Snoring - Causes, Symptoms, Diagnosis, Therapy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

snoring

By definition, snoring is a breathing noise that occurs during sleep in the upper airways - these range from the tip of the nose to the vocal cords. This means that one or more soft tissues are vibrating. Most of the time, snoring (rhonchopathy) has several causes at the same time, which are often mutually reinforcing. Snoring per se is not a disease, but it can put a massive strain on both those affected and those around them.

Simple, regular snoring is also a precursor to obstructive sleep apnea, a serious and sometimes life-threatening disease. A diagnosis that is as accurate as possible is therefore important. Countless, sometimes quite costly, methods promise remedial measures against snoring. In many cases, however, they achieve little or no success and can sometimes be associated with considerable side effects.

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What are the causes of snoring?

Breathing while sleeping and snoring © bilderzwerg

By constricting the upper airway, the airflow is slowed down and the necessary “air cushion” behind the soft tissues (soft palate, uvula and base of the tongue) becomes smaller. When these soft tissues begin to vibrate, it can create snoring noises.

In children, enlarged tonsils and tonsils are the most common cause. In adults, the problem is more complex.

Common causes are:

• Impaired nasal breathing: either due to swelling of the mucous membrane (e.g. runny nose, chronic inflammation of the paranasal sinuses, allergies) or due to anatomical changes (e.g. nasal polyps, enlarged nasal concha, curvature of the nasal septum);
• Enlargement of the palate, the base of the tongue, the tonsils or the uvula;
• Jaw misalignments ("overbite");
• Weakness of the muscles in the upper respiratory tract (soft palate, throat): This occurs more frequently with increasing age and after taking sleeping pills or consuming alcohol.

Obesity and smoking lead to an elevated diaphragm. As a result, the lungs cannot expand optimally, and less air is inhaled per breath. This means that the air flow is also weaker and the "air cushion" that is supposed to splint the soft tissues is smaller. In these conditions, snoring is more common. A hereditary component is also being discussed. In addition, genetic defects such as trisomy 21 can also be associated with snoring in children.

According to the German Society for Sleep Research and Sleep Medicine, the occurrence of snoring is age and gender dependent. The highest prevalence is found in middle to old age - for men the figures vary between 20 to 46 percent, for women between eight and 25 percent. However, snoring can also occur in childhood.

What are the symptoms?

Snoring can be a more or less massive acoustic burden for the person concerned and his / her surroundings. For those affected, snoring can be associated with problems falling and staying asleep, morning headaches / dry mouth, reduced concentration or performance, and daytime sleepiness / tendency to fall asleep. These are the first signs that you have obstructive sleep apnea (OSA) rather than simple snoring. This can cause serious complaints or illnesses.

How is the diagnosis made?

According to a guideline on the subject of "Diagnostics and Therapy of Snoring in Adults" drawn up by the Sleep Medicine Working Group of the German Society for Otorhinolaryngology, Head and Neck Surgery eV, a detailed discussion (anamnesis) should the bed partner should also take part, detailed information about the snoring problem is collected, such as:

• Occurrence over time: eg occasionally, more often or every night;
• Occurrence during the night: eg temporarily, continuously, location-dependent;
• Triggering factors and risk factors: alcohol, nicotine, allergic and non-allergic rhinitis, obstruction of nasal breathing etc.;
• Type of snoring: regular / irregular, frequency, volume, type of noise;

• aspects of sleep medicine such as

  • night awakening (e.g. with shortness of breath),
  • morning headache / dry mouth,
  • Reduced concentration or performance during the day,
  • Daytime sleepiness / tendency to fall asleep,
  • Difficulty falling asleep and staying asleep,

• simultaneously existing diseases such as

  • Cardiovascular diseases (high blood pressure, cardiac arrhythmias, heart attacks, strokes, etc.),
  • Overweight or obesity,
  • Diabetes mellitus.

