Silent Night

It’s a mainstay of marriage quarrels worldwide: The husband falls asleep, and his first few snorts are tentative and quiet. But within minutes his snoring builds to a jackhammer crescendo audible outside the room. His annoyed wife jabs an elbow into his ribs. “What?” he demands. “I wasn’t snoring.” He rolls over, and the scenario begins again.

The jokes are laughable, but the medical community considers snoring a condition worth treating seriously. Snoring is linked to other sleep disorders, including “restless leg syndrome”—when the arms and legs spasm as the snorer sleeps—and potentially life-threatening sleep apnea. Luckily, home remedies and non-invasive treatments are often the most effective cures.

By itself, snoring isn’t necessarily a health hazard. It can be hazardous, however, to a relationship. “I snored so loudly that my husband would stay up late watching TV to become really tired so he could fall asleep easily,” says Barbara Unverferth, a Web-content specialist in Placerville, California. A heavy snorer for years, Unverferth had always been nervous about sharing hotel bedrooms with colleagues for fear of waking them. Sometimes she even woke herself up.

Snoring occurs when the throat constricts or collapses and partially blocks the airway. The tongue and upper throat, or soft palate, meet the tonsils and uvula—the flap of skin that suspends from the back of the throat—during breathing. As the air whisks in and out, these tissues vibrate like the reed of a musical instrument. But the sound is never music to our ears.

As Unverferth’s snoring problem worsened over the years, her husband finally asked her to see a doctor. She hesitantly mentioned the problem to her OB/GYN during a routine checkup and was referred to an otolaryngologist—an ear, nose and throat (ENT) specialist. The ENT’s first move was to evaluate her for sleep apnea, a constriction that takes place deep in the throat, completely blocking air flow. The snorer stops breathing for several seconds, wakes briefly to begin breathing again, then goes back to sleep.

In serious cases, sleep apnea sufferers can stop breathing for up to half a minute. The body goes into panic mode as the oxygen supply is cut off. The heart pumps madly, trying to find oxygenated blood to circulate. It shifts into overdrive, dangerously increasing heart rate, signaling the brain to wake up the body and force it to roll over and open the throat—whatever it has to do to find air. After a night of constant waking, the sufferer often gets up with a headache and then struggles through a drowsy day. This added stress on the heart during the night increases blood pressure and the risk of a heart attack at any time of day or night.

Physicians can often diagnose sleep apnea with simple questions, says Joseph Kaplan, MD, co-director of the Mayo Sleep Disorder Clinic in Jacksonville, Florida. “We ask if the patient has any daytime symptoms such as sleepiness, tendency to doze or morning headaches. If a bed partner has witnessed apnea, that’s even more significant.”

Snoring is more prevalent in overweight people because increased fatty tissues in the throat narrow the airway, and poor muscle tone causes the soft palate to sag during sleep. The smaller the airway, the louder the snoring. Doctors agree that the simplest and most effective treatment for mild snoring is to lose weight and tone up. Nobody’s pushing any throat-specific exercises, unfortunately, so it’s a matter of addressing those perennial health care favorites: diet and exercise.

Alcohol before bedtime severely exacerbates the problem, according to the American Academy of Otolaryngology. So does taking tranquilizers, sleeping pills or anti-histamines before retiring.

A few home remedies seem to help. Sleeping on your side instead of on your back makes the throat less likely to collapse and block breathing. To encourage side-sleeping, doctors sometimes recommend the “tennis ball” treatment, which consists of sewing a pocket on the back of your pajama top and inserting a tennis ball. Kaplan’s patients have also found relief by elevating their heads—whether by using extra pillows or lifting the head of the bed frame several inches.

Although doctors won’t usually prescribe them, many snorers report success with over-the-counter nasal strips. These adhesive strips fit across the nose, flattening and widening the nasal passage. This encourages patients to breathe through the nose instead of the mouth, avoiding the snore canal altogether. “My problem was nasal congestion when prone,” says Tim Roehl, an aircraft-engine company president in Ada, Oklahoma. “I sleep better with the strips because I breathe better through my nose. My wife reports that my snoring is virtually eliminated.”

If home remedies don’t work, then an ENT explores medical treatments. Some patients have had success with non-invasive orthotic devices, fitted by a dentist. These mouthpieces go under various trade names, depending upon which company the dentist purchases them from, but they all work in similar ways. Biting down on the device repositions the jaw farther down and forward, opening the airway wider at the base of the tongue. Some mouthpieces hold the jaw firmly in place, and some allow slight movement. Leonard Vinci, DDS, a recently retired dentist in San Francisco, regularly prescribed such devices to patients. “We had several letters from spouses thanking us for enabling them to sleep in the same room with their partners after several years apart,” he says, even though the device he prescribed was fairly expensive and didn’t work for every patient. Unfortunately, it is impossible to predict success, so it may be a gamble to invest in the device.

The most common and most effective treatment for sleep apnea is continuous positive airway pressure (CPAP). In layman’s terms, the patient wears an oxygen mask that gently forces air into the lungs all night long. The American Academy of Otolaryngology also recommends some surgical treatments for snoring. All are variations on tightening or removing the soft tissue at the back of the throat. Unfortunately, the success rate is not as high as with CPAP, Kaplan says, because with apnea the soft-tissue collapse is much deeper in the airway than surgeries can treat. “The success rate is only about 30 to 40 percent, and success is defined as a reduction in apnea, not a cure,” he says.

Fortunately, Unverferth had no symptoms of apnea, which meant that her health wasn’t at risk—just her marriage bed, an important quality-of-life issue, says Kaplan. “The most important reason to treat snoring is because it’s disruptive to the relationship with your bed partner,” he says. “You can reach the 80-decibel level in snoring, the level of a vacuum cleaner.”

Unverferth’s doctor made a cursory examination of her nasal passages and swiftly diagnosed another common cause of snoring—a deviated septum. The cartilage separating her nostrils had gone astray, blocking 80 percent on one side. Her turbinates—bone-and-cartilage plates in the sinus cavities—were also enlarged. She chose corrective surgery to address both problems. Unverferth checked into the hospital at 9:30 a.m. one morning and was home before lunchtime.

“That night, I could breathe through my nose,” she says. “My husband noticed the difference immediately. He says it’s like comparing a chain saw to a cotton ball dropped on the floor.” Unverferth had long been a restless sleeper, waking several times a night. After the surgery, she had her first full night’s sleep in years. “A week later,” she says, “I woke up before the alarm sounded and actually felt like I could get up—feeling rested and ready to go.”