Snoring: Causes, Health Risks and Treatment

How snoring happens

During sleep, muscle tone in the throat drops. The soft palate, uvula, tonsils, tongue and walls of the throat can sag inward. Air flowing past these floppy tissues makes them vibrate. The narrower the airway, the faster the airflow and the louder the noise.

Snoring sits on a spectrum:

1. Simple (primary) snoring: noise without breathing pauses or drops in oxygen.
2. Upper airway resistance: extra effort to breathe causes brief awakenings and unrefreshing sleep, without full pauses.
3. Obstructive sleep apnea: repeated partial or complete airway collapse, with pauses of 10 seconds or more, oxygen drops and fragmented sleep.

If you want to understand a particular breathing sound, including snoring-like sounds while awake, see snoring as a symptom.

Causes and risk factors

• Sex and age: men snore more, and snoring rises with age. Women's snoring increases after menopause.
• Obesity: fat deposits around the neck and tongue narrow the airway.
• Alcohol, sleeping pills and some antihistamines: relax the throat muscles.
• Nasal obstruction: deviated nasal septum, polyps, enlarged turbinates, colds and allergic rhinitis.
• Anatomy: a long soft palate, large uvula, large tonsils, a large tongue or a small or receding lower jaw.
• Sleeping on your back.
• Smoking.
• Pregnancy, especially the third trimester.
• Underactive thyroid, which can cause tissue swelling.
• Family history.

Is snoring dangerous?

Simple snoring is not harmful to the snorer, though very loud long-term snoring may contribute to thickening of the carotid arteries. Its main effects are on the bed partner's sleep and on relationships.

Snoring becomes a health concern when it is part of obstructive sleep apnea. Untreated sleep apnea is linked to:

• high blood pressure, often hard to control
• atrial fibrillation, heart failure, heart attack and stroke
• type 2 diabetes
• daytime sleepiness and car crashes
• mood and memory problems

Diagnosis

A doctor or sleep specialist asks about snoring loudness, frequency, observed pauses, daytime sleepiness (often using the Epworth Sleepiness Scale), alcohol, medicines and weight. A bed partner's account is very useful, as are phone recordings. Examination checks the nose, mouth, throat, jaw, neck size and blood pressure.

• Sleep study: a home sleep apnea test or overnight polysomnography is needed to rule out sleep apnea before treating snoring as simple snoring.
• Nasal endoscopy or drug-induced sleep endoscopy: used by ENT surgeons to find exactly where the airway vibrates or collapses before surgery.

Treatment

Lifestyle changes

• Lose weight: often the most effective single change for people with excess weight.
• Side sleeping: positional devices, special pillows or a backpack-style wedge.
• Avoid alcohol for 3 to 4 hours before bed and avoid sedatives.
• Stop smoking.
• Raise the head of the bed by about 10 cm (4 inches).

Treating the nose

• saline rinses and steroid nasal sprays for allergies and chronic rhinitis
• external nasal strips or internal nasal dilators
• surgery for a deviated septum, polyps or enlarged turbinates

Treating the nose alone often reduces but does not eliminate snoring.

Oral appliances

A mandibular advancement device, a custom mouthguard that holds the lower jaw slightly forward, opens the airway behind the tongue. Devices fitted by a dentist trained in sleep medicine work better than over-the-counter versions. Side effects include jaw discomfort and changes in the bite. Tongue-retaining devices are an alternative.

CPAP

Continuous positive airway pressure (CPAP) is the main treatment for moderate to severe sleep apnea and also stops snoring. It is not usually used for simple snoring alone.

Surgery

Options include:

• Palate procedures: uvulopalatopharyngoplasty (UPPP), palatal implants or radiofrequency treatment to stiffen the soft palate
• Tonsillectomy, especially when tonsils are large
• Tonsil and adenoid removal in children, which usually cures snoring and childhood sleep apnea
• Jaw advancement surgery and hypoglossal nerve stimulation for selected people with sleep apnea

Surgery for simple snoring has variable long-term results, and snoring can return as tissues relax over time.

Outlook

Most people can reduce snoring substantially by combining lifestyle changes with nasal treatment or an oral device. Earplugs or separate bedrooms are reasonable practical solutions for partners. If snoring comes with pauses or daytime sleepiness, testing and treating sleep apnea improves energy, blood pressure and safety.

Frequently asked questions

What causes snoring?

Snoring is caused by relaxed tissues in the throat and nose vibrating as air passes through a narrowed airway during sleep. Common contributors are excess weight, alcohol, sleeping on your back, nasal congestion, large tonsils, aging and a family tendency.

How can I stop snoring naturally?

Sleep on your side, avoid alcohol and sedatives before bed, lose weight if needed, stop smoking and treat nasal congestion with saline rinses or nasal strips. These steps help many people. If snoring continues, an oral appliance or medical assessment may help.

Is snoring a sign of a health problem?

Occasional snoring is usually harmless. Loud, nightly snoring with pauses in breathing, gasping or daytime sleepiness can be a sign of obstructive sleep apnea, which raises the risk of high blood pressure, heart disease and stroke and should be tested.

Do anti-snoring mouthguards work?

Mandibular advancement devices, which hold the lower jaw forward, reduce snoring in many people and also treat mild to moderate sleep apnea. Custom devices from a dentist work better than boil-and-bite versions. They can cause jaw soreness and should be checked over time.

Can snoring be cured with surgery?

Surgery can reduce snoring when a clear cause such as large tonsils or a blocked nose is found. Results of palate surgery for simple snoring vary, and snoring may return over months to years. A sleep study should come first to rule out sleep apnea.