Why Do You Snore? Tips to Reduce Snoring

So why do some people in Singapore snore so loudly? Do you or your partner snore loudly? Is your sleep usually disturbed by your partner’s noisy breathing and snoring? At The ENT Clinic in Singapore, many men come to see us to seek help for their snoring; some women do too but in general, men tend to snore more than women.

Snoring strongly suggests a significant level of airway obstruction during sleep. Snoring does not happen when you’re not asleep because of your upright position and your muscle tone tends to be able to maintain the patency of your upper and lower airways. However, when you fall asleep, the muscles of your airway relax, so that the soft tissue inside your nose and throat may tend to collapse inwards. This leads to partial or complete obstruction of your airway at different levels to cause snoring. The airway obstruction causes recurrent sudden dips in your blood oxygen levels, which may occur repeatedly during your sleep, reducing the blood flow to your vital organs such as the brain and heart. So snoring may actually be a warning sign of underlying obstructive sleep apnea, a health condition which is associated with increased risks of heart disease, strokes, high blood pressure and dementia.

Real Life Case Study:

A 45 year old lawyer had extremely large tonsils blocking the back of his throat and airway, causing him to snore rather loudly. He also suffered from recurrent tonsil infections, leading to severe sore throats and difficulty swallowing. He was fed up of having to take repeat courses of antibiotics for his recurrent sore throat episodes and felt his overall general health was just poor, suspecting it was related to his poor sleep quality and breathing problems at night. We tried him on CPAP treatment (Continuous Positive Airway Pressure) but he felt claustrophobic, repeatedly tearing off the nasal mask at night after less than an hour as he just did not like having something stuck to his face. We discussed the alternative of surgery to improve his airway and he decided to proceed with this. After surgery, he felt much better, sleeping and breathing clearly without any more tonsillitis infections. He also lost weight after surgery which helped his breathing too.

So now, let’s talk about why you snore!

Lifestyle Contributors:

1. In the United States, 1 in 3 Americans have a problem with obesity. Weight gain increases the buildup of fatty deposits in your neck, weighing downwards on your airway when you lie flat to sleep. In Singapore, obesity is not usually the main cause of obstructive sleep apnea in the Asian population but structural issues of the nose and throat tend to be more common. But if weight gain is an issue for you, then careful diet and regular exercise 30 minutes 3-4 times a week is highly recommended. For some patients whose weight gain is uncontrollable, making it difficult to exercise, then I advise them to seek help from an Endocrine (Hormone) specialist to screen for thyroid and diabetes conditions. The Endocrine specialist may also start obese patients on special medications such as Saxenda to help with weight loss and control impaired blood sugar tolerance.
2. Alcohol is a muscle relaxant which worsens airway obstruction and hence, your snoring will be louder when you have drunk alcohol. You should not depend on  alcohol as a sleep aid because it acts as a delayed stimulant, making you wake up later on in the night. It leads to a drop in in your blood sugar levels, which increases the chances of disrupted sleep and nocturnal waking episodes.
3. Smoking causes a chronic inflammation process of your nose and airway so that the lining of your nose and throat remain persistently congested and swollen. The amount of thick slimy secretions or mucus is also much higher in people who smoke, even if it’s “only” social smoking. No matter if you’re smoking cigarettes, cigars or vaping, my advice is to avoid all types of smoking completely.

Structural Reasons for Snoring:

1. Huge tonsils: Tonsils tend to be large “golf balls” of lymph gland tissue in young children, but in most people, they will shrink around the age of 5-8 years so that most adults have minimal tonsil tissue remaining. When this doesn’t occur, then excess tonsil soft tissue may lead to overcrowding of the back of your throat, obstructing your airway to cause loud snoring and persistent mouth-breathing. If you notice a persistently dry or sore throat when you wake up in the morning, it may be because you have been breathing through your mouth throughout the night: Mouth-breathing is abnormal!
2. Deviated nasal septum: Sometimes, due to previous nasal trauma or developmental changes, you may have a crooked nose structure inside, leading to narrowing of one or both nasal passages. Unfortunately, there is no medication for this and surgical correction of a deviated nasal septum may be indicated to improve your nasal airway so you can breathe clearly again through your nose.
3. Enlarged turbinates: Turbinates are the fleshy “sausages” of the nose which help to warm and humidify the air you breathe into your nasal passages but sometimes they remain persistently swollen and inflamed due to underlying nasal allergies, such as to House Dust Mite, the most common allergen to irritate people’s noses in Singapore. People often call this condition “Morning Sinus” or
   “Sinus problems” but the correct term is Rhinitis, a condition associated with having a sensitive nasal lining.
4. Floppy soft palate and long uvula: The back of your throat may just be rather crowded with a tight narrow inlet for air to enter your throat and airway, due to these other anatomical structures. The uvula is the long structure you can see dangling at the back of your throat in the midline when you look into your mouth in the mirror.
5. Other structural factors such as having a large tongue or bulky tongue base, or backward-facing cartilage flap (the epiglottis), may also lead to airway obstruction, collapse and thus,, snoring.

Dynamic Factors to Explain Snoring:

1. If you suffer from generalised airway collapse at multiple levels of your throat and airway, then you might be better off with having a trial of CPAP, Continuous Positive Airway Pressure, to drive pressurised air into their airways to keep them open when they sleep. This prevents airway collapse at multiple levels, and these patients may not do so well with nose, throat or jaw surgery to treat underlying sleep apnea. You would of course have to wear either a special facemask, nasal mask or tiny nasal prongs inside your nose to deliver the CPAP to keep your airways open, so not everyone will tolerate having CPAP. I tend to offer those patients who are either obese or suffer from severe obstructive sleep apnea, a trial of CPAP first, before we consider resorting to surgery to fix their breathing issues.

So what are experienced ENT specialist Dr Annabelle’s Tips to Reduce your Snoring?

1. Losing weight can help to reduce pressure on your airway by reducing the fatty tissue building up on the front of your neck. This is usually safely done in a gradual manner over several months through careful diet and regular exercise such as brisk walking, swimming, running and cycling. Crash dieting NEVER works and certainly NEVER lasts, in addition to being risky and dangerous to your health. Walking is a highly underrated activity which is actually very effective at burning the excess calories off while being non-traumatic to your knee joints.
2. Try lying on your side rather than flat on your back. You can try to buy a wedge pillow to prob your neck and head upwards in a slightly extended position but this is unlikely to help those who are already suffering from moderate to severe sleep-related breathing issues.
3. Try a nasal decongestant like Afrin or Otrivine for a short period of time to see if it’s your nasal congestion causing the snoring.
4. Try taking an antihistamine tablet to minimise nasal allergy irritation and mucus secretions. You can usually buy some off the counter medications like Zyrtec, without a doctor’s prescription.
5. Wear a dental device/mouthguard to push your jaw forward to help open up your airway: This is called a Mandibular Advancement Device. This can be obtained from your dentist or may be sold at a local pharmacy. It has to be properly fitted inside your mouth, otherwise it can potentially obstruct your breathing further to worsen the snoring.