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Sleep Health Q1 2022

Postural advice may help to improve snoring

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Professor Joerg Steier, FRCP, PhD

Professor of Respiratory and Sleep Medicine,
Guy’s & St Thomas’ NHS Foundation Trust, King’s College London

Snoring is a very common condition and can signal other sleep disorders such as sleep apnoea, but frequently it is harmless to the snorer.

Everyone has heard about snoring, either by being told that they are a snorer or by having witnessed snoring within the family, amongst friends or even from the neighbour’s flat. Snoring is extremely common, almost half of the middle-aged male subjects in the UK snore to some extent. In women, snoring is slightly less frequent, but can still be highly prevalent (e.g., during pregnancy or in the elderly).

Causes of snoring

When we fall asleep the muscles that keep our upper airway in shape while we are awake start to relax and the airway starts to narrow. Furthermore, posture is relevant in that lying flat on the back in bed makes gravity pull out the tongue backwards leading to a further narrowing of the airway. In this state the walls of the upper airway begin to flutter when we breathe. This flutter causes the sound that we recognise as snoring.

Factors that make it more likely that we snore include:

  • Posture – sleeping on the back is worse than sleeping on the side or on the front.
  • A large neck circumference – weight loss can significantly improve snoring.
  • Lifestyle with alcohol or smoking, which can cause more relaxed muscles while asleep and airway inflammation.
  • Age – soft tissue elasticity deteriorates with age.
  • A blocked nose causes us to breathe through the open mouth.
  • Other anatomical factors, such as enlarged tonsils, adenoids, polyps or general narrowing of the airway.

It is important to recognise that snoring may be cardinal sign for other conditions, such as obstructive sleep apnoea (OSA).

Impacts of snoring

Snoring can be relatively harmless in that it may not cause direct physical harm to the snorer. However, in densely populated urban areas loud snoring may easily cause social tension, often being one of the reasons why couples sleep in different bedrooms. Substantial snoring can also cause microtrauma of the upper airway walls, causing injury, inflammation and leading to some scarring and soft tissue thickening in the long term.

Furthermore, it is important to recognise that snoring may be cardinal sign for other conditions, such as obstructive sleep apnoea (OSA). OSA may be associated with daytime symptoms (like excessive sleepiness due to fragmented sleep) and with long-term cardiovascular risks. If snorers experience daytime symptoms or family members have observed laboured breathing or breath-holding at night then sleep apnoea should be ruled out by visiting your GP.

It is important to ask the question: Is it simply snoring or not? Both cases can be helped substantially.

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