Diagnosis, effects and treatment for snoring & obstructive sleep apnoea

What is snoring?


Why do we snore? Approximately 60% of all men and 40% of all women over 45 years snore. A part of the upper airways, especially the area between soft palate and larynx, is primarily comprised of muscles. When these muscles are tensed, the pharynx is widened. When the muscles slacken during sleep, the lower jaw and tongue fall back especially when sleeping on the back. As the airways narrow, air has to be drawn in faster and with higher pressure. This causes a vibration and fluttering of the soft tissue which leads to snoring. Habitual snoring is not accompanied by breathing stops.

What causes snoring?


The narrowing of the upper airways can cause a vibration and fluttering of the soft tissue known as snoring. There are several reasons for snoring while sleeping. If nasal breathing is impeded, e.g. by a cold, an allergy, a septum curvature or nasal polyps, those affected primarily breathe through the mouth. Especially when sleeping in supine position, the lower jaw and tongue can fall back narrowing the throat. A small or shortened lower jaw, a large tongue as well as enlarged tonsils can enhance this effect. Another reason for snoring can be overweight, because fat can also deposit around the throat. The consumption of alcohol and sleeping pills can also have a negative impact. It contributes to a relaxation of the muscles. Smoking can irritate the mucous membranes which therby swell and narrow the upper airways. Another factor is the female hormone oestrogen that hinders the muscles from slacking. A lack of this hormone can promote snoring. This is the case, among other things, why proportionally more men snore than women. Women often begin to snore during their menopause. Moreover, the relaxation of the muscles decreases with increasing age.

What is obstructive sleep apnoea (OSA)?


Obstructive sleep apnoea is a sleep-related breathing disorder that involves the pharynx to repeatedly collapse during sleep. The danger arises when the snorer suddenly gets silent. The breathing stops for a short time and the amount of carbon dioxide in the blood increases. Obstructive sleep apnea syndrome (OSAS) exists when more than about ten breathing stops occur per hour. Depending on frequency and duration an undersupply of oxygen to the organism can appear. In case of suspected sleep apnoea, you should consult a doctor.


Apnoea–Hypopnoea Index (AHI)

The Apnoea–Hypopnoea Index (AHI) indicates the average number of apneic and hypopneic episodes per hour. The AHI index can be determined in the sleep laboratory by polysomnography. It provides information on the severity of sleep apnoea. An AHI > 5/h and < 15/h indicates a mild obstructive sleep apnoea. An AHI > 15/h and < 30/h is called a moderate OSA, an AHI > 30/h is classified as severe.

Obstructive sleep apnoea – diagnosis


To find out whether you only suffer from habitual snoring or also from obstructive sleep apnoea, there are different diagnostic measures.


The first step is an anamnesis by your doctor (e.g. ENT specialist). Based on a detailed interview and examination, the doctor identifies conspicuities in the nose and throat area. In addition, sleeping habits and other influencing factors, like overweight or consumption of alcohol and cigarettes can be obtained. For this purpose, it can also be helpful to consult your partner. Furthermore, standardised questionnaires enable an initial assessment.


In the second step an ambulatory sleep recording (also called polygraphy) is recommended, if required. Patients receive a mobile device that they have to put on before going to bed. This device records the sleeping behaviour and important physical activities at night. Thus, breathing stops can be diagnosed.


Depending on frequency and duration of the breathing stops, a polysomnography in a sleep laboratory is required. This is a detailed examination of the sleep. You spend one to two nights in a sleep laboratory where you are permanently guarded by professionals. Any conspicuity, e.g. in the field of brain activity or heart rate, is recorded and afterwards analysed.

Effects of sleep apnoea


An untreated obstructive sleep apnoea can have serious effects restricting the quality of life and shortening the lifespan. Below we have summerised possible effects of sleep apnoea for you.


