Snoring - Causes, symptoms and treatment. MF.

Snoring is a vibrating sound when breathing in a dream, which rarely disturbs the snoring, but can lead to insomnia surrounding.

Possible causes of snoring

The main mechanism of snoring is a change in breathing due to the appearance of an obstruction narrowing its lumen, or relaxing the walls of the pharynx. At the same time, air instead of passing directly into the lungs, twists and causes the soft tissues of the sky to oscillate and beat against each other. This creates a unique timbre and frequency of snoring. With further changes in the walls of the respiratory tract, the syndrome of obstructive sleep apnea( OSAS, periodic stops of breathing in sleep due to the overlap of the airways) develops.

The appearance of snoring is associated with a number of reasons.

1. Air flow obstruction can be created by:
• Nasal polyps
• Curved nasal septum
• Thornwald bag
• Edema of the nasal mucosa with rhinitis( runny nose), incl.allergic
• edema of the tongue or mucosa of the mouth and pharynx in case of allergic reaction

• hypertrophied tonsils( including adenoids)
• pharyngeal neoplasm
• anatomically narrow gullet lumen
• displacement of the lower jaw back
• underdevelopment of the upper or lower jaw
•increased tongue with acromegaly or Down's disease
• Adipose tissue deposition in the side walls of the pharynx with obesity

2. Relaxation of the pharyngeal muscles can be observed:
• under the influence of alcohol and drugs( muscle relaxants, tranquilizers, sleeping pills, narcotic analgesics);
• with hypothyroidism, when all the general tone of the muscles is reduced and the tissues become more friable;
• for neuromuscular diseases with impaired intake of nerve impulses from the brain responsible for muscle tone( myodastrophy, myasthenia gravis);
• In case of peripheral nerve injury( accidental or during an operation with a cut of the pharyngeal nerves);
• with damage to the brain and cranial nerves( cerebral edema, hydrocephalus, stroke, compression of the brainstem, hemorrhage into the trunk nuclei, and other diseases leading to depression and control of the pharyngeal muscles).As a rule, these are acute conditions that require immediate medical treatment. Snoring in this case is only one of the symptoms that goes into the background.

The variety of reasons for snoring and diseases in which it appears requires a compulsory and comprehensive examination.

Surveys and tests for snoring, why they are needed

When you snore requires complete diagnosis to identify the causes of this phenomenon and complications that can be dangerous. To this end, developed a certain algorithm for complex diagnosis of snoring.

1. Detailed conversation with the doctor-somnologist and examination to identify risk factors for breathing disorders in sleep and cardiovascular complications. Particular emphasis is placed on such conditions as the structure of the face, lower jaw, teeth, pharynx, curvature of the nasal septum, the presence of tonsillar hypertrophy, excess weight and concomitant diseases that can cause snoring.

2. Questionnaire to determine "sleepy" habits that affect snoring and assess the degree of drowsiness and the presence of other sleep disorders other than snoring.
3. Conducting functional tests with assessment of nasal breathing and extension of the lower jaw.
4. Sleep study to detect respiratory disturbances in sleep and assess their severity.

5. Conducting a complex of tests to assess risk factors for cardiovascular complications, the presence of hypothyroidism, diabetes mellitus or metabolic syndrome. These include the following tests:
• general blood test,
• blood sugar test,
• glycated hemoglobin,
• biochemical blood test for total protein, urea, creatinine,
• blood test for thyroid hormones( TSH, T4 free, AT-TPO);
• lipid spectrum of blood( total cholesterol, high-density lipoprotein( HDL), low-density lipoprotein( LDL), triglycerides, atherogenicity index);
• Urinalysis: Reberg's test, urinalysis for albumin.

6. Consultations of related specialists to clarify the reasons for snoring and its complications( otorhinolaryngologist, dentist-orthodontist, endocrinologist, nutritionist, cardiologist, neurologist and pulmonologist).

Snoring treatment

Based on the survey information received, the most appropriate method of treating snoring is selected. As a rule, it depends on a number of factors:

• what is the cause or cause of snoring,
• which one is more significant in developing snoring,
• what causes can be eliminated and which are not,
• degree of changes in respiratory depression in sleep,
• presence of irreversible snoring complications,
• what is the conditionhealth in general, whether there are concomitant diseases.

How to get rid of snoring at home

General prophylactic methods are aimed at eliminating those factors that lead to snoring and can be eliminated - bad habits, drug effects, air dryness, allergen action, obesity, weakness of the nose valves, body position during sleep.

• Failure or restriction of smoking 2-3 hours before bedtime. This will reduce inflammation, swelling of the mucous, reducing snoring. The same measure applies to alcohol. By giving up alcohol before going to sleep, you will reduce the relaxation of the muscles and the likelihood of snoring.
• Replace or discard drugs that relax the muscles( sleeping pills, muscle relaxants, tranquilizers, sedatives, narcotic analgesics).
• Use humidifiers or climate systems. This will improve the condition of mucous membranes and breathing in sleep.
• Remove from the bedroom all possible allergens( woolen things, including carpets, blankets, flowering and smelling plants, pets, old pillows and mattresses).
• Reduce weight, at least 10% of the initial body weight, if you have extra pounds. The breathing situation will improve by half.
• Use extension strips on the nose during sleep. So you expand your nostrils, and they will not stick together.
• If snoring occurs when you sleep on your back, lie on your side on orthopedic pillows with rollers or place a tennis ball under your back. This will not let you fall asleep on your back.

