What Can I Do to Stop Snoring?
Nearly 50% of all adults living in the United States snore, according to the American Academy of Otolaryngology, and over 25% are habitual snorers. Unofficial surveys indicate that approximately 100% of those individuals would like an answer to the question: "What can I do to stop snoring?"
When it comes to snoring cessation, an obvious and immediate challenge is that it transpires while you are asleep. Doctors define snoring as any sounds—ranging from barely noticeable to concrete mixer rumbles—generated when the flow of air past relaxed tissues in your throat causes those tissues to vibrate as you breathe. Most people who snore are not aware it's happening unless someone informs them, or a related condition develops that requires medical attention.
Almost all of us snore occasionally, but chronic snoring can be problematic, both because it can indicate a serious underlying health condition and because it can disturb the peace (and sleep!) of partners, family members, and others with whom you may be sharing a sleeping space.
Most people who seek out snoring solutions due so in order to resolve one or both of those fundamental issues. In some cases, lifestyle changes that address commons causes such as excess weight, alcohol consumption close to bedtime, or sleeping position can successfully stop snoring. If those solutions fail, other options such as medical devices or surgery may be necessary.
Understanding What Causes a Snoring Problem
The air that you breathe in and out of the nose and mouth travels through the mucous membrane-lined pharynx, the cavity behind the nose and mouth that connects them to the esophagus. When you fall asleep, and especially as you progress from a light sleep to a deep sleep, your muscles relax. As a result, the respiratory structures of and around the nose, mouth, and throat become less taut. Tissues in your throat may even relax so much that they begin to partially block your airway and vibrate, producing the characteristic sounds of snoring.
At the same time, breathing in generates low pressure that can push the walls of the pharynx further inward. The more narrow the airway becomes, the greater the force of the airflow through it. This increases tissue vibration, which amplifies snoring sounds.
Circumstances that, either individually or collectively, restrict the flow of air include:
- Relaxed muscle near respiratory tissues
- Slack respiratory structures
- Collapsed pharynx walls
- Inflamed respiratory tissue
- Fatty deposits lining the upper airways
- Tongue laxity
- Dilated adenoids and tonsils
- Weak throat muscles
The degree of airway restriction in the pharynx correlates to the level of boisterousness with which an individual snores.
In especially severe cases, airway restriction can actually block airflow, leading to a suspension of breathing. This phenomenon is called obstructive sleep apnea (OSA). Intense snoring followed by an abrupt stop indicates that the air pathway is completely obstructed. Pauses in breathing can last for seconds or several minutes multiple times throughout the night. Apnea sufferers often cough or snort once breathing resumes. While snoring intensity typically increases as sleep apnea worsens, loudness of snoring does not confirm sleep apnea, nor does it indicate apnea severity or intensity. If you're concerned that you or someone you know may have sleep apnea, you should speak with your doctor about treatment options.
10 Risk Factors Shown to Increase Your Risk of Snoring
Experts have found that a variety of factors can result in snoring, ranging from the anatomy of your mouth and sinuses and your weight to alcohol consumption and congestion stemming from a cold or allergies.
Certain genetic factors, as well as anything that affects your airways, can cause or aggravate snoring. Some known risk factors for increased snoring include:
- Gender: Studies consistently show that men are more likely to snore and more likely to have sleep apnea. That said, incidences of snoring tend to level out with age, perhaps due to hormonal changes that accompany menopause.
- Family history: If you have close relatives who snore, you're more likely to do the same. Genetics is a particularly strong indicator for your risk of obstructive sleep apnea.
- Shape of soft palate: If your soft palate is low and thick, this can narrow your airway. Having an elongated uvula (the triangular piece of tissue hanging from the soft palate) can impede airflow and increase vibration.
- Width of airway: In addition to structural impediments related to the shape of the soft palate, enlarged tonsils or adenoids can narrow the airway, which raises your risk of snoring.
- Deviated nasal septum: If the septum—the partition between your nostrils—is crooked, this can make you more prone to snoring.
- Weight: Individuals with high body mass indexes (BMIs) snore at higher rates. One reason for this may be the presence of extra tissues at the back of the throat which narrow the airway.
