Q: I'm a 58-year-old woman and am embarrassed to admit that I have a snoring problem. It's troublesome enough that it keeps my husband awake at night. The snoring first started about 10 years ago. Could it be related to menopause? Or maybe some other medical problem?
A: When you sleep, the small muscles that keep the pharynx (the back of your throat) open relax. This allows tissue to flop into the airway, essentially narrowing the opening. When the airway narrows too much, it disrupts the airflow, making it turbulent. This causes the surrounding tissue to vibrate, producing the noise we know as snoring. The source of your snoring depends on where in your airway the narrowing occurs.
Women are more likely to snore more after menopause, but it is not because of hormonal changes. As we (and this includes men) age, most of us tend to gain weight and lose muscle tone. Decreased muscle tone in and around the throat and weight gain contribute to snoring.
If you have excessive daytime sleepiness along with loud snoring, your snoring may be more than a nuisance. The problem may be sleep apnea, or some other type of sleep-disordered breathing.
Sleep apnea affects approximately 18 million adults in the United States. In sleep apnea, the airway becomes blocked or breathing muscles stop moving. Breathing temporarily stops or becomes shallower hundreds of times each night. The clues that you may have sleep apnea include:
- Loud snoring four or more times per week
- Someone telling you that you periodically stop breathing or gasp during sleep
- Daytime drowsiness, such as dozing off during the day when you are not busy or active, or when you are driving or stopped at a light
- Morning headaches
- A large neck (collar size): 16 inches or more in women, 17 inches or more in men
- History of high blood pressure
People with untreated sleep apnea can have difficulty concentrating and are more likely to get into traffic accidents. Untreated sleep apnea can lead to an enlarged heart. If you suspect that you may have sleep apnea, talk with your doctor. The usual test to confirm the diagnosis is a special sleep study, called a polysomnogram. Lifestyle changes, a machine that helps keep the airway open (called CPAP), and, for some people, surgery can all help improve sleep apnea.
Unlike sleep apnea, there are no medical consequences from snoring. But it can be disruptive to a relationship and make sleeping away from home awkward.
For some people, snoring may be temporary. For example, a cold or allergies can swell the nasal passages. Being exposed to smoke and other fumes can cause some people to snore.
Other causes of snoring include:
- A particularly large uvula (the cone-shaped tissue that hangs down the back of your throat)
- A deviated septum
- Enlarged tonsils, adenoids (tissue near the tonsils), or tongue
- An elongated soft palate (this is the roof of your mouth)
- A very small jaw
- Poor muscle tone in the tissues around the upper airway
- Excess fat in the neck area, which may reduce the width of the air passage and promote snoring
There are some simple things you can try to dial down the decibels.
- If you sleep on your back, switch to your side. You might try sewing a tennis ball into the back of your pajamas to keep you from rolling onto your back.
- Limit alcohol use. Alcohol is a muscle relaxant, including the muscles around your throat. Sleeping pills sometimes have the same effect.
- If you are overweight, shedding a few pounds can help.
- Another option is a consultation with your dentist to discuss whether a type of mouth guard that repositions the jaw and the tongue might stop the snoring.
If none of these work for you, there are some surgical options. Correcting a deviated septum may help stop the snoring if the problem is vibration within the nose. Or you may have very large tonsils and adenoids that can be removed. Other procedures, which may not be covered by health insurance, include laser therapy or high frequency radio waves that shrink excessive tissue inside the throat.
Another possibility is palatal implantation, also called the Pillar procedure. The Pillar procedure is performed in the doctor's office. It takes about 15 minutes and requires only a local anesthetic. The doctor implants plastic stents that are less than an inch long into the soft palate. Over time, scar tissue forms around the implants. The tissues stiffen and there is less vibration even when the muscles in the throat relax during sleep. So far, the results of the procedure have been very good.
It may feel awkward to bring up snoring with your doctor, but you should. It's nothing to take lying down.
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