Snoring in a dream in Women and Men: causes and treatment

What is snoring?

Snore Is a wheezing sound in the nose and throat during sleep. Snoring is quite common and becomes more common with age. About 57% of men and 40% of women snore. However, snoring as such depends on who hears it, with the volume and duration of snoring varying from night to night. Thus, the percentage of people who snore is an estimate only.

Occasionally snoring is quiet, but usually snoring is clearly visible, and sometimes it is so loud that it can be heard in another room. Snoring only interferes with other people, usually a roommate or roommate who is trying to sleep. It is seldom known to the person who snores that he snores until others tell him about it. However, some people hear their own snoring when they wake up.

Snoring can have serious social consequences. It is often the cause of tensions between a snoring person and a bed or roommate.

Other symptoms, such as frequent waking, difficulty breathing or choking during sleep, excessive daytime sleepiness, and headache in the morning, may occur depending on the cause of snoring.

Snoring is caused by fluttering of the soft tissues in the throat, especially the soft palate (the back of the palate). The fact that people do not snore when awake suggests the cause is muscle relaxation during sleep. This relaxation is believed to reduce tissue stiffness and make fluttering (like a cloth flag fluttering in the wind, in contrast to a metal plate of the same size). In addition, relaxing the tissues narrows the upper airways, which makes flutter easier.

Causes

Primary snoring - This is snoring that does not cause awakening more often than usual during the night. During sleep, the volume of air flow to the lungs and the level of oxygen in the blood are normal. Since there are no deviations in these factors, people do not experience excessive daytime sleepiness.

- Disturbed breathing during sleep.

Snoring is often a symptom of sleep-disordered breathing. Sleep breathing disorder can range from upper airway resistance syndrome to obstructive sleep apnea syndrome (OSA). These conditions differ mainly in the degree of airway obstruction (the degree of airway obstruction), as well as in the location of the obstruction. The effects of exposure are mainly sleep and / or airflow disturbances.

Five times or more per hour of sleep, people with OSAS stop breathing for a short time, or their breathing becomes very shallow. They also have one or more of the following symptoms:

• daytime sleepiness, episodes of unintentional falling asleep, lack of alertness after sleep, fatigue or insomnia;
• waking up from delay or difficulty breathing either from suffocation;
• bedmate complaints of loud snoring, respiratory arrest, or both during sleep.

People with Upper Resistance Syndrome have excessive daytime sleepiness or other symptoms, but the complete set of signs necessary for the clinical diagnosis of OSAS is absent.

- Risk factors.

Risk factors for snoring include the following:

• advanced age (over 50);
• obesity, in particular the distribution of fat in the neck and waist;
• drinking alcohol (a very common cause of snoring) or other sedatives;
• long-term (chronic) nasal congestion;
• small jaw or deep bite;
• menopause;
• male gender;
• Negroid race;
• during pregnancy;
• disorders that block the airways, such as glands, large tongue, large soft palate, deviated septum, and nasal polyps.

Snoring is often hereditary.

Complications

It is not known whether snoring itself causes unwanted effects. However, with OSAS, the risk increases high blood pressure, stroke, heart disease and diabetes mellitus.

Diagnostics

For physicians, the primary goal is to identify people at high risk for obstructive sleep apnea syndrome. Not all people who snore have obstructive sleep apnea (OSA). However, most people with OSAS snore.

Warning signs

The following symptoms are cause for concern:

• episodes of lack of breath or choking during sleep (witnessed by a bedmate);
• headaches on waking up in the morning;
• sleepiness during the day;
• obesity;
• very loud, incessant snoring;
• high blood pressure.

These symptoms may indicate sleep apnea syndrome.

When to see a doctor?

If you have warning signs, you should see your doctor as an examination may be needed.

People without warning signs are unlikely to need testing and may want to try out general measures to reduce snoring before seeing a doctor. If such measures do not help and snoring is extremely disturbing to your bedmate, you should see a doctor.

- What does the doctor do?

Doctors first ask about snoring and other symptoms, and then about other illnesses the patient has suffered. Since several important facts are noticed mainly by other people, doctors try to talk to a neighbor in bed or in a room whenever possible. They then do a physical examination. Knowing your medical history and physical examination helps the doctor decide if tests are needed to diagnose OSAS.

Doctors ask how strong the snoring is. For example, a bedmate might be asked the following questions:

• Whether the patient snores every night, and if not, how often.
• Whether the patient snores all night long, and if not, how long during the night.
• How loud the snoring is.

The patient and bedmate are also asked to describe:

• How often the patient wakes up during the night;
• Does the patient stop breathing and have episodes of shortness of breath or choking;
• Does it seem to him that after sleep there is no feeling of vigor, and does he have headaches in the morning;
• How sleepy the patient is during the daytime.

Doctors also ask about other medical conditions that may be associated with obstructive sleep apnea. (OSAS), in particular, the presence of high blood pressure, heart disease, stroke, acid reflux, atrial fibrillation (heart rhythm disorder), depression and diabetes mellitus. They ask questions about the amount of alcohol consumed, including how close to bedtime the alcohol is consumed. It is also important whether the patient is taking any sedatives or muscle-relaxing drugs.

During the physical examination, doctors measure the patient's height and weight to calculate the body mass index (BMI). The higher the patient's BMI, the higher the risk of OSAS. Doctors can measure the circumference of the neck. OSA is most likely when the neck is more than 16 inches (41 centimeters) in women and 17 inches (43 centimeters) in men.

Doctors also examine the nasal cavity and mouth for signs of airway obstruction and for risk factors for snoring, such as nasal polyps, deviated nasal septum, chronic nasal congestion, a high and arched palate, a small jaw or deep bite, and an enlarged tongue, tonsils, or uvula (a process hanging down the back of throat). Doctors measure blood pressure because OSAS is more likely with high blood pressure.

