Night shift at the Sawmill

Here’s one of those things that I should have learned about in medical school, but really didn’t.  If my patient’s snoring isn’t caused by sleep apnea, then I’m tapped out as to what to do about it.  But Twitter and AMR inspired me to do a little research this week.

Some snoring is nearly universal, and up to 45% of us are habitual snorers.  So be careful before you criticize your spouse or parent too much, next time you have a cold, or get pregnant, or gain that extra 5 pounds, your criticism may come back to you.  Funny how that works.

The overall cause of snoring is increased upper airway resistance, and the reason for that can be pretty broad. Certainly OSA can also be a cause of the snoring, but may also be a result. The more resistance there is, the more likely that arousals and apnea are also present.  Nasal congestion, tonsillar hypertrophy, obesity, and craniofacial abnormalities like acromegaly can all increase resistance by just having less room for air to move through.  Sort of like a stenotic valve causes a murmur.

So why care?  Certainly we all know the health risks of untreated sleep apnea, that I won’t cover here, but what if there isn’t apnea?  There have been some mixed results, but there are few observational studies that link snoring (without apnea) to hypertension and atherosclerosis.  But in reality, it is often the bed partner who urges the patient to get some help.  Marital harmony and relieving embarrassment are real issues for patients and probably the place where treatment can have the most benefit.

Treatment for snoring can take a variety of approaches.  Weight loss alone can go a long way. A very small observational study showed statistically significant decreases in snoring with as little as 3kg of weight loss, and near absence of snoring in patients who lost 8kg.  Other lifestyle changes that are always good: quit smoking and drinking.  Snorers are more likely to use both substances.

Changing sleep position may work.  Many snorers sleep on their backs, which causes open mouths, and smaller airways.  About ½ of patients can be trained to sleep on their sides instead.  The entrepreneurs of the world have come up with a ton of products, but a simple home remedy is to attach a tennis ball to the back of a T-shirt.  You can pin a sock to the shirt, and then put the ball inside, or you can duct tape the ball on the back of the shirt.

Increasing nasal patency may do the trick.  During a cold, nasal decongestants can be helpful (although only for 3 days or you risk rhinitis medicamentosa). Nasal steroid may help some, and are worth a trial.  Some nasal dilators have been proven effective, particularly the external ones like Breathe Right strips. 

Finally, mechanical appliances (mouth guards, chin straps) or surgery may be the answer for some, if the above approaches don’t help.

A good bit of this information came from a great patient education website that I found. It is a great place to direct patients to find out info about all sorts of things that really don’t need a “medicine” to fix.  Sleep, diet, stress relief, even a variety of psychiatric topics such as ADD, bipolar disorder, and PTSD.

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