Snoring is common — so common that it is often forgotten that it can have long-term health implications.
“Snoring often points to a bigger problem,” says Dr Sachin Kumar, senior consultant, pulmonology and critical care medicine, Sakra World Hospital, Bengaluru. Experts say snorers should even watch out for changes in their heart health and for issues such as sleep apnea and obstructive sleep apnea (OSA).
Snoring and the throat
According to the Australia-based Sleep Health Foundation, a person snores when some parts of their throat vibrate when they are asleep. The part of the throat that vibrates is called the pharynx, which is right behind the tongue. Several muscles hold it open and relax when a person is asleep. This makes the pharynx vibrate more easily and it also becomes narrower. When a person breathes in, the pharynx vibrates and makes a noise. The narrower it is, the more easily it will vibrate, and the louder the person will snore.
“Snoring is a harsh or hoarse noisy breathing which occurs during sleep,” says Dr Rajesh Chawla, chest diseases specialist and sleep medicine, Indraprastha Apollo Hospitals, Delhi. “This is because there’s an obstruction to the air movement — maybe from the nose [or] the obstruction could be in your throat when your tonsils or adenoids are enlarged, or maybe the person is obese (as there is less space because there’s a lot of fat in the region). When people with this condition sleep there’s a decrease in the tone of the neck muscles. All these can result in the obstruction of the airways and in snoring.”
He says that snoring is sometimes seen in almost 45 per cent of the people who come to doctors but about 20 per cent of them will have an associated disease along with it, what’s called OSA.
“If an individual snores every night, it’s a sign that the air isn’t moving freely through their nose and throat,” says Dr Kumar. “These individuals must be experiencing some amount of obstruction in their breathing pathways known as sleep apnea. It’s estimated that patients with sleep apnea are two to four times more likely to develop heart arrhythmias (abnormal heart rhythms) than people without this condition. Sleep apnea increases the risk of heart failure by 140 per cent and the risk of coronary heart disease by 30 per cent.”
In a 2008 paper, Imre Janszky et al say that sleep-disordered breathing has been associated with an increased risk of developing coronary heart disease. The authors say that apart from this, there are several potential routes by which such breathing may affect the outcome of acute myocardial infarction (heart attack).
Symptoms of obstructive sleep apnea
Dr. Kumar says habitual snorers have several signs and symptoms of OSA:
- Excessive daytime sleepiness
- Loud snoring
- Observed episodes of stopped breathing during sleep
- Abrupt awakenings accompanied by gasping or choking
- Awakening with a dry mouth or sore throat
- Morning headache
- Difficulty concentrating during the day
- Mood changes, such as depression or irritability
- High blood pressure.
Understanding snoring and obstructive sleep apnea
“OSA is a disease where the airways are obstructed during sleep because there’s an obstruction in the upper airways,” Dr Chawla says. “It could be the tongue falling back and there’s less space for people who are obese to breathe. When the air passes, these airways vibrate and there’s a snoring sound as it progresses. Then the breathing stops for 10 seconds or up to 20 seconds in many people with this condition. There’s a drop in oxygenation during that time and the person wakes up. This kind of OSA can occur almost 50 to 60 times in one hour of sleep.”
People who are not obese but have OSA, also undergo problems with snoring, he says.
“Alcohol increases the tendency for OSA in people with structural abnormalities of the jaw, the nose and the throat,” says Dr Chawla. “Individuals with OSA tend to wake up during their sleep as their brain wakes them up due to the low oxygen that gets pumped because of this condition. The individuals might not feel the waking state, but their brain activity is woken up and their deep sleep is affected.”
The effect of it is that the next day the person feels excessive daytime sleepiness – a symptom of OSA – which, in turn, affects the heart, the brain and the libido, he says.
Fighting OSA associated with snoring
Dr Chawla suggests the following steps for individuals who have OSA:
- Weight reduction
- A person should get a sleep study (called complete polysomnography) done. Once this test establishes that there is OSA, the person is titrated with a machine called CPAP which they have to apply while sleeping. There will be no snoring after this, the airway will remain open, the person will get restful sleep and their blood pressure will also get better.
- Some other modalities are also available, but they are not very successful – like dental appliances. Even surgery has been done in some individuals but has not been found to be too effective.
Snoring and the heart
“Though snoring isn’t directly related to heart disorders, it occurs when there’s narrowing or obstruction to the airflow through the nose and mouth, causing the noise,” says Dr Divya Marina Fernandes, consultant, heart failure specialist and interventional cardiologist, Aster RV Hospital, Bengaluru. “If snoring is associated with obstruction to breathing, then it can be a heart-related issue. With the OSA condition, the airflow is compromised and people have pauses in breathing while sleeping. These pauses can [happen] multiple times, causing low oxygen levels and leading to fluctuations in heart rate and blood pressure. There’s a release of stress hormones indirectly, leading to increased pressure on the heart [and] causing high blood pressure, heart attacks and stroke.”
OSA coupled with diabetes, hypertension and obesity put a person at higher risk of developing cardiovascular problems. “Stopping smoking, reducing alcohol intake, having a healthy diet of fibres, proteins and vegetables, exercising regularly and maintaining adequate weight are all important to reduce the symptoms,” says Dr Fernandes.
Consult a doctor
If there is excessive snoring, a person should get checked for OSA. “Meet a pulmonologist and get a sleep study done to confirm the same,” says Dr Fernandes. “If proven, a BIPAP machine will help bring down the pauses during breathing and maintain adequate oxygen levels, thereby bringing down the risk.”
- Snorers should not ignore their condition. They should consult a doctor and get a breathing test done to find out if they suffer from sleep issues
- Medications do not help in such cases; the attempt should be to find out the core reason behind the snoring
- If a person addresses their snoring issues, then their heart health can be maintained well.