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SNORING AND SLEEP APNOEA

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A few facts about snoring; 40 percent of normal adults snore at least occasionally, 20 percent are habitual snorers, it is more common in males and overweight persons, and it usually gets worse as we age. It is often said laugh an the world laughs with you, snore and you sleep alone!

    What Causes Snoring?

    The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages of the upper airway and in particular the back of the mouth at the level of the soft palate and uvula and base of the tongue. More specifically it is the vibrations created by the tongue vibrating against relaxed and bulky soft tissues of the palate and uvula and pharyngeal walls.

    Snorers usually have:

    - Lax tissues in throat due to poor muscle tone. Alcohol and certain medications, can relax body tone where by the tongue falls backwards into the airway and obstructs it and at the same time vibrates against nearby tissue. Poor muscle tone is more evident in deep sleep known as REM when the body paralyses but the mind continues working (dreaming).

    - Excess tissue usually in the back of the mouth like large tonsils and adenoids in children can cause snoring. People who are obese also snore due to excessive tissue narrowing the airways. More rarely masses and space occupying lesions can also impede the airway and by way of the increased neck pressures created in the throat on breathing can increase the narrowing and hence.

    - Not uncommon findings in adult snorers is a long soft palate and/or uvula.

    - Nasal airway obstruction by way of the fact that it creates a large negative pressure in the throat, and pulls together the excessive floppy tissues of the throat, can bring on snoring.

    Obstructive Sleep Apnoea

    Obstructive sleep apnoea is a not so uncommon condition which is thought to affect 2-4 % of men and 1-2% of women.

    In this condition there is repetitive collapsing of the upper airway during the night at the level of the throat which shuts off the airway to air entry causing a drop in the oxygen levels of the blood. The sleep apnoea syndrome that can have deleterious effects on ones health is defined as having at least 5 episodes of cessation of airflow for some 10 seconds in every hour. It is classified as mild in this situation and moderate when these arise to over 15. During the night people with this condition may find themselves awakening abruptly gasping of air and feeling a choking sensation.The frequent arousals of the brain at the end of an apnoeic episode lead to excessive tiredness during day and sometimes morning headaches.

    A self score sheet known as the Epworth sleepiness scale can reveal how likely it is to sleep in certain situations making the possibility of sleep apnoea more so.

    Obstructive Sleep Apnoea is associated with high blood pressure, coronary artery disease, stroke, and other medical conditions.

    Some cases of obstructive sleep apnoea can be managed by surgery particularly in the younger population like removing tonsils, adenoids, soft palate and uvula or surgery to the base of the tongue. These procedures can be done with a scalpel, laser, or radiofrequency coablation. Correcting the inside of the nose may be a solution for some

    For mild snoring a mandibular advancement splint or dental splint that holds your jaw forward may be helpful provided it is tolerated by the patient.

    In the older population CPAP or continuous positive airway pressure is the mainstay of treatment of sleep apnoea with excellent results.

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