Every night millions of Britons are engaged — often obliviously — in a snoring chorus of rumbles, rasps and grunts while their suffering partners lie awake beside them. A recent study found many of us lose the equivalent of three weeks sleep every year because of our other halves' snoring.
Dr Ayham Al-Ayoubi says: "It's a widely under-reported problem that can have a significant impact on people's well-being and relationships," A recent study found many of us lose the equivalent of three weeks' sleep every year because of our other halves' snoring "I have seen two people who said they would have to cancel their engagement if their partners' snoring couldn't be fixed.
Dr Ayham Al-Ayoubi says: "In the majority of cases, simple lifestyle changes can have a big impact," Sometimes, however, the problem may require surgery.There are potential risks to the snorer's health, too, as certain types of snoring make you prone to high blood pressure, diabetes and even stroke. An estimated three million Britons snore regularly. The causes range from allergies to a late-night tipple and being overweight. Pinpointing the root of the problem is key to finding the right treatment. So how can you — or your long-suffering partner — work out what's behind your snoring?
Dr Ayham Al-Ayoubi reveals the different types of snoring, and how to tackle them.
Nasal Snorer- sounds like someone trying to do an impression of Darth Vader.
THE CAUSE: If your nasal passages are partially blocked, more air is forced through the mouth while you sleep. This extra pressure causes the soft and dangling tissue of the throat to collapse. When it's collapsed, the soft tissue vibrates as air rushes past it, emitting the characteristic snoring sound. A common cause is an allergy or sinus infection which causes inflammation and swelling of the lining tissues.
Deformities of the nose such as a deviated septum (where the wall of cartilage that separates one nostril from the other is crooked) or nasal polyps (fleshy, non-cancerous growths) can also cause obstruction and sleep problems.
TAKE THE TEST: Stand in front of a mirror, holding one nostril closed and breathe in. If the open nostril tends to collapse, try propping it open by holding the outer rim with the clean end of a matchstick. Now, with your mouth closed, try breathing in through your nose — if breathing is easier with the nostril propped open, you could be a nasal snorer.
Allergies can be seasonal, such as hay-fever. However, if your nose is blocked all year round, this suggests a structural problem with the nose rather than an allergy. Other symptoms to look for include a dry mouth, bad breath or headaches caused by dehydration.
Dr Ayham Al-Ayoubi explains : The saliva dries in the open mouth as the air rushes to the back of the throat. Without saliva, the bacteria that cause bad breath can flourish. "If you snore and you need to constantly sip a glass of water by your bedside through the night, some form of nasal obstruction could be to blame."
WHAT YOU CAN DO: Breathe Right nasal dilator strips— special plasters you put on the outside of the nose which stretch the nostrils open — can provide extra external support to improve airflow, explains Dr Ayham Al-Ayoubi. "In extreme cases we can perform surgery to insert small rods, or silver rings, which keep the airways open," he says. If you have a deviated septum, an operation to straighten it, known as a septoplasty, is also possible.
Dr Ayham Al-Ayoubi Adds: Polyps can be surgically removed with total resolution of the snoring. If you think allergies may be to blame, ask your GP for testing. "Using a mattress cover and man-made fibres for duvets and pillows can eliminate dust and house mites, a common cause of nasal congestion, and using nasal steroid sprays for a minimum of two months can help,".
Drinking alcohol just before bed can exacerbate the problem of tongue snoring by relaxing the muscles that support the tongue
SOUNDS LIKE: A high-pitched snore that comes in fits and starts, and stops when you roll on your side.
"The sound made by a tongue-based snorer is often higher pitched as it's more focused on the denser tongue muscle rather than the flappy palate," says Dr Ayham Al-Ayoubi. “It also tends to be in shorter bursts rather than the continuous flapping vibration of the soft tissue in the throat."
THE CAUSE: Roughly 30-50 per cent of snorers are tongue-based snorers,' says Dr Ayham Al-Ayoubi."Here, the tongue is in the wrong position, blocking the air flow through to the throat — perhaps as a result of a small lower jaw; or else the supporting muscles are too relaxed, allowing the tongue to fall back when you lie down, or you could simply have an overly-large tongue."
Drinking alcohol just before bed, sleeping pills and other medication such as antihistamines can exacerbate the problem by relaxing the muscles that support the tongue. Men in particular suffer from tongue-based snoring because they tend to put on weight around the neck, explains Dr Ayham Al-Ayoubi, and this can cause “a build-up of fatty tissue around the base of the tongue, constricting the airways".
