It matters: positional snoring or sleep apnea?

Snoring spoils many people's nights. According to one study, 40–50% of the population snores (both men and women). However, it matters how severe the snoring is – while positional snorers only snore in certain body positions and there are several clever solutions to their problem, those suffering from sleep apnea can go without oxygen for long seconds due to their snoring, which can have serious consequences.

What is snoring?

During sleep – like other muscles – the muscles of the neck, the pharynx and the connective tissues relax. The in-and-out airflow sets the soft tissues of the upper airway (soft palate, uvula, tonsils, base of the tongue, and the back and side walls of the throat) into motion, and the rough, raspy sound produced by the vibration of these tissues is what we call snoring. Imagine the sound like when you stretch the opening of an inflated balloon and the air whistles out.

Snoring can be classified by loudness and frequency:

• Mild snoring occurs only occasionally, for example when you sleep on your back, are very tired, have overeaten or consumed alcohol.
• Moderate snoring occurs regardless of which position you lie in.
• Snoring is considered serious if it continues all night in any body position and is so loud that it can be heard in another room.
• Severe if the snoring that occurs independently of sleep position can be heard throughout the entire house.

What causes snoring?

There are several causes of snoring; the most common are:

• Obesity: If the BMI (Body Mass Index) is above 25, the excess fat not only accumulates under the skin but also "invades" the area between the pharyngeal muscles and pharyngeal mucosa; the double chin associated with overweight also narrows the airways.
• Poor muscle tone: Muscles and tissues relax most during the deepest sleep phases. When lying on your back, the tongue can fall back into the upper airway as its muscles relax, narrowing the airway opening and causing snoring.
  Muscle tone decreases with age: as you get older, tone declines. That is why snoring is more common and often louder in older age. (Poor muscle tone can also be connected to obesity: people who are overweight usually move less, which leads to weaker muscle tone.)
• Illnesses, infections: Inflammation of the nasal mucosa due to respiratory infection or allergies; deviated nasal septum and nasal polyps can also cause snoring.
• Anatomical traits: The size and tone of the soft palate and uvula, the base of the tongue, or the tonsils can all contribute to snoring. Some conditions that cause tongue enlargement (for example hypothyroidism or Down syndrome) also lead to snoring.
• Tranquilizers, alcohol, overeating: Each of these disrupts normal sleep rhythm because tissues relax earlier and more than they should.
• Smoking: Irritation from smoking increases swelling of the nasal, pharyngeal and laryngeal mucosa, which narrows the airway.

The unpleasant effects of snoring

Snoring does not only make your bed partner's night difficult. As a snorer you almost never sleep well, so you may experience:

• morning headaches
• memory problems
• difficulty concentrating
• daytime sleepiness
• dulled senses
• reduced libido
• mood swings

When it's less serious: positional snoring

Positional snorers only snore in certain body positions (usually when lying on their back); when they change position the disturbing sound stops. There are several clever devices that help them. These include a pillow that inflates or a wristwatch that delivers a small electrical "nudge" when snoring is detected. These devices do not stop the snoring itself but encourage the snorer to change position. After a few days of use, these devices usually no longer disturb sleep.

When snoring becomes dangerous: sleep apnea

"Apnea" is a word of Greek origin meaning "without breath".

From this you can infer how serious sleep apnea is. It is a condition characterized by loud snoring during sleep and long pauses in breathing between snores. Breathing pauses that approach one minute in duration mean insufficient oxygen reaches the body. Micro-arousals are common; the affected person usually does not notice them, but they prevent continuous rest and the brain's regeneration.

People with sleep apnea have an increased risk of

• high blood pressure,
• heart failure,
• heart attack, and
• stroke.

Sleep apnea affects 2–4% of the Hungarian population, meaning roughly 200,000–400,000 people in Hungary today suffer from this condition.

There are two different types of apnea:

• The most common is obstructive sleep apnea (OSA), also called upper airway apnea.
  In this case the soft palate muscles relax and obstruct the pharynx, making breathing difficult and noisy because the relaxed pharynx blocks the airflow. Breathing then stops intermittently, oxygen levels in the blood drop, the patient gasps for air and sleep is interrupted.
• The less common central sleep apnea (CSA) occurs when the pharynx remains open, but the chest muscles and diaphragm do not work because the brain does not send proper signals to the respiratory muscles (unlike obstructive apnea, where the diaphragm and chest muscles work harder).
  In this case the brain wakes the patient, so these micro-arousals are more conscious.

Snoring is a rather unpleasant problem that people often do not consult a doctor about. However, sleep apnea should not be underestimated, as it can sometimes lead to serious complications.

If you have regular, disturbingly loud snoring, be sure to consult a sleep specialist (sleep laboratory), because determining the cause and recommending specific treatments is the job of an experienced specialist. Effective solutions also exist for patients suffering from sleep apnea!