The old saw (pardon the pun) about the middle aged man sleeping in the spare room because of his snoring isn’t a myth. Snoring seems to affect many more men than women (almost three quarters of men, according to one study, compared with half of women). The usual profile of a snorer is a middle aged man who is slightly overweight. Dr Earl Dunn of the University of Toronto Sunnybrook Medical Centre Sleep Laboratory says that snoring is frequently related to being overweight. “We’ve found that if a moderate snorer loses weight, the snoring becomes less loud, and in some people it actually disappears.”

In the view of Dr Philip Smith, director of the Johns Hopkins University Sleep Disorders Centre in Baltimore, Maryland, men who are just 20 per cent over their ideal body weight can develop snoring (Prevention Magazine (ed), The Doctors Book of Home Remedies, Bantam, 1991).

Its cause is the palatine uvula, the tissue that hangs in the back of the throat, which relaxes during sleep. When you breathe in, this tissue vibrates, which is similar to the action of a reed in a wind instrument.

Lately, doctors maintain that snoring may be something more than a nuisance. The louder the snore, the more it is likely to lead to a serious condition called obstructive sleep apnoea (OSA), where the pharynx collapses, the airways are obstructed and the patient has episodes where he literally can’t breathe, a problem said to affect about 4 per cent of middle aged men and 2 per cent of middle aged women (Lancet, 1997; 350: 122; Lancet, 349: 201-2).

All the medical journals are aflutter about the supposed association between OSA and hypertension or stroke, based largely on a few studies (Lancet, 1997; 350: 495). The theory is that sleep apnoea may increase stroke risk by reducing blood flow in the middle cerebral artery (Stroke, 1998; 29: 87-93).

Nevertheless, careful review of the literature shows that the relationship between OSA, snoring and cardiovascular diseases is far from clear. One review by two independent assessors of 45 papers concluded that the link between OSA and hypertension, cardiovascular disease and increased mortality is poorly established. The only connection they would make with any certainty was that people with OSA tended to be obese and older (Lancet, 1997; 350: 122).

The latest drastic medical cure for snoring is a LAUP operation (laser assisted uvula palatoplasty), which removes the offending tissue in your throat, an in office procedure performed by an ear, nose and throat specialist. At least one study demonstrates a 95 per cent success rate without complication, although others report side effects such as hypernasal speech, permanent incompetence of the upper palate, narrowing of the nasal passages or throat, air way compromise and even death (The Lancet, 1997; 350: 78).

The other solution for OSA, which also cures heavy snoring, is the continuous positive airways pressure (CPAP). Patients are fitted with a nose mask attached to a pump supplying air slightly above the pressure of the atmosphere. This cumbersome gadget manages to keep the airways open. Nevertheless, the same review of 45 papers on OSA concluded that only a single study was truly scientific, and even there there were certain flaws, leading the researchers to conclude that the evidence about CPAP wasn’t “sufficiently robust” (Lancet, 1997; 350: 122).

Whether you suffer from OSA or common or garden snoring, the evidence also shows that you should sleep on your side. OSA is often found to worsen when patients lie on their backs; in fact some patients have what is termed “positional” sleep apnoea, with episodes of decreased or shallow breathing at least twice as high when on their backs as when on their sides (Chest, 1997; 112: 629-39). This means that if your husband is snoring and on his back, you can push him gently onto his side and it should ease off. Another possibility is for you to sew an uncomfortable button or tennis ball on the back of his pyjamas, so if he rolls over onto his back in his sleep he will get annoyed by this large bump and roll back to his side. This, of course, assumes that he wears anything to bed.

One overlooked cause of snoring is allergies. Oftentimes, sleep experts find that sneezing and snoring occur in tandem, and that snoring often develops from frequent colds or nasal allergies. Further evidence is the fact that OSA and bedwetting sometimes go hand in hand (Lancet, 1997; 350: 221-2). This could be, as has been suggested, because of an interruption in sleep patterns, or it could be due to an allergy. Alternatives columnist Harald Gaier often finds that children with persistent bedwetting often become dry as soon as their allergies are located.

Other useful tips from sleep disorder experts include avoiding alcohol and sleeping pills, cigarettes and even pillows, which are known to make things worse. Dr Westbrook, director of the Mayo Clinic Sleep Disorders Center in Rochester, Minnesota, also says that elevating the bed by placing bricks or a batch of books under the legs at the head of the bed will help to stop snoring (The Doctors Book of Home Remedies).

