goodhealth.

Im a snorer

Snoring can be a mildly annoying habit or indicate a more serious issue. Bonnie Vaughan looks at the causes and treatment

WhAT
ts no exaggeration to say that snoring is a serious problem. The noise generated by the vibration of the soft, floppy tissue at the back of the airway can be as gentle as a kittens purr or as loud as a jackhammer. When its raucous and relentless, snoring is not only a notorious relationship killer, it can also be hazardous to your health. Snoring can be divided into three basic categories: Simple snoring, which is mild and intermittent and happens to most people at some point; problematic snoring, which disturbs a partners sleep and occasionally the snorers as well; and obstructive sleep apnoea (OSA), a temporary stoppage of breathing during sleep, potentially up to hundreds of times a night, which causes the heart to race, oxygen levels to drop and sleep to become extremely fragmented. OSA has been linked to high blood pressure, heart disease, diabetes, depression, obesity, stroke, and even an increased risk of dying of cancer. And its not just the snorer whose health is at risk. Their bed partner is continually woken up by the snorting, wheezing or gasping emanating from their mate. Its a vicious circle for both parties, resulting in fatigue, poor memory and concentration, and possibly hypertension and depression.

SnOrInG?

About 25 per cent of the adult population snores, the classic snorer being male, overweight, aged between 30 and 65 and possibly a drinker and/or smoker. But thats by no means an exclusive profile. Twenty-four per cent of women are habitual snorers, and at least 2 per cent of middle-aged women have OSA, compared to 4 per cent of middle-aged men. Although obesity is a major contributing factor, you dont have to be carrying extra kilos to snore. Other potential causes include nasal congestion due to illness, allergies or nasal deformities, genetic predisposition, large neck circumference, sleep position, smoking, pregnancy, menopause, sleeping medications, or eating or drinking alcohol close to bedtime.

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photography juIcyImAGeS.neT

When IS IT A

OPTIOnS
here are some examples of snoring and oSa therapies that are widely in use, as well as some newer treatments that are currently under evaluation.

According to Dr Peter Buchanan, a sleep and respiratory physician at the Woolcock Institute of medical research, Its important to separate out people whose snoring may be problematic for social reasons and people who have other symptoms that may be linked to underlying, undiagnosed sleep apnoea of varying severity. The first clue that you might have OSA is if a bed partner witnesses you gasping or stopping breathing while you sleep. Other signs are continually waking up unrefreshed or feeling sleepy, even when you think youve slept well. you may also wake up during the night with the sense that youre choking, or with a snort. At that point, Dr Buchanan says, you should be addressed by further assessment.

Suitable for: mild-to-severe sleep apnoea. A device that uses a compact air pump to provide steady pressure through a face mask or nose-only nozzle to prevent the airway from collapsing while sleeping. The cPAP is currently considered the most effective treatment for sleep apnoea, although many people find it difficult to tolerate.

continual positive airway pressure machine (cPAP)

vibration. The long-term results of the procedure are not yet known.

Pillar procedure
Suitable for: mild sleep apnoea due to palatal problems. Three tiny implants made from woven polyester are injected into the soft palate tissue. It is uS FDA approved but still awaiting government approval in Australia, so its not yet eligible for medicare or insurance reimbursement.

mandibular advancement splint (mAS)

Suitable for: heavy snoring; mild-to-moderate sleep apnoea. An oral device custom-fitted by a dental surgeon to push the lower jaw and tongue forward to open the airway and reduce soft-tissue vibration. The pressure can cause some discomfort and affect teeth and jaw alignment, so progress must be monitored.

Apnex hypoglossal nerve stimulation (hGnS) system

Suitable for: moderate-to-severe sleep apnoea. A small electrode is implanted under the tongue and synchronised to a pacemaker-style sensor device surgically inserted in the chest to detect changes in the patients breathing pattern and stimulate the tongue and soft tissue muscles to open the airway. This treatment is currently in trials in the uS, europe and Australia, with promising results. To participate in the trials, go to www.sleepapneatrial.com.

ABOuT IT?
In many cases, snoring can be alleviated by such basic lifestyle adjustments as losing weight, quitting smoking, avoiding sleeping on your back, and limiting your alcohol consumption. If nasal congestion is the cause, then antihistamines or nasal strips may do the trick. If the problem is more serious, ask your GP for a referral to a qualified sleep physician, who will help determine the nature and severity of your snoring and assess your risk factors. you may need a sleep evaluation study a procedure that involves connecting sensors to your body to record brainwaves, eye movements, heart rate and breathing patterns to determine if you have OSA. Or, if your snoring is related to a respiratory problem, you may be referred to an enT specialist who qualifies in sleep disordered breathing. Determining the solution requires interpretation, considering a range of options and tailoring those to the severity of the sleep apnoea and the specific needs of the individual, advises Dr Buchanan.

Provent therapy
Suitable for: heavy snoring; mild-to-severe sleep apnoea. A disposable adhesive device that acts as a one-way valve is adhered to each nostril to help increase air pressure and control airflow. This treatment requires a prescription from a sleep physician or GP. Initial clinical trials have so far been promising. For more information, visit www.proventtherapy.com.

Breathing exercises
Suitable for: mild-to-heavy snoring; mild-to-moderate sleep apnoea. Australian physiotherapist Tess Graham has been conducting breathing retraining programs for more than 20 years, and says that poor breathing habits are directly related to snoring and OSA. her new book, Relief From Snoring and Sleep Apnoea (Viking, $29.95), outlines the science behind her theory and provides exercises to help you observe, analyse and ultimately transform your breathing patterns.

Injection snoreplasty
Suitable for: snoring due to soft palate vibration. A new non-surgical procedure in which the soft palate is injected with chemical agents to create stiffening to minimise

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