Intraoral device( s)

The aim of the method is to move the lower jaw forward during sleep and fix in this position. This widens the antero-posterior size of the pharynx, not allowing the walls to touch each other. A very convenient method, especially for travel.

Surgical methods for treating snoring

More often associated with the removal of obstructions in the air path during breathing. These can be interventions on the nasal septum( nose plastic), the sky( removal of the palatine, implant in the soft palate, uvulopalatoplasty, widening of the pharyngeal lumen), removal of enlarged tonsils or polyps. Surgical methods differ in the type of intervention: classical( using a scalpel), radio frequency, laser, chemical, combined. All these approaches have pros and cons. Especially it is necessary to distinguish laser operations. They have a greater risk of complications for people with snoring in the background of the syndrome of obstructive sleep apnea.

PAP-therapy for the treatment of snoring

Other names for this method of treatment of snoring: PAP-therapy, PAP, PAP, treatment of PAP.This shortening from the first letters of the Latin name PositiveAirwayPressure is a positive pressure in the airways that reflects the essence of the treatment. At the moment of breathing in a dream, the device as a compressor supplies air under pressure, which spreads the pharyngeal walls, preventing them from converging. The main indication for this method of treatment is apnea, which is often combined with snoring. However, considering the general nature of these disorders, snoring is also eliminated. There are several types of PAP-therapies:

• CIPAP( or CPAP) from the ContinuousPositiveAirwayPressure, which means a constant positive airway pressure. The device always blows on one level.
• autoCAP( autoCPAP).The principle of operation is the same, only the device adjusts for inhaling and exhaling the patient.
• BIPAP( BiPAP, or BiLevel) is a two-level PAP device mode. In this case, fixed values ​​of air pressure on the breath and on the exhalation are given.
• autoBiPAP - automatic two-level PAP mode.
• TriLevel - a three-level mode of operation, when additional support at the end of the exhalation is added to the autoBiPAP.

The PAP-therapy regimen is chosen by a physician-somnologist on the basis of the research data and the clinical picture. Selection can take several days.

PAP therapy for snoring

The choice of treatment is based on the severity of snoring and apnea, as well as on the combination of the causes of the appearance of sounds in a dream.

1. If snoring is just a sound that is not complicated by stopping breathing in a dream, then all of the indicated methods of treatment will do.
2. In the case of a combination of snoring with obstructive apnea of ​​any severity( with an index of stops of breath at an hour of more than 5), surgical interventions in the soft palate( for example, removal of the palatine tongue) are excluded.
3. Snoring and respiratory arrest of mild to moderate severity can be treated with general prophylactic measures and intraoral devices( cap).
4. Snoring and obstructive sleep apnea syndrome of moderate and severe degree require PAP therapy to spread the airway walls when they are closed. Perhaps a combination with kapami.

The presence of daytime sleepiness, overweight, hypertension, diabetes, IHD and hypothyroidism requires a more careful approach to treatment and often a combination of several treatments. Complex treatment is also necessary for several reasons for snoring, since each of them can have independent significance in the formation of sound. For example, the combination of a curved nasal septum and obesity. If you apply only nose plastic, excess weight will remain and will cause snoring. Therefore it is important to treat snoring under the supervision of a doctor-somnologist.

Than snoring is dangerous

Snoring itself is not dangerous, it's just a sound, albeit unpleasant. It is dangerous what he says. This can be an acute situation( as described above), requiring the intervention of a physician( such as a stroke).Or the syndrome of obstructive sleep apnea, which develops in every third snoring and within 3-5 years ends with strokes, heart attacks, diabetes mellitus, arrhythmias or fatal outcome. Often snoring is the only sign that indicates this. Ignoring this problem can end sadly.

To which doctor to apply for snoring, and when it should be done

The earlier the treatment of snoring is started, the easier and faster it passes. This will protect you from irreversible complications, life-threatening.

There are no delay in cases when snoring is combined with increased weight, hypertension, increased insulin and sugar levels, pain in the heart, awakening at night for urination, morning headaches and daytime drowsiness. These are signs of pronounced disturbances of breathing in a dream. Urgently make a note to the doctor.

In order to cure snoring, you need to contact a doctor-somnologist. This is a specialist who has been trained in the field of sleep medicine. Unlike ordinary doctors, who also deal with the treatment of snoring, the somnologist sees the whole picture as a whole. This allows you to identify the main cause of snoring and cope with it quickly and effectively without harm to health.

It is this doctor that conducts sleep studies that determine the further treatment tactics. It is possible that the somnologist will refer you to an orthodontist, an ENT doctor or a nutritionist, but you will know for sure that this will help. You do not have to choose a method of treatment, experiencing each of them on yourself.

Elena Tsareva, doctor-somnologist,
Unison-Clinic,
www.clinic.unisongroup.en