The upper airways are also examined for changes. With regard to the nasal air passage, certain functional tests (e.g. rhinomanometry, rhinoresistometry and acoustic rhinometry) can be useful. Computed tomography (CT), magnetic resonance tomography (MRT), digital volume tomography (DVT), cephalometry (lateral x-ray) and orthopantomogram (OPG) / panoramic tomography (PSA) are available as imaging methods.

The most important clinical examination is the "Müller" maneuver. It is endoscopically checked in which area the airway collapses. If an obstructive sleep apnea syndrome is suspected, an objective medical examination should be carried out. This can be done using “screening” devices at home or as polysomnography (PSG) in the hospital. An allergological examination is recommended for the standard evaluation because one in five people will suffer from an allergy at least once in their life.

How is snoring treated?

Snoring per se is not understood as a disease with a medical risk. Therefore no treatment is necessary, unless this is requested by the person concerned. A large number of questionable therapy methods are offered against snoring. In individual cases, the effectiveness and the risks should be carefully weighed against each other. Non- or minimally invasive procedures should be preferred.

Conservative method

According to the Sleep Medicine Working Group of the German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery eV, the effects of various conservative procedures have been examined in various studies. At least in individual cases, a certain effectiveness could be proven for the following methods:

• Avoidance of sleeping pills;
• Avoidance of evening alcohol consumption;
• Abstinence from nicotine;
• Maintaining a stable sleep-wake cycle with appropriate sleep hygiene;
• Weight reduction for severely obese people;
• Avoid lavish meals before bed;
• Strengthening the muscles of the floor of the mouth, for example through electrical stimulation, singing exercises or targeted speech exercises;
• Prevention of supine position in the event of snoring that is purely supine,
• Elevation of the upper body;
• Nasal entrance dilators (nasal entrance dilators) especially in cases in which the origin of the nasal obstruction lies in the area of the nasal valve;
• Decongestant nasal sprays: are not suitable for long-term use due to potential damage to the mucous membranes, but with their help the effect of a nasal operation can be simulated beforehand;
• Systemically used drugs such as pseudoephedrine, domperidone or protryptinine can be effective, but have considerable side effects and have not yet been approved for the treatment of snoring;
• Positive Pressure Breathing (CPAP): often eliminates snoring, but is rarely used due to possible side effects and high costs.

Intraoral devices

• Mandibular protrusion splint: Special devices that can be inserted into the oral cavity, especially mandibular protrusion splints, can be used for the therapy of snoring. They are supposed to cause the throat to widen by moving the lower jaw forward. Possible side effects are increased saliva formation, complaints in the area of the masticatory muscles and the temporomandibular joint as well as long-term changes in the position of the teeth. Therefore, the splint fitting and regular checks of the dental and jaw findings should be carried out by a dentist during therapy with mandibular protrusion splints. Snoring can be reduced in around two-thirds of patients who are suitable for this method.
• Snoring brace: It splints the soft soft palate and prevents snoring noises that arise in the area of the soft palate. The snoring brace also prevents obstructions in the middle and upper throat. Breathing pauses and sleep apnea - if they occur in the soft palate - are reduced in many cases.

Operative therapy

In operative procedures, it is always necessary to weigh up whether there is a single cause or several causes. With single causes, the probability of success is high, with many causes multiple therapy may be necessary. Operations on the nose, palate and tongue base are possible. Minimally invasive therapy (radiofrequency-induced thermotherapy, RFITT) is modern, in which only scars are created under the mucous membrane. Often, however, there is a decrease in the effect as the tissue recovers. In these cases the therapy can be repeated.

To check the success of the therapy and, if necessary, to plan further measures, a follow-up examination should be carried out after two to three months.

Whom can I ask?

Whom can I ask?

For diagnosis and possible treatment of snoring, you can contact the following offices:

• Family doctor,
• Specialist in ear, nose and throat diseases (ENT),
• Specialist in oral surgery.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Medical aids & aids
• Health Professions AZ
• and via the online guide to reimbursement of social insurance costs.