A Morning headaches are generally a symptom of something else. They are linked with snoring (J Neurol, 1996; 243: 621-5) or sleeping with someone who snores (Health Care Women Int, 2000; 21: 81-90), teeth-grinding (J Oral Rehabil, 1997; 24: 581-7), limb-movement disorders and hypertension, and strongly associated with mood disorders such as depression and anxiety (Cephalalgia, 2002; 22: 333-9). But most doctors believe the main cause is obstructive sleep apnoea syndrome (J Neurol, 1996; 243: 621-5; Arch Intern Med, 1999; 159: 1765-8).

A comprehensive study of morning headaches, involving nearly 19,000 adult Europeans, found that 7.6 per cent (one in 13) of us wake up with a headache (Arch Intern Med, 2004; 164: 97-102). More women than men, mostly those aged 45-64 and more married than single people were morning-headache sufferers; there were also more who were unemployed and homemakers than workers and students.

Also, it was more common in those with a body mass index (BMI) below 20 (below the norm) or over 27 (obese), and among those suffering from musculoskeletal, heart or respiratory diseases, high blood pressure or thyroid disorders. Those who drank six or more glasses of alcohol a day had nearly twice the rate of morning headaches as abstainers. Likewise, rates were higher among those taking hypnotic, anti-anxiety, antidepressant or neuroleptic medications. There was no association with tobacco use.

Clearly, long-held beliefs that morning headaches are mostly related to sleep/breathing disorders are misleading. While these may be linked – for example, musculoskeletal pain can disturb sleep and, thus, lead to morning headaches – the list of causes is long.

Things that can influence morning headaches include:

* dehydration. Make sure you drink an adequate amount of water every day

* digestive problems, particularly eating foods to which you are allergic or sensitive

* bedding. If your pillow doesn’t support your head and neck properly, this could lead to spinal or musculoskeletal problems, resulting in headaches. The same applies to a worn-out mattress.

Snoring appears to be more common under certain types of conditions. It’s more common in people that are overweight or have excess fat around the neck, use of alcohol or drugs, 60% men and 40% women snore with the likelihood of increased snoring with age. Snoring also is more prominent with people that sleep on their backs, or in positions where the head is in such a position where the structures of the airway are obstructed. Snoring usually occurs when one is inhaling, instead of exhaling.

Snoring by itself is not serious. However, sleep apnea (obstructive sleep apnea-hypopnea syndrom ,OSAHS), is a medical problem. There are today, sleep disorders clinics and physicians that treat sleep breathing problems. The clinics give a questionnaire to determine the likelihood of dozing off in a variety of daily situations

Sleep apnea is a associated with total obstruction of the airway in which breathing stops all together. The origin of the word apnea comes from the Greek language meaning “want to breath”. Breathing must stop totally for at least 10 seconds or longer, by definition, to be called sleep apnea. To determine if a snoring falls into the category of sleep apnea, the sleep disorder clinics give a questionnaire which tries to find out the likelihood of dozing off in appropriate times during the day. Scoring 10 or higher is considered hypersomnolent, or sleep apnea. Then a plysomnography (PSG) test is performed. The person stays overnight at the clinic to perform the sleep test. The cost for this test is around $1200.00. Insurance often pays for PSG if the doctor needs it to diagnose the condition.

There are three types of apnea:

The most common type is called “obstructive sleep apnea.” This is characterized with total obstruction of the airway, total collapse of breathing, with effort to breath. The other two types are not that common and have to do with a problem with the central nervous system (central sleep apnea) or in combination with obstruction of the airway (mixed sleep apnea). Sometimes when there is a fall in the blood oxygen level, there may be an episode of shallow breathing, where the airflow is decreased by 50% during sleep and may last for 10 or more seconds. This is called hypopnea. This is more of a mild interruption of breathing.

One side affect of sleep apnea is interrupted sleep. Studies have shown when sleep is disturbed, the quality of life is also affected. Some of the side affects include headaches (especially in the morning), fatigue, difficulty concentrating, falling asleep at inappropriate times, high blood pressure, irregular heart rate, heart attack and stroke. Questions to ask yourself to determine if you suffer from sleep apnea include:

• Wake up very tired in the morning
• Have a hard time concentrating
• Headaches, especially on awakening in the morning
• Falling asleep easily during the day
• Sleepy and fatigue during the day
• Depressed or easily get angry, especially on awakening in the morning

So what does one do about snoring or the more serious sleep apnea? There are many products available that boast to totally cure snoring, and give peace to your loved ones who have to hear the snoring. Usually a jab from a loved one in bed will cause the snoring to stop. The problem with that is the loved one will continually be awakened.