1. Effects on cardiovascular system: The effects on the heart, the blood circulation and the brain are particularly serious. Nocturnal breathing stops can lead to a shortage of oxygen in the brain. As a result, the heart rate increases in order to balance the lack of oxygen. The risk of disruptions of the blood circulation rises since the heart muscle is in constant effort. That is why sleep apnoea often leads to high blood pressure, arrhythmia as well as an increased risk of a heart attack. Moreover, the probability of a stroke and suffering from a sudden cardiac death at night rises with increasing age.


2. Increased diabetes risk: The exact link between an obstructive sleep apnoea and diabetes mellitus type 2 is currently being researched. However, we know that the breathing stop and thus the triggered wake-up call can cause immense stress reactions in the body. As a result, the body releases an increased number of stress hormones. Those hormones can lead to a rise of the blood pressure. At the same time, the endogenous insulin production is blocked. This permanent strain of the body can lead to a permanent increase of the blood sugar level.


3. Heartburn: Snorer and especially people with sleep apnoea often suffer from heartburn at night. A negative pressure results when inhaling caused by the narrowed airways. Thus, gastric acid can rise through the gullet and comes into contact with the mucous membranes. Since those don’t have a protective function – in contrast to the gastric mucous membrane – the typical unpleasant, burning pain in the chest results.


4. Reduced potency and sexual desire: Persons concerned often complain about loss of libido. An impaired sexual desire occurs both with men and women. With men, the insufficient oxygen supply can result in increased potency problems.


5. Increased danger of accident: People with sleep apnoea syndrome are exposed to an increased danger of accident. They do not get enough sleep due to a restless sleep. The tiredness during the day can result in concentration difficulties and increases the risk of microsleep. This can have serious consequences especially in road traffic.

Snoring and sleep apnoea – treatment


How to treat snoring and sleep apnoea? Since snoring can be caused by many factors, there is not the universal panacea. It is necessary to check where your snoring is originating from. Yet, there are a number of measures that can help prevent snoring and breathing stops.


1. Reduce overweight: Being overweight enables fat to deposit in the throat area which can narrow the airways. Exercise and healthy eating can help to counteract the symptoms.


2. Abstaining from alcohol and tobacco: Alcohol and sleeping pills slacken the musculature. Moreover, cigarettes can irritate the mucous membranes which, as a result, swell and narrow the airway. That’s why you should refrain from smoking especially before going to bed.


3. Have a quiet and restful sleep: Enough sleep is very important. Air your bedroom before going to bed and make sure it’s sufficiently cool. Ensure that your biological sleeping rhythm is balanced and don’t rack your brain over everyday stress at night. A full stomach can also cause a fitful sleep.


4. Make sure your nasal breathing is free: Those who can’t breathe freely through their nose at night, often automatically shift to mouth breathing. Is a nasal congestion caused by a cold or an allergy, nasal sprays can help. An alternative are nasal dilators. They soflty spread the nasal wings and allow for an improved nasal breathing.


5. Prevent supine position: Sleeping in supine position encourages the lower jaw and tongue to fall back in the throat narrowing the upper airways. That’s why you should try to sleep on the side or the stomach. Positioning aids or supine position preventers are supportive and induce you to sleep in lateral position. They cause a training effect, so that many patients no longer have to wear these aids regularly after a few weeks.


6. Oral Appliances: Mandibular advancement devices cause the desired advancement of the lower jaw and tongue and thereby an opening of the upper airways. It can be distinguished between two types. Custom-made mandibular advancement devices are fabricated in a dental laboratory. Whereas prefabricated SomnoGurad oral appliances are made of thermoplastic material that softens when heated in a hot water bath. The material can be formed according to the teeth during the fitting.


7. CPAP-Therapy: CPAP-masks are especially suitable when suffering from severe obstructive sleep apnoea. The abbreviation stands for „Continuous Positive Airway Pressure“. The patient is exposed to a positive airway pressure preventing the upper airways from collapsing.