The Serious Side of Snoring
How to tell if your snoring is just an annoyance or a reason to see your doctor.
Feb 13th, 2023 •
Perhaps the only good thing you could say about snoring is that it’s not one-dimensional. You might remember the scene from “Jurassic Park” where the tyrannosaurus rex, a towering prehistoric leviathan, unwittingly gives away its presence to the main characters when its lumbering footsteps send small shock waves through a glass of water in their vehicle. It’s an incredible piece of cinematography, conveying the enormous scale of the creature by insinuation.
Now let’s take my sleeping mother, put that same glass a hundred yards away, and watch as her snores not only vibrate the water but shatter the glass. Her snores are something of a legend.
I come from a family of earth-shaking snorers, so snore-centric sleep health is near and dear to me. I think it’s important we take a thorough look at what snoring is, and why it might be a sign of certain body systems going off the rails.
Do We Take Snoring Seriously Enough?
Snoring is funny. I think it’s funny. Well, I used to.
We’ve been conditioned to think in such a way. Between cartoons, film, and comic strips, we find a loud and exaggerated snore comedic. However, off of the screen (or page), snoring can be an indicator of damaging lifestyle factors or life-threatening health problems like sleep apnea.
With 40% of men and 24% women snoring habitually, this is a widespread issue not to be taken lightly. Many who snore fail to realize these sounds can be a signal from the body screaming that something is wrong, or worse—a symptom of several potentially life-threatening disorders.
What is Snoring?
A snore is an involuntary hoarse snorting sound due to obstructed air movement while breathing during sleep. It is caused by vibration of the muscles and soft tissues in the back of the throat, the soft palate (roof of the mouth) and/or the uvula.
When these tissues are enlarged or relax too much and touch each other, the airway through the throat is obstructed and, as air tries to pass through, the soft tissues vibrate and this produces the snoring sound.
An estimated 45% of people snore at least occasionally, and 25% snore regularly. It is about twice as common in men as in women, and tends to increase with age.
Types of Snoring
Common or “conventional” snoring (i.e. not related to a sleep-disordered breathing problem like sleep apnea or upper airway resistance syndrome) may be annoying, but it is not in itself dangerous to the health. Chronic snoring, however, may lead to severe sleep problems and other possible complications, or it may be a symptom of other sleep disorders, such as sleep apnea, which may require direct treatment.
Conventional snoring is most common in the deepest part of non-REM sleep (stage 3), followed by lighter non-REM sleep (stage 2), and it tends not to occur at all during REM sleep, when breathing is usually at its shallowest. However, snoring resulting from sleep apnea mainly occurs during REM sleep, when the loss of muscle tone is most likely to compromise respiratory systems and cause apneas.
The noise level of snoring is typically around 60 dB (a similar level to loud talking), but it can rise to 80-90 dB (as loud as a pneumatic drill or a lawnmower) or, in extreme and rare cases, to over 110 dB (almost as loud as an airplane talking off). Any noise over around 85 dB for an extended period of time is considered potentially harmful.
Severe snoring can disturb the snorer’s own sleep (as well as that of their sleeping partner), even if it is not part of another disorder such as sleep apnea. It has also been associated with an increased risk of heart attack and stroke, decreased libido, marital problems, etc.
Related: How to Stop Snoring
Causes of Snoring
Even though a large percentage of the population snores, it isn’t because of one universal snoring trait. There are actually all kinds of common causes of snoring, from sleep apnea to sleep position to relaxed throat muscles. If you snore, here are some of possible reasons why:
- Muscles relaxing
- Enlarged tonsils
- Deviated septum
- Swollen turbinates
We’ll take a deeper look at each of these causes in the following sections.
1. Muscles Relaxing
Naturally, most of us breathe through our nose, only when we’re not getting enough air through the nasal passage, our mouth starts opening, and that’s when the snoring starts.
Snoring is due to a disruption of the upper airway, especially when your throats’ soft muscle relaxes. When we go to bed, the soft muscles behind our nose and throat will start relaxing. In the case of snoring, it has relaxed too much and has blocked the respiratory pathway, creating a resistance against air that is trying to squeeze through. Any air that is squeezing through will create some sort of vibration between the soft muscle tissues, resulting in snoring.
2. Enlarged Tonsils
Tonsils are clusters of lymphoid tissues, and they have a role of defending your body from germs and bacteria, preventing you from getting infections to other parts of the body. Tonsils are usually really good at what they’re doing, but unfortunately, in rare circumstances, viruses and bacteria may get into your tonsils, resulting in them swelling up when infected. Tonsils sit very closely to the back of your throat, so a swollen tonsil will actually create a little obstacle for air to pass through, causing you to snore louder than usual.
Adenoids are very similar to tonsils, except instead of them sitting at the back of your throat, they’re positioned more closely to the back of your nose, on the roof of your mouth. Adenoids are also a part of your immune system, they are responsible for producing white blood cells and antibodies to fight off germs, and it works together with your tonsils to prevent infections to your body. Although much rarer in adults, they can be infected and grow into a big and swollen mass of tissue, blocking your nasal passage, resulting in snoring.