TAKE THE TEST: Stick your tongue out as far as it will go and grip it between your teeth, says Dr Ayham Al-Ayoubi. Now try to make a snoring noise. If the snoring noise is reduced with your tongue in this forward position, then you are probably what is known as a "tongue-base snorer".
WHAT YOU CAN DO: If your tongue is falling too far back, a bespoke mandibular advancement device (MAD) has been shown to be effective in the majority of users, says Dr Ayham Al-Ayoubi.
This is in effect a plastic mouth guard that pulls the lower jaw and in turn, the tongue forward to open the airways. A low-tech solution to prevent the tongue falling into the back of the throat is sewing a tennis ball into the back of your pyjamas. “This simply prevents you sleeping on your back," he says.
Losing weight and avoiding night-caps and smoking (which irritates the throat and nasal linings) are also important.
Mouth snorer: Low-frequency rumbling, similar to nasal snoring
SOUNDS LIKE: Low-frequency rumbling, similar to nasal snoring. You snore whether on your side or back.
THE CAUSE: One of the most common causes of snoring is breathing through the mouth. This causes the soft tissues of the palate or the uvula (the dangling tissue in the back of the mouth) to bump against each other and vibrate, triggering the snore. This is known as “palatal" snoring.
TAKE THE TEST: Open your mouth and make a snoring noise, says Dr Ayham Al-Ayoubi. Now close your mouth and try to make the same noise. If you can only snore with your mouth open then you are a “mouth breather". You could also look at the soft tissue towards the back and top of the mouth. "There should be an open passageway for air to travel through — if the tonsils are clearly visible, or if the palate hangs down, this could well point towards mouth snoring — it's like a sheet flapping in the wind."
WHAT YOU CAN DO: Maintaining a healthy body mass index, limiting alcohol intake and stopping smoking can all help prevent palatal snoring by tightening the neck muscles and pulling up any soft tissue responsible for the noisy vibrations.
Dr Ayham Al-Ayoubi says "The surgical solution I advocate in this situation is pillar implants that support the palate," These plastic rods are inserted into the soft, floppy part of the palate in a 15-minute procedure.
A NICE study three years ago found 67 per cent of cases had a reduction of at least 50 per cent in their snoring compared with none in the placebo patients. Other surgical options include trimming the uvula using laser or electrical forceps, or radiowaves to scar and so stiffen the tissue in the palate.
SOUNDS LIKE: A crescendo of loud snoring followed by silence lasting from a few seconds up to 20, and then coughing, gasping or spluttering (your partner will describe it as if you are choking or gasping for air).
THE CAUSE: Obstructive sleep apnoea, which occurs as a result of narrowing of the airways. An estimated 4 per cent of men and 2 per cent of women are affected. During sleep, airway muscles relax too much and, as a result, tissue blocks the passage of air.
Partial blockage results in snoring, but in a total blockage — apnoea — the patient can stop breathing for up to 20 seconds at a time. When air is completely cut off, the brain sends an emergency signal, causing the airway muscles to contract. This reopens the airway, allowing the sufferer to take in a big gulp of air. The whole process is repeated, sometimes hundreds of times a night."In most cases, the sufferer has no recollection of the events, but will wake up feeling exhausted," says Ayham Al-Ayoubi, Ear, Nose and Throat surgeon at Barnet and Chase Farm Hospitals NHS Trust and North Middlesex University Hospital.Left untreated, sleep apnoea can increase the risk of high blood pressure, stroke and diabetes.
TAKE THE TEST: This is the same test as for mouth snoring, says Dr Ayham Al-Ayoubi, but the determining symptom of sleep apnoea is daytime exhaustion."Sufferers regularly find it impossible to stay awake while seated, especially driving, wake up feeling exhausted and often put on weight as they eat sugary snacks to temporarily boost concentration and energy levels," says Mr Al-Ayoubi.
WHAT YOU CAN DO: "One of the most effective therapies is continuous positive airway pressure (CPAP), a mask worn at night where air is pumped continuously to keep the airways open,"
Dr Ayham Al-Ayoubi "However, a large number of sufferers find a CPAP intrusive or invasive and many don't continue with it." Surgery to remove the excess floppy tissue can help, but less drastic measures include losing weight and eliminating other lifestyle factors such as drinking or smoking.
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