- Alcohol consumption: Drinking alcohol just prior to bedtime can increase the likelihood you will snore. Alcohol relaxes your throat muscles, which decreases your body's ability to minimize airway obstruction.
- Nasal congestion: Both short- and long-term congestion related to respiratory illnesses or allergies can elevate your risk of snoring.
- Sleep position: Sleeping on your back typically results in the loudest and most frequent snoring due to gravity's constricting effect on the airway.
- Lack of sleep: Being under-slept can lead to greater throat relaxation, which ups the odds of snoring.
Snoring is one of the most commonly reported sleep disturbances among adults, and the risk of snoring loudly and disruptively on a recurrent basis increases with age. A 2017 study published in Sleep and Breathing showed that rates of snoring rise with age, peaking for both men and women between the ages of 50 to 59. Snoring incidences then tend to decrease, though women experience less of a decline than men, perhaps related to menopausal hormone changes.
Rates of snoring are higher among men than women across all age groups. According to an article published in the BBC's Science Focus Magazine, the likelihood that a man snores is roughly twice the likelihood that a woman does. One possible explanation for this discrepancy has to do with a space behind the tongue called the oropharynx. When the tongue relaxes while we sleep, it can fall into this space, which obstructs our breathing and results in snoring. Since this space tends to be larger in men than women, it's easier for a tongue to drop into it.
It's also likely that our hormones influence snoring patterns. According to an article penned by Dr. A.K. Simonds of the Royal Brompton Hospital for the British Snoring and Sleep Apnea Association (BSSAA), "The relationship between hormone levels and sleep is complex and not yet fully understood." Simonds goes on to explain that obstructive sleep apnea, which, as mentioned previously, is a disorder associated with snoring, is more common among men than women, Furthermore, the prevalence of OSA increases among women after menopause, highlighting the role played by testosterone, estrogen, and progesterone in the development of snoring and related disorders.
The link between hormones and sleep-disordered breathing could give rise to novel treatment approaches. The findings of a 2003 study published in the American Journal of Respiratory and Critical Care Medicine show that the prevalence of sleep-disordered breathing among post-menopausal women using replacement hormone therapy was approximately half that seen among women who did not use hormone replacement therapy.
Hormones are also the reason former non-snorers may begin to snore during pregnancy. According to Dr. Louise O'Brien, a researcher at the University of Michigan Institute for Healthcare Policy and Innovation who specializes in the connection between sleep and outcomes for pregnancy and maternal and infant health, rates of snoring increase substantially during pregnancy. One reason for this is that changes in hormone levels result in blood vessel dilation, which causes mucous membranes in the nose to swell. This narrows the nasal passages, essentially forcing you to breathe through your mouth, and often leads to snoring.
Certain foods and allergens may induce inflammation and nasal congestion that can lead to snoring. Casein protein in dairy products and gluten protein in wheat may cause mucous membrane flare-ups in the gastrointestinal and respiratory systems.
Taking muscle relaxants and drinking alcohol before bedtime also raise snoring risk, due to the increased laxity they cause in the muscles involved in respiration.
How Snoring Can Indicate—or Cause—Other Health Conditions
To best understand the immediate and long-term ramifications of snoring, researchers customarily analyze snoring according to either subjective or objective criteria.
Subjective analysis of snoring centers on a listener’s perception and snoring’s impact on family members and partner relationships. The interpersonal impact of snoring is poorly addressed in most American households, though it can put serious strain on relationships. Together with chronic snorers, cohabitants can experience both psychological and physical damage associated with snoring-related sleep deprivation, such as:
- Daytime drowsiness
- Compromised reflexes, leading to an increased risk of accidents
- Lack of concentration
- Poor sex drive
- Heightened irritability
- Anxiety and depression
Objective snoring analysis, on the other hand, tracks snoring sound intensity as well as snoring prevalence over a specific time duration and snoring frequency during a sleeping session—all variables that can be assessed through quantifiable means, including acoustical measurement.
However, scientific scoring standards and phraseology for principal or incidental snoring events have yet to be established—which hinders concerted efforts to explore the more accurate social and clinical impacts of snoring.