4. Deviated Septum
Deviated septum is also known as a “crooked nasal passage”. The nasal airway is supposed to be clean and clear of obstruction for air to pass in and out without resistance.
If your doctor mentioned you have a deviated septum, think back to your childhood, have you ever been hit in the face by a football? Or accidentally bump yourself in the face? Any of these scenarios could result in you suffering with a deviated septum. In saying that, a deviated septum does not necessarily come from such unintentional events, things like birth defects, genetics, or a broken nose may also play a part in you having difficulty breathing on one side of the nostrils.
5. Swollen Turbinates
Turbinates are a series of shelf-like structures in your nasal cavity. They are responsible for creating turbulence (hence the name turbinates) when air is passing through.
Turbinates have two main functions:
- Trap dirt from the air you’re breathing in
- Slows down air that’s coming through so it’s warmed up to an appropriate temperature before sending the air down towards your lungs.
There are 3 of these bony and soft like tissue in each of your nostrils. In some people, their turbinates may be quite swollen due to allergies, and become overly enlarged, causing a resistance in the airway, and ultimately, snoring.
Alcohol helps relax our mind, not only that, it relaxes your muscles too, especially the ones at the back of the throat. Alcohol is a depressant, and there is a huge negative correlation between drinking and snoring, this is true even to those who claim they are normally non-snorers.
Alcohol may assist you in having a longer, uninterrupted sleep, while it can also create a lot more resistance in your airway due to the extra folding of the muscle, resulting in the extra effort required to breath during the night. Studies have shown that the likelihood of people who do not snore, is 4 times more likely to snore after consuming alcohol, while regular snorers has the elevated risk of 8 times more than they normally do.
If you have ever witnessed your parents’ snore, or your grandparents snore, chances are you will be part of the chorus. DNA plays a big part in snoring because of your muscle composition. A lot of physical attributes such as narrow nasal passage, narrow throat, large muscle mass, or enlarged adenoids or tonsils, could contribute to your snoring.
Obesity is the major cause of snoring. Overweight people are more susceptible to snoring due to their wider necks, and heavier fatty tissues surrounding their neck. The extra fatty tissues around the neck allow your airways to be compressed and condensed, resulting in the restriction of airflow.
The general rule of thumb is, if your neck’s circumference is more than 42cm (16.5 inches), chances are you are a snorer. Even if you’re not overweight in general, even carrying excess weight around the throat can cause snoring.
Related: Best Mattresses for Heavy People
More and more people these days are snoring, and some of the blame goes to lifestyle changes that contribute to underlying physical causes. In other words, millions of people are sedentary screen-heads with easy access to unhealthy food.
Can you think of a home without a TV? I certainly can’t. I’ve even come across houses where there’s more televisions than people living in it! If we’re not staring at our huge, super-bright TVs at all hours of the day, we’re glued to the smaller screens of our mobile devices. Fast food franchises are located on seemingly every corner, and you don’t even have to go there in person. Thanks to food delivery apps, a high-fat, ultra-processed meal is as close your smartphone. We see office workers sitting on the same chair for 8 hours a day, sometimes even more. When it’s quitting time, too many of them go home and trade the office chair for the couch and stream their evenings away.
Don’t get me wrong, I love technology, I love the convenience of getting a quick bite, but it is taking a toll on our bodies. Staying fit is crucial as poor muscle tone and a loss of muscle structure can definitely cause snoring.
Related: Sleep and Fitness
Unfortunately, aging is something that is inevitable. You may realize your partner’s snoring is getting worse and worse in your Golden Years. Snoring can start at any age, but we snore more as we get older due to our muscles become increasingly flaccid. As we get older, most of us put on weight, often gaining weight around the neck, so the “throat space” becomes much narrower.
For women in particular, the change may be seen soon after going through menopause. During the time when women are still able to bear children, snoring can be dangerous as it decreases the amount of oxygen intake to the fetus, the hormone progesterone is able to activate a defense mechanism to prevent mothers from snoring. Post menopause, the hormone level of changes, resulting in the loss of defense mechanism, and sometimes weight gain may be an occurrence.
Related: Sleep and Aging
Should I Be Concerned if I Snore?
I don’t want to go the WebMD route and convince you it means you’ll die of incurable brain cancer in a few weeks, but snoring can be a sign of some serious sleep disorders—namely sleep apnea.
At its most mild and intermittent, snoring may cause some fragmented sleep and irritation of the soft tissues along your airway. Not great, not terrible. Many people that snore suffer no devastating adverse effects and have no underlying disease or disorder, just possessing one or more of the risk factors above. Quitting smoking and losing weight might do it for them.
There are, however, a portion of serial snorers out there for whom the nightly roars serve as a sign of something much more serious than the fact that you might have a chubby neck.
Sleep apnea is a disorder characterized by momentary lapses in breathing occurring during sleep. Individuals with the disorder often find themselves waking up struggling for air after an episode of hypoxia, the body reacting violently to being starved of oxygen.
These respiratory pauses can either be mechanical (physical blockage of the airway due to extraordinary muscle relaxation or swelling) or chemical (a lack of signals from the brain telling the body to breathe) and occur anywhere between five to 100 times an hour.
