low pressure that then acts like a vacuum to suck in air. Conversely, by using CPAP, the constant flow of air creates high, positive pressure that forces outwards and pushes the airways open.

What makes a CPAP device?

There are three main components to any CPAP machine:

  • Flow generator
  • Hose
  • Mask

The generator pushes air through the hose, to the mask and into your airways.

Whilst the generator and tube are much the same (with some subtle variations and features unique to each product such as humidifiers), the mask is the part that varies the most. When being fitted for a CPAP device, it is important to consider the type of mask that is best for you.

The importance of a correct fit

Compliance is a big problem when it comes to CPAP treatment, with many users giving up after only a few nights. So whilst CPAP can be very effective in treating snoring and sleep apnea, it is only useful when it is actually being worn.

There are many reasons that make people stop their CPAP treatment, but most complain of discomfort. One study found that over a period of three years, 91% of users had abandoned their CPAP treatment [1].

Therefore, getting the right mask for you is vital to ensure you get the most out of CPAP.

 

SnoreLab’s guide to troubleshooting problems with your CPAP device.

Read

Nasal masks

This mask is dome shaped and forms a seal around the nose. Shapes vary so there are many options to suit different face shapes. Because air is not being introduced directly into the nose, the airflow feels a bit more natural. This also allows for higher pressures to be used, ideal for people with severe sleep apnea.

However, as the name suggests, nasal masks only work through the nose. Nasal masks are not effective if you breathe through your mouth whilst you sleep. Many devices address this by coming with a chin strap to prevent your mouth falling open. This option is therefore not suitable for people who suffer from allergies or have chronic sinusitis.

Air leakage is a potential problem with nasal masks; the seal formed by the padding can be compromised if you have facial hair. Some users also complain of discomfort from the straps on the head or pressure on the bridge of the nose. You can often mitigate this with proper fit and adjustment.

Nasal mask pros

  • Many different shapes for optimal fit
  • Higher pressures possible, therefore suitable for severe sleep apnea
  • Less claustrophobic than full face masks

Nasal mask cons

  • Potential air leakage with facial hair
  • Difficult to wear before bed or with glasses on
  • Not suitable for mouth breathers and people with nasal congestion

Nasal cushions

Also known as a nasal pillow, this type of mask rests on your top lip and uses two cushioned prongs that fit directly into your nostrils. This is the smallest and most simple of all CPAP masks so is popular with people who find other masks claustrophobic and uncomfortable.

Nasal cushions are less cumbersome than alternatives and cover less of your face. This is ideal if you want to wear the mask for some time before bed. With its slimmer design, you needn’t alter your nightly routine where other masks would be in your field of vision and prevent you from wearing glasses.

Nasal cushions are also beneficial for those who have more facial hair, as the seal is only formed on the nostrils.

Because the air is forced directly into your nose, high pressures can be uncomfortable. This means nasal cushion masks are less appropriate for people with severe sleep apnea. The direct airflow can cause nasal dryness and discomfort.

Again, the device only works for nasal breathers. If you have a tendency to breathe through your mouth when asleep but can still breathe properly through your nose, nasal pillows can still be effective when used with a device that holds your mouth closed.

Nasal cushion pros

  • Less claustrophobic
  • Can be worn comfortably whilst awake
  • Less prone to air leakage
  • Suitable for people with facial hair

Nasal cushion cons

  • High pressures can be uncomfortable, therefore is less suitable for severe sleep apnea
  • Can cause nasal dryness
  • Not suitable for mouth breathers

Full-face masks

These masks are larger, covering the nose and mouth, so are ideal for mouth breathers. If you have experienced discomfort with a chinstrap, or frequently have a blocked nose, full-face masks could be the answer.

Higher pressures are more tolerable with full-face masks as the air isn’t being sent directly into your airway. Being able to use high pressures makes this mask ideal for those with severe sleep apnea.