Nevertheless, researchers highly suspect that snoring may be a symptom or cause of serious medical complications, including heart disease and diabetes. Researchers at Henry Ford Hospital in Detroit found a connection between snoring—independent of sleep apnea—and changes to the carotid artery, likely the result of trauma and subsequent inflammation caused by the vibrations of snoring.
Obstructive sleep apnea has long been linked to an increased risk of high blood pressure, cardiovascular disease, and stroke, but the findings of the research team led by Dr. Robert Deeb of the Department of Otolaryngology-Head & Neck Surgery at Henry Ford, indicate that snoring's adverse impact on heart health begins long before sleep apnea presents itself.
A 2013 article published in the journal Sleep found that daytime drowsiness from sleep deprivation linked to snoring was a significant precursor for future cardiovascular risk among older adults. Separately, a 2016 study conducted in China showed that snoring increases the risk for left ventricular hypertrophy.
A 2017 study in the journal Sleep Breathing sheds some light on why snoring can be so harmful for heart health. The study suggests that loud and heavy snoring vibrations may trigger inflammation in body tissue and damage the endothelium, a thin layer of cells that line the organs and other internal structures. Damage to the vascular endothelium, the lining of the blood vessels, is common and an early event in the progression of cardiovascular disease.
Furthermore, the International Journal of Environmental Research and Public Health published evidence that moderate, strong, and very strong snoring intensity levels were associated with dyslipidemia, specifically, high total cholesterol and high low-density lipoprotein cholesterol.
Snoring has also been linked to the development of metabolic disorders. A heightened frequency of snoring as well as subsequent awakenings and breathing disruptions were associated with increased risk of metabolic syndrome, including diabetes, in a 2017 study that also emphasized the need for more standardized objective measurements when probing the causative aspects of snoring.
Research published in the journal Sleep suggests that snoring is associated with chromosomal leukocyte telomere attrition. Telomere length is an indicator of biological aging, and an attenuated length may be a marker of compromised immunity and age-related disease.
And while the snoring that can develop during pregnancy does not appear to harm fetal development, the same cannot be said for the effects of chronic snoring. Dr. O'Brien of the University of Michigan's Institute for Health Policy and Innovation says research indicates that those who snore regularly and badly prior to and during pregnancy may have breathing problems that can affect oxygen supply to the fetus. O'Brien also reassuringly reminds readers that chronic snoring can often be treated (more on that in the next section).
When to Consult a Doctor About Snoring Problems
If you suspect that you are snoring or you have observed snoring symptoms in a cohabitant, you should consult a physician or sleep specialist. Snoring symptoms can appear mild, but they may indicate more serious problems.
During a first appointment to discuss a snoring problem, your doctor will review signs and symptoms specific to snoring as well as your general medical history. They will also perform a physical exam. Usually this appointment will be with a primary care physician, though they may decide to refer you to a doctor who specializes in sleep disorders.
To get the most out of that initial appointment, it can be helpful to gather some information your doctor will likely want from you as well as a list of questions you have about your snoring. This might include making a list of any symptoms you're experiencing, even those that do not seem directly linked to your snoring. For instance, chest pain at night can be symptomatic of obstructive sleep apnea. Make a list of any medications you're taking too, including vitamins and supplements. Last but not least, make a list of questions you have for your doctor. To help you brainstorm, here are some typical questions snorers might have:
- What makes me snore?
- Could my snoring be a symptom of a more serious heath problem?
- Do I need any tests?
- If so, can you explain what will happen during those tests?
- I have other health conditions, what would be the best way to manage those alongside my snoring?
Don't limit yourself to these questions, they're intended as a jumping-off point, not a definitive list!
You may also find it useful to consider some questions your doctor will likely ask you, such as:
- When did you begin snoring?
- How often do you snore?
- Have you noticed things that seem to improve or worsen your snoring?
- Do you ever snort, choke, or gasp, causing you to wake up?
- Are you experiencing daytime symptoms like drowsiness or irritability?
If relevant, your doctor may also wish to speak with your partner about the frequency, duration, and intensity of your snoring.