Although doctors cannot accurately predict the risk of the disease, the more risk factors and warning signs a person has, the more the risk of OSAS increases.

- Carrying out analyzes.

If obstructive sleep apnea syndrome (OSAS) is suspected, doctors usually do tests to confirm the diagnosis.

The examination consists of polysomnography. In this test, the patient sleeps overnight in a sleep laboratory while breathing and other functions are monitored. A sleep laboratory can be located in a hospital, clinic, or other facility that is equipped with a bed, bathroom, and monitoring equipment. Polysomnography can be done at home (home sleep study) if the snoring person has many other underlying medical conditions. However, since snoring is common and polysomnography is expensive and time-consuming, polysomnography is usually done only in cases of reasonable suspicion of SOAS. Thus, usually only patients with warning signs (especially those with there were cases of breath holding, witnessed by another person, or having several factors risk).

If people without warning signs have no other sleep disorder besides snoring, tests are usually unnecessary. However, they need to schedule regular follow-up visits so that the doctor can check to see if warning signs develop.

Snoring treatment

Snoring causes, such as chronic nasal congestion and obstructive sleep apnea (OSAS), are treatable.

For snoring as such, treatment includes conventional measures to eliminate risk factors as well as physical methods to open the upper airway.

- General recommendations.

Several general measures are used to reduce primary snoring. None of the measures are universal, but may help in some cases. Possible measures include:

• sleep with your head up;
• do not drink alcohol or take sedatives for several hours before going to bed;
• weight loss;
• Treating nasal congestion - for example, with an anti-congestion agent and / or a corticosteroid nasal spray.

The best way to raise your head is to place blocks under the two bed legs at the head of the bed, or to use a wedge-shaped pillow that angles your entire upper body. Pillows should not be used to lift only the head.

For the bedmate, earplugs or a noise generator may be helpful. Sometimes it is necessary to arrange alternative sleeping conditions (for example, a separate room).

- Mouth apparatus.

Oral appliances are used only during sleep. They include:

• mandibular repositioners;
• tongue clamps.

These devices, which must be fitted by trained dentists, help to maintain airways open during sleep in people with obstructive sleep apnea (OSA), and may decrease snore.

Mandibular repositioners Are small plastic devices that are inserted into the mouth, like a mouth guard or orthodontic retainer. They push the lower jaw and tongue forward and thus keep the airway open during sleep. Many of these attachments can be tweaked slightly for best results. Adjustable devices are more efficient than fixed devices.

IN tongue retainers suction cups are used to displace the tongue anteriorly. If the root of the tongue sinks, it can obstruct the flow of air. Such devices are less convenient than mandibular repositioners.

Oral appliances can be used alone or in combination with other treatments for respiratory disorders associated with with sleep, such as weight optimization, surgery, or continuous positive airway pressure ways.

Oral appliances can cause discomfort and excessive salivation, and teeth may not be in the correct position. But most people tolerate such devices well.

- Continuous positive airway pressure (CPAP).

With CPAP, people breathe through a small mask worn over their nose or over their nose and mouth. The mask attaches to a pressurized air device to prevent the airways from narrowing and collapsing during inhalation (that is, when snoring is most common).

CPAP is extremely effective in relieving obstructive sleep apnea (OSA) symptoms and in reducing snoring, but it is rarely used to treat snoring without OSAS. Some people find CPAP devices uncomfortable or bothersome, but most people with OSAS are comfortable using these devices.

Careful medical supervision is required during the first 2 weeks of use to ensure proper adherence of the CPAP device mask and to help you get used to sleeping with the mask. OSAS patients are usually more motivated to use CPAP compared to patients who are concerned only with snoring, because in the absence of treatment OSAS leads to the manifestation of significant symptoms and increases the risk of heart disease and stroke.

- Surgical intervention.

Some types of upper airway obstruction that partially explain snoring, such as nasal polyps, enlarged tonsils, and deviated nasal septum, can be treated with surgery. But whether such procedures help to reduce snoring, and if so, how much, has not been proven.

Moreover, a number of surgical procedures have been developed specifically to treat OSAS, and some of them may help reduce snoring. These procedures change the shape of the soft tissues of the palate and / or uvula, or make the soft palate harder with implants or injections. Such procedures include uvulopalatopharyngoplasty, laser uvuloplasty, injection plastic surgery for snoring, radiofrequency ablation, and palatal implants. More research is needed to determine if these surgical procedures can effectively treat snoring.

At uvulopalatopharyngoplasty surgically reshape the soft tissues of the palate and uvula. Excess soft tissue is removed and the airway is widened. The operation is performed under general anesthesia in a hospital. As a result, snoring may decrease, but this effect sometimes lasts only a few years.

IN laser uvuloplasty a high-energy laser or microwave device is used to reshape the tissues, and this procedure is less invasive than uvulopalatopharyngoplasty. However, it has not been proven that such a procedure can reduce snoring, although some people benefit from it.

When conducting injections for snoring (a type of sclerotherapy) a substance is injected into the soft palate that irritates the tissues and causes the formation of a fibrous scar. As a result, the soft palate and uvula become more rigid and their ability to vibrate is reduced. Further research is needed to understand whether this procedure can help eliminate snoring.

At radiofrequency ablation a probe is used to supply heat (from an electric current) to the tissue of the soft palate. With this procedure, the tissues shrink and become stiff. The procedure reduces snoring, but more research is needed.

Palatal implantsmade of polyethylene, can be surgically inserted into the soft palate to make it harder. Three small implants are used. It has not yet been proven that such implants themselves are useful in treating snoring.