What causes snoring?
Snoring is the sound made by soft tissues vibrating when the airway in the nose, mouth and throat narrows during sleep. The structures that vibrate most are the soft palate, the uvula, the tonsils, the adenoids and the tongue base.
Snoring is common; it affects about 40 per cent of men and about 20 per cent of women. Occasional mild snoring is usually not a problem. Loud snoring every night, however, can disturb sleep and may be a sign of sleep apnoea.
The main causes of a narrowed airway are:
- Excess weight and fat around the neck
- Relaxation of the throat muscles with age
- Alcohol or sleeping pills before bed
- Nasal blockage: a deviated septum, enlarged turbinates, allergy
- Large tonsils, a long uvula, a sagging soft palate, a bulky tongue base
- A set-back lower jaw and palate structure
Snoring or sleep apnoea?
In simple snoring, breathing does not stop during sleep. In obstructive sleep apnoea, the airway closes again and again during sleep; breathing stops or decreases for a short time and the person wakes without realising it. Medically, sleep apnoea is defined as an average of five or more breathing events per hour of sleep together with symptoms such as daytime sleepiness, or an average of 15 or more events per hour even without symptoms.
It is advisable to see an ear, nose and throat specialist if:
- Your partner notices that your breathing stops during sleep
- You wake up gasping or with a choking feeling
- You wake up tired despite sleeping long enough, or doze off during the day
- You have morning headaches, a dry mouth, or difficulty paying attention and concentrating
Untreated sleep apnoea can increase the risk of high blood pressure and heart and vascular disease, so severe snoring should be taken seriously.
How is it examined and diagnosed?
The most important step in treating snoring is to find where the airway narrows. At the examination the inside of the nose is assessed with an endoscope, and the soft palate, uvula, tonsils, tongue base and larynx are evaluated. Weight, neck circumference and jaw structure are also taken into account.
If sleep apnoea is suspected, a sleep study (polysomnography) is requested. This test shows whether apnoea is present and how severe it is, and so determines the choice of treatment.
Non-surgical treatment options
Treatment for snoring is chosen for each person; for many patients the first step is non-surgical.
- Losing weight and exercising regularly
- Avoiding alcohol and sedatives before bed; not stopping any medicines you take without talking to your doctor
- Sleeping on your side rather than your back, and keeping your head raised
- Treating nasal blockage caused by allergy or colds
- A mouth appliance that holds the lower jaw forward during sleep (made by a dentist or jaw surgeon)
- Positive airway pressure devices such as CPAP in moderate and severe sleep apnoea
Surgical treatment is considered when these measures are not enough or when there is a clear structural narrowing causing the snoring.
How is snoring surgery performed?
Snoring surgery is not a single operation; depending on the level at which the airway narrows, one or more areas are treated.
- Nasal surgery: septoplasty, turbinate reduction, nasal valve surgery or polyp surgery. Opening the nose does not treat sleep apnoea on its own, but it can reduce simple snoring in some patients and makes it easier to use the device for patients who need CPAP.
- Tonsil and adenoid surgery: if large tonsils narrow the airway, a tonsillectomy is performed.
- Soft palate surgery: reducing or tightening excess tissue in the soft palate and uvula (such as uvulopalatoplasty or anterior palatoplasty) and radiofrequency treatment of the soft palate.
- Tongue base surgery: radiofrequency reduction of the tongue base, removal of the lingual tonsil and, in selected patients, more extensive procedures.
The success of soft palate surgery depends on the anatomy: it is higher in patients with large tonsils, a tongue base that does not narrow the airway and a weight close to normal, whereas on its own it may not be enough for people with severe sleep apnoea, marked excess weight or a set-back jaw. That is why selecting the right patient is the most important factor in the result.
Radiofrequency treatments do not require major surgery and can be helpful in simple snoring and mild sleep disorders.
Recovery
Recovery depends on the type of operation. After nasal surgery alone or radiofrequency treatment, you return to daily life quickly. After tonsil or soft palate surgery, pain on swallowing can last from a few days to two weeks; during this time soft, cool foods are eaten and plenty of fluids are taken. Healing and the change in snoring are assessed at the check-ups.
Risks and results
- Bleeding and infection
- Pain on swallowing and temporary difficulty swallowing
- A dry throat or a feeling of something in the throat after soft palate surgery
- Snoring returning over time, especially with weight gain
Snoring can come back; however, in the right patient, surgery using the technique suited to the site of narrowing can give a long-lasting reduction in snoring. Weight control and avoiding alcohol help maintain the result.
How does the process work with Prof. Dr. Öner Çelik?
- Consultation: the site of narrowing is identified with an endoscopic examination of the nose and throat at the clinic in Suadiye.
- Tests: a sleep study is requested if sleep apnoea is suspected.
- Plan: non-surgical measures, device treatment or surgical options are discussed together with their risks and expected results.
- Surgery and check-ups: if surgery is needed, it is performed at Maltepe University Hospital; check-ups continue at the clinic.
Details are on the your treatment in Istanbul page.
Frequently asked
Can snoring be treated with surgery?
Surgery is considered when weight loss, sleeping position and an oral appliance are not enough, or when snoring is severe. The area that narrows the airway (the nose, soft palate, tonsils or tongue base) is identified at the examination and treatment is planned accordingly.
More detail: Snoring surgery.
How is snoring surgery performed?
Snoring surgery is not a single procedure. The examination identifies where the airway narrows; one or more procedures are then combined on the nose (deviation, turbinates), the tonsils, the soft palate or the tongue base.
How can I tell whether I snore?
If you sleep alone, it is hard to notice; a partner’s observation or a sound recording during sleep gives an idea. If there are pauses in breathing during sleep, morning tiredness or daytime sleepiness, an examination and, if needed, a sleep study are recommended.
References
- Kent D et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(12):2499-2505.
This content is for information only and does not replace medical advice. Every medical procedure requires an individual assessment and may carry risks. Results vary from person to person.
