SNORING AND SLEEP DISORDERED BREATHING

 

What is snoring and sleep disordered breathing?

 

Snoring occurs when a part of the throat air passage has atendency to collapse and vibrate. When asleep, the muscles that constitute andsupport the walls of the throat and other throat structures are relaxed. Thisallows collapse and vibration of these structures when breathing in thuscausing snoring.  The main issueswhen assessing a patient with this problem are:

 

  1. Where (at what anatomical site) is the collapse/vibration occurring? This allows assessment as to candidacy for appropriate intervention/treatments.
  2. Is there obstructive sleep apnoea? The extreme end of the spectrum is apnoea-when the throat collapses completely during sleep. This causes interruption of breathing because the throat is “shut” (Apnoea). What happens as a result (at a simple level) is oxygen levels in the blood stream decrease, this causes a degree of arousal and the muscles of the throat tense up and the throat opens up, restoring normal breathing. A cycle of apnoea-arousal-resumption of breathing re-occurs throughout the night. In the long-term, obstructive sleep apnoea, untreated, can cause high blood pressure and put a strain on the heart. Also not to be under-estimated are the effects on permanent daytime tiredness on quality of life and the increased chance of accidents (e.g. driving) as a result.

 

What causes snoring and sleep disordered breathing?

 

  1. Weight. There is a well-proven and certain link between being over-weight and sleep disordered breathing. If you are over-weight, this is the first thing to try to address.
  2. Alcohol. Drinking alcohol regularly in the evening is going to promote snoring and sleep disordered breathing by relaxing the muscles of the throat excessively.
  3. Nasal obstruction. This occurs through a combination of mouth breathing (the jaw sinks back and narrows the throat) and breathing with more effort (more collapsibility as a result)
  4. Large tonsils. Narrow the throat airway.
  5. Other anatomical configurations, such as a long palate, large tongue, floppy uvula, narrow voice box inlet, weak lower jaw, narrow throat etc. This is assessed in clinic and can determine whether a given form of treatment is likely to be successful.

 

I snore-what can or should I do BEFORE consultation?

 

  1. Loose weight (if applicable)
  2. Do you think you might have sleep apnoea (see below). If so, seek early referral.
  3. Refrain from-drinking alcohol regularly in the evening.
  4. Simple measures, such as:
    1. Earplugs for your partner
    2. Avoid sleeping on your back
    3. Ascertain whether nasal blockabge seems to be causing the problem by trying nasal strips. You can also try a decongestant tablet or nasal spray-but these are NOT long-term measures (just try for a week to gauge effect)
  5. Consider trial of Mandibular Advancement Device/Splint (see below).
  6. Talk to your GP. Even if its just for referral, your GP needs to know, may be able to suggest other measures and it is prudent to make sure there are no other problems such as high blood pressure etc.

 

What happens at consultation?

 

1.    History is taken

2.    Basic examination of the mouth, throat, neck and nose

3.    Flexible naso-pharyngo-laryngoscopy. A tiny fibre-optic camerais used to examine the nose (more thoroughly), the back of throat and voicebox. This examination can help to ascertain which anatomical site(s), theproblems lies at and whether there is an option for surgical treatment.

4.    Discussion

 

Possible outcomes

 

  1. Reinforce basic measures, described above.
  2. Sleep study if sleep apnoea is a concern
  3. Mandibular advancement device recommended (if not tried already)
  4. A form of surgical treatment to palate/oropharynx (throat)-under local or general anaesthetic (see below)
  5. Address nasal blockage- with medicines (prescription sprays for rhinitis-chronic nasal congestion) and/or nasal surgery (usually minor).
 Do I have obstructive sleep apnoea?


 

Obstructive sleep apnoea is characterised by periods ofstopping breathing (apnoea) during sleep because the throat has collapsed. Itseffects are described above. The two things to look out for are: (1) witnessed(by partner usually) periods of apnoea regularly during sleep; (2) excessive daytimetiredness. The Epworth Sleepiness score is a questionnaire that gives anoverall score of daytime tiredness.

 

This link will allow you to calculate your Epworth Score:

http://www.patient.co.uk/showdoc/40002436/

 

If there is a suggestion of obstructive sleep apnoea, then Irecommend an overnight sleep test.

 

There is a continous spectrum between simple snoring andobstructive sleep apnoea. For example, many patients with problems snoring alsohave a degree of daytime tiredness without actually having OSA.

 

 

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