The two are referred to as Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA), with the former the most common manifestation of the disorder. The combination of the two is known as Complex Sleep Apnea Syndrome or Treatment-Emergent Central Sleep Apnea.
The disorder is disconcertingly common. 3-7% of adult men and 2-5% of adult women have OSA severe enough to bring about daytime sleepiness. The true prevalence is like much higher, with the medical community believing sleep apnea is heavily under-reported.
Snoring vs. Sleep Apnea
In most cases, snoring is a precursor of sleep apnea. No snoring? Most likely you do not have sleep apnea.
Some people’s intensity of snoring may be very loud, but are not actually causing any harm or danger to their bodies at all (except when their partners poke them during the night).
As long the individual is breathing, and their lungs have constant access to sufficient amount of oxygen during the night, they are usually okay. We will eventually talk about how we know if there’s a lack of oxygen while sleeping.
As we explained before, snoring comes from a slight obstruction in the airway, sometimes, people snore too much and eventually their airways are fully obstructed. An “apnea” or sometimes spelled “apnoea” (depending on where you are in the world), by definition means one episode of “stop breathing.”
When a person stops breathing continuously for 10 seconds, this is counted as one “apnea”, the amount of times you have apnea episodes per hour determines how severe your level of sleep apnea is, we will discuss more on these later.
Symptoms of Sleep Apnea
Whether it’s a buildup of fluid in the neck or a genetic disorder like Polycystic Ovarian Syndrome, sleep apnea poses grave health risks to afflicted individuals—even though the symptoms don’t always seem obvious.
Loud and frequent snoring is the most common symptom in sleep apnea cases, but it’s not necessarily there 100% of the time. Nearly all sleep apnea patients snore, but few who snore have sleep apnea. Snoring without being affected by the disorder is known as “primary snoring.”
The second most visible symptom in cases of sleep apnea is waking during the night out of breath or gasping. This should be a pretty strong signal you need to speak with your doctor.
Other symptoms include fatigue and sleepiness, dry mouth upon waking, brain fog, sexual dysfunction, and poor sleep quality.
Not sure if you’re at risk for sleep apnea? You can start by taking this 1-2 minute sleep apnea questionnaire. Note: This is purely for informational purposes. Only a licensed doctor can provide a true medical diagnosis, but this can help you understand if you display some of the symptoms of sleep apnea.
You can also try an at-home or overnight sleep apnea test.
Complications of Sleep Apnea
But wait, it gets worse.
Undiagnosed or untreated sleep apnea can result in a laundry list of potentially life-threatening conditions including but not limited to:
- Cardiovascular disease
- Liver problems
- Metabolic disorders
- Kidney disease
- Behavioral disorders
- Disorders of the eye
- Complications during pregnancy
- Dangerous interactions with sedatives and painkillers
The mechanisms that connect sleep apnea with the above disorders are many and complex and should be discussed with a trained medical professional.
So if I Snore and Don’t Have Sleep Apnea, I’m Good?
Well, maybe not. Emergent research has suggested a relationship between the so-called “primary snoring” discussed previously and a thickening of the arterial walls in the carotid arteries.
These two arteries fork from the aorta and are responsible for delivering blood to the head and brain. Obviously, the restriction of blood to the brain is a very serious issue, and this sort of impediment in delivering oxygen to the brain has a strong relationship with increased risk of a stroke.
It’s important to note that in this study, subjects were chosen specifically that snored habitually but did not have sleep apnea. Despite being just primary snorers, these individuals showed much higher rates of carotid thickening than did non-snorers. Additionally, this type of carotid thickening was not present in others at risk for cardiovascular disease like smokers or those with high cholesterol.
While the link here might seem equal parts convincing and terrifying, the research has been met with conflicting studies that show no evidence of carotid dysfunction amongst primary snorers. The suggestion, perhaps, is that snoring is a symptom of other dysfunctions or detrimental lifestyle factors that would also contribute to cardiovascular disease, as opposed to the root cause.
Treatment Options for Snoring
It gets complicated here. Sleep apnea is more an umbrella term for disorders that cause repeated and complete obstruction of airways during sleep than a specific disorder with one single cause. Tonsils, tongues, and tracheal issues (among many others) could all be the culprit of your breathing obstruction.
Continuous Positive Airway Pressure (CPAP) machines are the most oft-prescribed solution for sufferers of sleep apnea. The machine pumps a pressurized stream of air into a mask secured onto sleeping users, forcing their airways to stay open during the night.
While there are other treatments available, some for the symptoms and some to fix the underlying disorder responsible for your sleep apnea, we’ll leave that to the doctors to discuss.
Try Not to Lose Sleep Over Snoring
It’s important to remember that most snoring is probably fairly inconsequential. Even if you’re a loud snorer, the chances of having a stroke or going into cardiac arrest during your sleep are minimal.
However, habitual snorers should probably see their primary care doctor if for no other reason than to give them peace of mind. As always, sleep disorders are never improved by stress and sleep loss, so it’s important to get to the root of the issue as opposed to letting it stew.
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