The added weight of a full-face mask means it has a tendency to loosen during the night, particularly if you are a restless sleeper. However, there are several straps that can be adjusted to get an optimum fit. This mask is ideal for people who sleep on their back.

Due to the increased area in contact with your face, there are more potential areas for air leakage, especially for those with facial hair. Leakage that occurs out of the top of the mask can sometimes dry out and irritate your eyes.

The bulk of a full-face mask makes it difficult to wear before you sleep as it interrupts your field of vision and makes it difficult to wear glasses.

Full-face mask pros

  • Ideal for mouth breathers
  • Suitable for people who sleep on their back
  • High pressures are tolerable, therefore is suitable for severe sleep apnea

Full-face mask cons

  • Potential air leakage
  • Bulky, so can move during the night
  • Difficult to wear whilst awake

How do I know which CPAP mask is right for me?

How a CPAP mask feels is different for every individual. General comfort and feelings of claustrophobia are subjective and dependent on the materials, design and fit of the mask.

When in consultation about using CPAP, it is important tell your doctor about all aspects of your sleep and nightly routine to decide on the best mask for you. Remember to try different types and make sure you get an optimum fit with the adjustments available.

Use this table to decide which CPAP mask is best for you:

Body Clock: Sleep, Light and Melatonin

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Science, Sleep

Body Clock: Sleep, Light and Melatonin

Have you ever wondered why you feel sleepy at night and awake in the day? This daily fluctuation is your natural body clock working correctly. Humans are naturally diurnal, meaning that we are meant to be active whilst it’s light, and should go to sleep when it’s dark.

Eyes and the brain

Our eyes don’t work very well in the dark, so it makes sense that we use this time to sleep and recover. Our feelings of sleepiness or wakefulness are dictated by light and what it does to our brains.

When light hits the back of our eyes, a cascade of information zips through the brain, telling a small gland deep in its center to stop the release of an important hormone, melatonin. When light diminishes at night the brakes are taken off. This hormone, sometimes nicknamed “the vampire hormone”, is now released in abundance and sets up our bodies for sleep. Melatonin lowers our blood pressure and body temperature, telling us that now is the time to go to bed [1][2].

Synchronization

Unfortunately, our internal body clock isn’t perfectly matched to the celestial clock of the Earth. Whilst the Earth does a full rotation in twenty-four hours, our body clock exceeds this by about fifteen minutes. Left to its own devices, our brains would switch between nocturnal and diurnal every month [2].

Light and melatonin brings our rhythm back in line with the day/night cycle of our planet. Artificial light can also influence melatonin release which is why SnoreLab uses darker colors.

Jet lag

Now consider long-haul flights, something that nature and evolution didn’t take into consideration. When we travel to a different time-zone, despite changing the clocks on our watches and phones, our body clock takes a bit more time to reset.

With the different patterns of light in far-flung destinations we can slowly coax our clock into synchronizing with our location. In the meantime, we have to put up with the uniquely miserable phenomenon of jet lag.

Let’s imagine we’ve travelled east, it’s 11pm local time but our body is convinced it’s only 4pm. We are not ready for sleep just yet but we try to force the issue, eventually falling asleep at 2am local time. Time to wake up at 7am for an important meeting, but internally, it’s midnight – time to sleep. But now we’ve got to get up and face the day perpetually in a state of groggy under-functionality.

Every day we are in this new environment, the new light pattern we are exposed to brings our rhythm back in line by about an hour. It will therefore take roughly seven days to fully get over this seven-hour difference [3].

Age

Jet lag isn’t the only shift in our internal cycle. Melatonin’s daily pattern changes throughout life. During adolescence, its release is delayed to later in the night which is why teenagers go to sleep and wake later. As we age, melatonin production diminishes, meaning we wake up earlier and generally sleep less [2].

Conclusion

Light, or lack thereof, is vital for good sleep hygiene, and good sleep hygiene keeps exhaustion and snoring at bay. When you set SnoreLab before bed, make sure it’s the last thing you do with your phone at night.

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