ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, April 30, 1996 TAG: 9604300050
SECTION: EXTRA PAGE: 1 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Snoring is no joke, certainly not to the snorer's sleepless companion and often not to the snorer, either.
Roommates have moved out of snorers' bedrooms, spouses have filed for divorce and at least one man - a notorious gunfighter named John Wesley Hardin - committed murder when he could no longer take the incessant noise.
Snorers, too, are often unhappy about their plight, complaining of bruised ribs inflicted by bed mates, disturbed or lonely nights and a refusal of friends and relatives to travel or visit with them overnight.
As one sage put it, ``Laugh and the world laughs with you; snore and you sleep alone.''
The number and variety of snoring solutions concocted through the years - patent applications have been filed for hundreds of devices - speak to the commonness of the problem and the discord it causes.
But except for the time-honored poke to prompt the snorer to turn from back to side, until recently few of the remedies had any biological basis and some that blocked breathing through the mouth were downright dangerous.
Now, however, the marketplace is replete with more scientifically devised treatments that when properly applied can reduce, if not entirely eliminate, snoring in a large percentage of patients. They range from inexpensive gadgets available in drugstores to more costly custom-made mouthpieces to even-more-costly surgery.
But before going beyond the simplest of solutions it may be best to uncover the cause of the problem and, if possible, correct that directly. This effort may require the services of an otolaryngologist or a sleep specialist.
Who snores and why
Snoring occurs when muscles in the mouth, throat and neck relax and the loss of muscle tone allows the tissues in the throat to collapse, reducing the space through which air can flow. When you lie on your back, your tongue falls back toward the throat, further narrowing the airway. Each time you inhale, the air squeezing through the narrow passage causes surrounding tissues to vibrate. The result is a snore.
Nearly half of adults - more men than women - snore some of the time and 25 percent are habitual snorers. Sedentary people snore more than those who are physically fit. Because muscle tone declines with age, the likelihood of snoring rises as people get older. Overweight people, too, are more likely to snore because fatty tissue in the neck reduces their airways.
Dr. Derek S. Lipman, the author of ``Stop Your Husband From Snoring'' (Rodale Press, 1990), says the ``typical snorer is a large, heavily built man in his 40s or 50s who has gained weight and neglected regular exercise.''
Drinking alcohol (especially heavy drinking) or taking tranquilizers or sedating antihistamines shortly before bedtime can aggravate snoring by reducing muscle tone.
Anatomical factors that increase the risk of snoring include enlarged tonsils or adenoids (a common cause of snoring in children), an especially large tongue or soft palate and uvula (the U-shaped tissue that hangs from the roof of the mouth), a receding chin and a deviated nasal septum (the tissue separating the two sides of the nasal cavity). Snoring also may result from upper-respiratory infections, nasal polyps, nasal allergies or exposure to irritants that cause congestion or obstruct nasal breathing.
The most serious cause of snoring is obstructive sleep apnea - a brief, total obstruction of breathing during sleep that can recur hundreds of times a night, resulting in raucous snores and snorts each time breathing resumes. Obstructive sleep apnea can develop into a life-threatening condition. Anyone suspected of having this problem, particularly those who experience daytime sleepiness, should be examined by a sleep specialist without delay.
What can be done
Forget the chin and head straps, neck collars and electrical devices that shock the sleeper each time he or she snores. However, rib pokers might be spared the trouble of rousing a back sleeper if a tennis ball (half or whole) is sewn into a pocket between the shoulders of the pajama top. Elevating the head of the bed by about six inches or using a specially designed pillow that keeps the sleeper off his back may also help.
For the millions plagued by chronic nasal congestion, a simple Band-Aid-like nasal strip called Breathe Right is often helpful. A strip properly placed over the bridge of the nose lifts the nasal passages and increases airflow. Breathe Right strips are sold in pharmacies and sporting goods stores (they were first popularized by athletes) and were recently approved for marketing as a snoring treatment by the Food and Drug Administration. Note, however, that it may take a week of consecutive use for sleepers to relearn to breathe through their noses and close their mouths when asleep.
Various oral appliances have been designed to increase airflow by repositioning structures in the mouth. Most of the devices must be custom-molded by a dental specialist.
The American Sleep Disorders Association recently concluded that oral appliances are appropriate for use in patients with ``primary snoring'' (that is, snoring that is not accompanied by apnea, inadequate oxygenation of the blood or excessive daytime sleepiness), in patients with mild obstructive sleep apnea who are not helped by simple measures like weight loss or sleeping on the side, and in patients with more severe apnea who cannot tolerate treatment with a positive-pressure breathing device.
The association, in its journal Sleep, cautioned that oral appliances can sometimes aggravate temporomandibular joint disease or cause dental misalignment or discomfort.
Finally, there is surgery to remove enlarged tonsils or adenoids or nasal polyps. Surgery can also change the shape of the jaw or reduce the size of the soft palate and uvula. This latter procedure, uvulopalatopharyngoplasty, is comparable to a tonsillectomy. It tightens up flabby tissues to enlarge the air passages.
A new outpatient procedure - laser surgery to reduce the size of the soft palate and the uvula - is gaining in popularity. After applying a local anesthetic, the surgeon vaporizes the excess tissue with a laser beam. Two to five 30-minute sessions four to six weeks apart are usually needed to complete the procedure. The main side effect after each session is a weeklong sore throat. Before choosing laser surgery, check with your insurer; many companies consider laser surgery ``cosmetic'' and do not cover the costs.
Even medically proved snoring remedies may not eliminate the problem. But it is likely to become less frequent, more subdued and better tolerated by bed partners, who might then only need a pair of ear plugs, not a soundproof chamber, to get a good night's sleep.
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