In some cases, your doctor may request an imaging text—for example, an X-ray or MRI—to check for structural issues like a deviated septum.
Another option, depending on the intensity of your snoring and associated symptoms, would be to conduct a sleep study. Based on your symptoms and any other medical issues you may be experiencing, your doctor will determine whether it would be best to conduct the sleep study at your home or in a sleep center. Overnight stays at a sleep center allow for a polysomnography, a detailed analysis of your breathing during sleep. During a polysomnography, you will be connected to sensors that track a variety of physiological factors relevant to snoring, such as:
- Brain waves
- Blood oxygen level
- Breathing rate
- Sleep stages
- Eye and leg movements
How Can I Stop Snoring?
Anti-snoring treatments can be divided into two general categories: lifestyle changes and medical treatments. Often, lifestyle changes alone will suffice, but when they prove insufficient, your doctor may recommend certain devices or surgical interventions.
Many of the first treatments to try to stop snoring fall into the category of lifestyle changes. Some of those changes should be fairly simple to implement and can have a rapid positive impact.
For example, if you enjoy a nightcap at the end of a long day, you'll need to switch to a nonalcoholic beverage or be sure to leave adequate time between imbibing and when you'll be going to sleep.
If you tend to have a stuffy nose or other signs of congestion, finding an effective way to clear that up—such as using a neti pot to rinse your nasal passages—may go a long way toward reducing your snoring.
Changing your sleeping position is another simple adjustment that can lead to dramatic results. Sleeping on your side, rather than your back, can significantly alleviate positional causes of snoring.
It's also crucial to avoid sleep deprivation, which often coincides with and intensifies snoring, though this may be more challenging to implement. Finally, and firmly in the category of challenging and long-term lifestyle shifts, weight can contribute to snoring symptoms. If you or a medical professional believe that could be a factor for you, it may be beneficial to make a plan to lose weight in a healthy way.
Taking an essential amino acid supplement can help you lose weight and help mitigate and protect against other underlying health issues, such as heart disease.
One reason your primary care physician might refer you to a specialist is if they believe neuromuscular exercises could help to address respiratory structure impairments.
For snoring linked to obstructive sleep apnea, or snoring that does not respond to other treatment approaches, doctors may recommend the use of oral appliances.
Oral appliances fit into your mouth and position your jaw, tongue, and soft palate to keep your air passage wide open. They can cause tooth damage if improperly fitted, so you'll need to work with a dental specialist. You'll also need to follow up with a sleep specialist to ensure the device is working. Continued use of an oral appliance will entail dental visits at least every 6 months during the first year of use as well as annual visits over the course of your lifetime to check the fit and assess your oral health. Some common side effects associated with oral appliances include jaw pain, facial discomfort, and excessive salivation, or conversely, dry mouth.
One of the most-time tested treatments for sleep apnea is the use of continuous positive airway pressure (CPAP). This involves wearing a mask that covers your nose and/or mouth and directs pressurized air into your airway to keep it open. The mask, which connects to a small bedside pump, must be worn continuously while you sleep. CPAP machines are a reliable and effective way to treat obstructive sleep apnea and eliminate snoring, but some people find it difficult to adapt to the feel of the mask or the noise of the machine.
If all other treatment approaches have been exhausted, you may be a candidate for upper airway surgery. A number of procedures can be used to open the upper airway. One such procedure, uvulopalatopharyngoplasty (UPPP) involves tightening and trimming excess tissue from the back of the throat. However, some worry that if further tissue damage develops, more invasive surgery may be required.
Other options include maxillomandibular advancement and radiofrequency ablation. Maxillomandibular advancement involves moving the upper and lower jaws forward, which helps open the airway. Radiofrequency ablation, a newer procedure, applies a low-frequency radiofrequency energy that can help shrink and strengthen tissue in the soft palate, tongue, or nose. A draw of radiofrquency ablation is that it can be performed as an outpatient procedure.
Finally, a novel surgical technique called hypoglossal nerve stimulation can be applied to the nerve that controls the forward movement of the tongue to prevent it from blocking your airway.
These surgeries tend to be options of last resort as their effectiveness varies and patient responses can be difficult to predict.