Other treatments include a lubricant spray that promises to stop the snoring. The manufacturer claims the lubricants, including almond oil, olive oil, sunflower oil, vitamins B6,C and E will help you stop snoring. A device called the Harmony Sleep Companion that vibrates and wakes you when snoring starts, so you can roll over on your side is another means available to stop snoring. Cutting the uvula is the surgical means of removing the flap hanging in the back of the throat. It’s painful and about two thirds successful for snoring.

Radio wave treatments called SOMNOPLASTY, shrinks the tissue in air passages. This treatment involves a small radio frequency generator attached to a needle that pierces the tongue, throat or soft palate. This is not painful, even though it sounds as though it is. For half an hour the inner tissue is heated to 158 to 176 degrees Fahrenheit causing the inner tissues to shrink. You may or may not see results, for which you need to wait a week or two. The procedure may have to be repeated. Although not painful, this should be the very last resort for treatment.

Another device fits on the nose and keeps the nasal passages open by applying pressure to the septum. Your dentist can make guards to stop snoring. There are two types: mandibular advancement devices, or MADs, keep the lower jaw forward. Tongue retaining devices (TRD), holds or pulls the tongue forward out of the airway. The tongue, therefore wont fall back into the airway causing obstruction. The purpose of each of these guards is the same—to keep the airway open wide enough to prevent breathing and sleeping problems and snoring.

If you suspect that you have severe sleep problems and snore, the sleep center is a good place to start. After filling out the questionnaire and possibly doing the overnight sleep test, they can determine what treatment will be the best route to take. If you simply snore and don’t have severe sleeping problems, avoid alcoholic drinks, tranquilizers, and sleeping pills before going to bed. Make sure your nasal passages are open and that you don’t suffer from sinus allergies or any thing else clogging your nose. A gentle elbow or jab from your loved one in bed is not a bad idea either. Sweet dreams.

Snoring can be merely a nuisance or can be a signal of a serious health problem, sleep apnea, which might even require surgery. Sleep apnea is a condition where breathing is stopped for a time period of at least 10 seconds, but usually 20 to 30 seconds or even up to 1 or 2 minutes during sleep. It is more common in men than in women and typically affects men who are middle-aged and older. It can result from:

• An obstructed airway. This is more common as people age, especially those who are obese or who have smoked for many years.
  
• A central nervous system disorder such as a stroke, a brain tumor or even a viral brain infection.
  
• A chronic respiratory disease.
  

• Sleep on your side. Prop an extra pillow behind your back so you won’t roll over. Try sleeping on a narrow sofa for a few nights to get accustomed to staying on your side.
  
• Sew a large marble or tennis ball into a pocket on the back of your pajamas. The discomfort it causes will remind you to sleep on your side.
  
• If you must sleep on your back, raise the head of the bed by putting bricks or blocks between the mattress and box springs. Or buy a wedge especially made to be placed between the mattress and box spring to elevate the head section. Elevating the head prevents the tongue from falling against the back of the throat.
  
• If you are heavy, lose weight. Excess fatty tissue in the throat can cause snoring.
  
• Don’t drink alcohol or eat a heavy meal within 3 hours before bedtime. For some reason, both seem to foster snoring.
  
• If necessary, take an antihistamine or decongestant before retiring to relieve nasal congestion (which can also contribute to snoring). [Note: Older men should check with their doctor before taking decongestants. Decongestants that have ephendrine can give older men urinary problems.]
  
• Get rid of allergens in the bedroom such as dust, down filled (feathered) pillows and bed linen (this may also relieve nasal congestion).
  
• Try over-the-counter “nasal strips”. These keep the nostrils open and lift them up, keeping nasal passages unobstructed.
  

Questions to Ask

Do you notice the following signs of sleep apnea during your working hours: Sleepiness or chronic daytime drowsiness Poor memory Lack of concentration Irritability Falling asleep while driving or working Loss of sex drive Headaches
Has someone else noticed that breathing has stopped for 10 seconds or longer (sleep apnea) in the midst of snoring?
Has snoring persisted despite using the self-care tips below?