What to Know About Snoring and Sleep Apnea

Snoring can be an annoyance that occasionally disrupts a good night’s sleep. Or it could be a sign of sleep apnea, a potentially serious breathing condition.

“Patients come to see me because they’re experiencing constant snoring that’s become pretty severe,” says Columbia sleep medicine specialist Yi Cai, MD. “Sleep apnea is the condition we usually worry about, but there are a growing number of treatments to consider.”

Dr. Cai discusses the causes of snoring, ways to reduce snoring, and signs that sleep apnea could be the underlying problem.

What is snoring?

While we're awake, muscles work to keep our upper airway open. At night, the muscles in our bodies relax, including those in the upper airway. If those muscles relax to the point at which airflow vibrates the tissues in the back of the throat, snoring occurs. 

Snoring is very common and becomes more common as we age: Around 40% of adult men and 30% of adult women are regular snorers, according to the National Sleep Foundation. Importantly, snoring may also be a sign of sleep apnea.

What is sleep apnea?

Obstructive sleep apnea is a condition in which breathing is interrupted while you sleep. It can have serious health consequences, such as increased risk of high blood pressure, heart disease, and even early mortality. It is estimated to affect almost one billion people worldwide.

Sleep apnea involves recurring episodes in which breathing pauses and the airway collapses, which can cause drops in oxygen. The body may try to wake itself up to breathe, which may take the form of a slight “arousal” that can disrupt sleep. Because many patients don’t remember these experiences the next day, a bed partner who sees these episodes can be helpful in diagnosing sleep apnea.

There are several signs of sleep apnea you may be able to notice in yourself, such as:

• Waking up gasping: An episode of choking or gasping for air may be extreme enough that you fully wake up and remember it.
• Daytime sleepiness: Sleep apnea can prevent people from progressing to deeper sleep stages for a good night’s rest. So they feel very tired during the day and may fall asleep during a conversation or even while driving. 
• High blood pressure: Sleep apnea can increase the risk of hypertension. The combination of regular snoring and hard-to-treat high blood pressure could be a sign of sleep apnea.

Ways to improve snoring and sleep apnea

From nighttime tips to overall lifestyle changes, Dr. Cai suggests several ways to cut down on snoring, as well as improve sleep apnea symptoms, including the following.

• Avoid alcohol: Avoid alcoholic drinks four to six hours before bedtime. Alcohol further relaxes throat muscles, making snoring worse.
• Stop smoking: Smoking can exacerbate snoring by causing inflammation and swelling in the airway.
• Change sleep position: A bed partner may notice if your snoring is worse when on your back. If so, try sleeping on your side. Although pillows or positioning devices may help, Dr. Cai finds them ineffective.
• Maintain a healthy weight: When we gain weight, fat can deposit in the upper airway making the vibrations of snoring worse. Weight loss could therefore help reduce snoring.
• Minimize acid reflux: Heartburn can irritate the upper airway, which exacerbates snoring. Avoid spicy or very acidic foods before bed. Or sit upright for at least 30 minutes after eating to let food digest instead of coming back up from the stomach.
• Consider your environment:Irritants like seasonal allergens can cause swelling inside the nose or airway, which can contribute to snoring. If you have common signs of allergies (such as sneezing and watery eyes), treating those symptoms may alleviate snoring.

Treatments for sleep apnea

If you have sleep apnea, the good news is there are an increasing number of options for getting help.

A continuous positive airway pressure (CPAP) machine is the most common treatment for sleep apnea. It involves wearing a mask that delivers a steady flow of air into your nose and mouth. Although these devices have become smaller and less noisy in the last decade, many patients still struggle with using them.

“While CPAP is still the most common first-line therapy, if it doesn't work, there are now several alternativesto consider. There’s no ‘one-size-fits-all’ treatment,” says Dr. Cai. At the CPAP alternatives clinic, Dr. Cai and her team work to understand each patient’s airway features and needs to customize treatment.

For those who struggle with CPAP, alternative treatments include:

• Hypoglossal nerve stimulation: This small, implantable device stimulates the tongue muscle during sleep, preventing airway collapse. It is activated at bedtime with a small remote.
• Oral appliances: Dental devices that reposition the lower jaw to keep the airway open are considered for mild and moderate cases.
• Other surgical options: In some cases, procedures can remove excess tissue in the throat, stiffen the airway to prevent collapse, or adjust the jaw positioning.

For anyone living with constant snoring, seeing a sleep specialist who can conduct a sleep study and diagnose sleep apnea could be the first step in finding relief from symptoms and getting a quality night’s rest.

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Yi Cai, MD, is the director of sleep surgery and assistant professor of Otolaryngology/Head and Neck Surgery at Columbia. She specializes in the diagnosis and surgical management of obstructive sleep apnea. Her research on sleep apnea is funded by the American Academy of Sleep Medicine, Triological Society, and the American Heart Association.