Ever experienced sleepless nights next to a loud snorer? It's time to ask your snoring partner to get some help!
Snoring is a common problem, affecting about 15% of Singaporeans. If you've just been brushing it off as a nuisance, here's the deal - snoring may be symptomatic of a more serious health concern.
As an ENT specialist, I often see 2 types of patients in Singapore with snoring issues:
- The first group of patients snore on such a regular basis that it disturbs their bed partner’s sleep.
- The second group of patients experience snoring as a presentation of a more serious health condition called obstructive sleep apnea, where their breathing stops during sleep for short periods.
Up to 75% of people who snore have obstructive sleep apnea.
1. Why do you snore?
Snoring is caused by a partial blockage in your upper airway during sleep.
Your upper airway consists of the nose, mouth, throat and voice box. Any partial blockage in these areas will result in vibrations of the upper airway walls, which causes snoring.
2. What can you do about your snoring?
If you ONLY suffer from snoring and your Sleep Study is normal (covered below), you have primary snoring.
Primary snorers can be a real nuisance to their bed partners. Here's some effective measures to reduce snoring that I recommend to my patients:
- Lose weight, if you are overweight or obese
- Sleep on your side – this prevents your soft palate and back of the tongue from flopping back and blocking off your upper airway
- Get your blocked nose treated by medication or surgery
- Practice good sleep hygiene – a good night’s sleep helps to prevent snoring
Sleep hygiene deserves a whole article on its own, but some handy tips I teach my patients are:
- Avoid caffeine at least 6 hours before sleeping (eg. coffee or tea)
- Avoid exercise in the late evening or night - this releases more endorphins which keeps you up
- Reduce your alcohol intake before sleeping – too much alcohol before sleeping relaxes your upper airway muscles, and makes it more likely for your upper airway to close off during sleep
3. You've tried all of that, didn't work. What else can the doctor do for your snoring?
For patients whose main problem is a floppy soft palate, I can perform an office-based procedure to stiffen the soft palate (radiofrequency or coblation of the soft palate).
For those with very large tonsils, removal of the tonsils will help create more space in the upper airway, and may reduce snoring.
As mentioned earlier, many patients who come to see me with bad snoring problems, really have obstructive sleep apnea.
4. What is obstructive sleep apnea (OSA)?
Obstructive sleep apnea is a condition where you stop breathing (or “choke”) during your sleep for a short period of time. These “choking episodes” can occur many times throughout the night without you realizing it.
Common symptoms of sleep apnea include:
- Excessive daytime sleepiness
- Witnessed choking or gasping episodes by your bed partner
- Difficulty waking up in the morning
- Morning headache
- Poor concentration during the day
- Need to urinate frequently at night
- Mouth breathing
5. What causes obstructive sleep apnea?
Obstructive sleep apnea occurs due to a partial or complete blockage of your upper airway during sleep. This blockage can occur at any part of the upper airway.
Common causes of blockage include:
- In your nose – Obstruction due to enlarged inferior turbinates (due to a sensitive nose), sinusitis, nasal polyps or enlarged adenoids
- In the mouth/throat – Obstruction due to having a big tongue at the back of your throat, or having a long and floppy soft palate
- Small chin – If you have a small chin, your tongue may be pushed backwards, which results in a smaller upper airway
- Overweight/obesity – If you are overweight or obese, your airway is likely to be narrower due to more fat and soft tissues in your neck
6. Why should you bother about obstructive sleep apnea?
Moderate to severe sleep apnea has been shown to cause the following health problems:
- Heart issues - higher risk of high blood pressure, irregular heart beats and sudden cardiac death, as well as a strong association with heart attacks
- Brain problems - poorer concentration and memory with a higher risk of being involved in road traffic accidents, and an increased risk of stroke
- Hormonal system dysfunction - greater risk of diabetes
- Dental issues - malaligned teeth due to mouth breathing
Sleep apnea is also known to cause behavioural and growth problems in children.
7. What should you do if you think that you've got obstructive sleep apnea?
In Singapore, ENT specialists most commonly manage snoring and sleep apnea problems.
When I see a patient with suspected obstructive sleep apnea, I'll take a clinical history and perform a complete physical examination to determine possible blockage sites in the upper airway.
To assess the upper airway, I often need to perform a nasoendoscopy which involves a small scope inserted through the nose, and down to the level of the voice box. This is a relatively painless procedure that's done in my clinic.
Sleep disorders are also sometimes jointly managed by other specialties, such as:
- Neurologists (brain specialists)
- Cardiologists (heart specialists)
- Respiratory physicians (lung specialists)
- Psychiatrists with an interest or training in Sleep Medicine
If you have other symptoms (eg. inability to sleep, falling asleep too quickly, sleep walking, abnormal body movements during sleep etc), I may refer you to one of these other specialists for further assessment and treatment.
8. How is obstructive sleep apnea diagnosed?
Obstructive sleep apnea can only be diagnosed with a Sleep Study. A full Sleep Study involves the placement of sensors on different parts of your body to monitor the following:
- Body activity during sleep (eg. brain, heart, lung and muscle activity)
- The quality of your sleep
- The amount and loudness of your snoring
- Whether you stop breathing during sleep
There are different types of Sleep Study (one example shown above), and I'll usually discuss the pros and cons of each Sleep Study with you to help you decide on which suits you best.
9. How is obstructive sleep apnea treated?
If your Sleep Study confirms that you have sleep apnea, your treatment options include:
- Lifestyle modifications
- Continuous Positive Airway Pressure (CPAP) therapy
- Dental devices
In most cases, a combination of lifestyle modifications and CPAP therapy are considered to be the gold standard treatment in the management of sleep apnea.
The exception is in children, where enlarged tonsils and adenoids are the most likely cause for sleep apnea, so surgery is usually recommended as the first line of treatment.
10. You are geeky
For those who love additional reading, here's some extra details for each of the treatment options that I offer my patients:
- Lose weight (if you are overweight or obese)
- Sleep in a side position (I tell my patients to tape a tennis ball at their back to ensure that they sleep in a sideways position)
CPAP therapy (Continuous Positive Airway Pressure)
This is the most ideal treatment for obstructive sleep apnea. In CPAP therapy, you'll wear a mask connected to a small machine.
This machine pumps air through the mask and into your upper airway during sleep. Hence, your airway will never collapse or close during sleep, ensuring that no choking episodes occur.
For those who are not able to accept or tolerate CPAP therapy, dental devices can be worn at night to pull your jaw and tongue forward during sleep.
Surgery This option is reserved for those who've failed a trial of CPAP therapy or dental devices. The type of surgery depends on where the blockage is in the upper airway.
Sometimes surgery may be offered to unblock the nose, and make CPAP therapy more comfortable and effective. The most common surgery for obstructive sleep apnea is a procedure to widen and stiffen your throat (UPPP, or uvulopalatopharyngoplasty).
So if you know that one person who snores loudly enough to bring the roof down, point him to this article. Help is at hand!
Dr Gan Eng Cern is an ENT Specialist at Mount Elizabeth Novena Specialist Centre (A Specialist Centre for Sinus, Snoring & ENT), and is also a Senior Clinical Lecturer at the National University of Singapore. He obtained Subspecialty training in Nose and Sinuses, and has a passion for the treatment of snoring and Obstructive Sleep Apnoea (OSA). Dr Eng Cern enjoys jogging regularly to keep his spare tires under control.