By Lim Wey Wen

AFTER a long day at work, Matt nods off during a late night project discussion in his office. Suddenly, his colleagues are distracted by short, coarse grunts followed by sharp, shrilly whistles coming from his side of the table.

As they turn towards him, Matt wakes up with a blush creeping up his neck while he stares into five grinning faces.

Now, the scene may be completely fictional, but it is not unknown of.

Snoring can be a normal condition in people - young or old - and about 50 to 60 per cent of people snore at some point of their lives, says Ear, Nose and Throat (ENT) surgeon Dr K Gopalan Nair at the Breathe Right nasal strips launch recently.

But it is when a person's snoring becomes a social disturbance, he or she may need to seek help, Dr Gopalan says.

As a gauge of how many Malaysians actually snore, a survey of about 1,000 Malaysian adults found 30 per cent of their respondents saying, "Yes, I snore" and 37 per cent saying that their partner snores. More men say they snore, and more women claim that their partners do.

The pertinent questions are: "Are they bothered by their own snoring or their partners?" And, "Are they doing anything about it?"

Among the self-professed snorers, 36 per cent think that their snoring at least occasionally disturbs their partner but 53 per cent of their partners say they were disturbed by the night "orchestra".

But more importantly, out of the estimated 50 per cent of the respondents whose sleep are disturbed by snoring, nine out of 10 are not taking any measures to deal with it.

Why do people snore?

"Snoring is a noise generated as a result of partial obstruction of the airways," he says. As the obstruction is partial, Dr Gopalan says it can be reversed. "You can take away the partial (obstruction) and you don't snore any more. It is treatable."

While fatigue, stress, or the nightcap before you hit the sack are among the reasons why we may snore sometimes, the origin of the snoring phenomenon lies within the anatomy of our nose and mouth.

Any changes to the structures around and in the nose can cause snoring. If you have allergic rhinitis (inflammation of membrane linings in the nose), a blocked nose or sinusitis, you can snore, says Dr Gopalan.

There are also inherent structures of a person's nose and mouth that make he or she more likely to snore. They include characteristics like a long soft palette and uvula (the roof your mouth and the small piece of soft tissue that can be seen dangling down over the back of your throat), a deviated septum (the structure that separates the left and right nostrils) or a tongue that falls backwards during sleep.

"As you doze off and progress from a lighter sleep to a deep sleep, the muscles in the roof of your mouth (soft palette), tongue and throat relax. The tissues in your throat can relax enough that they vibrate and may partially obstruct your airway," says a Mayoclinic article on snoring. "The more narrowed your airway, the more forceful the airflow becomes. Tissue vibration increases, and your snoring grows louder."

"This excessive vibration can occur very commonly in people who are obese and overweight," Dr Gopalan says. When a person who is obese sleeps, his tongue might fall backwards and partially close the normal pathway of air that enters through the nose.

Fatigue, alcohol before sleep, stress and a more serious condition called obstructive sleep apnoea (OSA), however, can also result in more relaxed throat tissues, causing a person to snore during sleep.

With restricted airflow, "the brain will send a message saying that 'there is not enough oxygen, Open Sesame (the mouth is open)'. And then you snore," Dr Gopalan explains.

On another note, if you snore during pregnancy, it is probably due to increased blood flow in the body, including the nose.

(Page 1 of 2)Not just a social problem

To Dr Gopalan, the most important element in treating snoring is in educating the snorer and his or her partner on the ways to look out for danger signs when it comes to snoring.

While mild, intermittent snoring may be just be an irritation that disrupts sleep, snoring that is loud, persistent and followed by stopped or laboured breathing and choking may indicate other health problems.

One of the causes of loud snoring - OSA - is a serious condition that requires treatment. "About one out of 10 people who snores may have OSA," Dr Gopalan says.

"And in OSA, when the patient is sleeping, he suddenly stops breathing. Then he chokes but he doesn't realise it."

However, the spouse or sleeping partner may pick it up. And when that happens, you better seek treatment, Dr Gopalan cautions.

"Because what happens is the saturation of oxygen (in your blood) that goes to your brain decreases dramatically and you may end up dying, or having a stroke or heart attack," he says. "It may even lead to hypertension."

People who have sleep apnoea also experience sleep deprivation, making them sleepy during daytime or unable to concentrate on their daily activities.

As Dr Gopalan relates a personal experience of his friend who left work and found himself lying in a hospital with a fractured leg due to an accident, lack of quality sleep due to sleep apnoea can pose risks to people who suffer from it.

Therefore, if you realise that your snoring is a problem, consulting a physician may benefit both you and your partner. You can rule out harmful conditions such as OSA, nasal congestion or obesity, and your partner may finally be able to get a good night's sleep after you seek medical advice.

Snore no more

The treatment of snoring depends on its severity. To reduce snoring, Dr Gopalan says some of the easiest ways are to lose weight, avoid taking sleeping tablets or consuming alcohol in the evening and stop smoking.

Dental appliances and nasal strips to open the airways through mechanical means can also be used.

However, if a person has OSA, detection and treatment must be started early by ENT or respiratory specialists to prevent further complications like hypertension, heart attacks and stroke, Dr Gopalan says.

OSA can be treated with the help of a Continuous Positive Airway Pressure (CPAP) machine. "What a CPAP machine does is it pushes in air through the obstructed part directly into the lungs. It is a live-saving machine for some patients who have moderate to severe sleep apnoea," Dr Gopalan says.

If all above fails, surgical or invasive methods to correct or removing parts of the structures that are obstructing the airways can be discussed.

"Nasal symptoms and snoring are all treatable symptoms. Patients who have severe snoring may have OSA, especially in the overweight population," Dr Gopalan says.

That is why if you are in doubt, always consult a doctor, he concludes.

References:

1. Snore tests: Identify the cause of your snoring, British Snoring and Sleep Apnoea association, www.britishsnoring.co.uk

2. Snoring, Mayoclinic, www.mayoclinic.com/health/snoring/DS00297

This story was first published in The Star on Nov 9, 2008.

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