Snoring

WHEN TO SEE YOUR DOCTOR

* Your spouse notices your loud snoring is interrupted by pauses in breathing of about ten seconds or more, perhaps followed by gruff snorts or gasps for air.

* You also complain of frequent daytime sleepiness or fall asleep during the day.

* You snore and have any of the following: high blood pressure, leg swelling, problems getting an erection, memory lapses or difficulty in concentrating.

What Your Symptom Is Telling You

Your snoring punctures the night with the low, distant rumble of an approaching freight train, swelling louder and louder. You—and probably anyone in hearing distance—are riding the Red-Eye Express at least as far as Tired Days Junction.

Snoring is so common, so difficult to cure and usually so medically insignificant that doctors can be reluctant to treat it. "Snoring may be a normal human condition," says Paul Gouin, M.D., director of the Sleep Disorders Program at Ingham Medical Center in Lansing, Michigan. "So many people are snorers (men more so than women) that it'd be kind of hysterical to become overly concerned," Occasionally, however, snoring has a darker side—sleep apnea.

"At the bottom of everything, we're looking at a structural issue, at how people's throats are built," says Dr. Gouin. "When awake, throat muscles keep the airway open and unrestricted." Once asleep, muscle tone decreases and the throat relaxes. In snorers, the tongue or the tissue on the inside of the throat partially obstructs the smooth passage of air through their windpipes. Like the sudsy slurp of air sucked through a straw at the foamy bottom of a milkshake, snoring is the sound made when oxygen is inhaled between the obstructing tissue.

Now take a wet paper straw and suck really hard. The sides of the straw, already weak and spongy, collapse, permitting no air to pass. That's what happens inside the throats of people with sleep apnea. "In the act of breathing, you're trying to suck your throat down your throat," Dr. Gouin explains. "In trying to overcome the partial obstruction, you inhale harder, and the relaxed walls of the throat fly inward and stick to each other."

A person with sleep apnea stops breathing, not just once or twice but as frequently as hundreds of times during the night. All this gasping and snorting interferes with restful slumber, possibly straining the heart and forcing a rise in blood pressure.

Symptom Relief

Not every snorer has sleep apnea, doctors say. But almost every person with apnea is a snorer. For both, keeping the throat unrestricted can be as difficult as maneuvering the straw between the bubbles in the shake. "Treatment is very frustrating to deal with," says Mark Mahowald, M.D., director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis. "You can't predict with any certainty the degree of success."

Nonetheless, the treatments are legion, and all of them work for some people.

Round up the usual suspects. Colds, sedatives, allergies, obesity, advancing age and drinking alcohol before going to bed all can affect your nighttime respiration and all should be considered in snoring treatment. "But you can have those things—you can have all of those things—and still not be a snorer," Dr. Gouin says. Conversely, you can eliminate all of them and still rattle the rafters.

Roll over, Beethoven. If dogs can be taught to roll over, so can snorers. And when you talk about positions in bed, the best one—at least to prevent snoring—may be on the side, as relaxed tongues and throat tissue are less likely to block air. "You can teach yourself to sleep on your side with position training," says Suzan Jaffe, Ph.D., clinical director of the Sleep Program at Hollywood Medical Center in Florida.

Stay off your back. Sew a pocket for a tennis ball into the back of your pajamas between your shoulder blades, near the neck. "Within a few weeks," Dr. Jaffe says, "you will have trained yourself to sleep on your side, and you won't need the tennis ball."

If that doesn't work, ask for an elbow nudge. "It's the famous honey-turn-over technique," Dr. Gouin says. Nudging the snorer enough to turn him or her over is all that's needed in certain cases.

Become tongue-tied. Mouthpieces and other professionally fitted dental devices, which retain the tongue and form an easier passageway for air, are "enjoying a resurgence of interest," according to Dr. Gouin. While they may sometimes be effective, snorers may find them uncomfortable to wear, he says.

Just say no. Resist the urge to purchase gimmicky items that promise relief. Neck braces and molded pillows designed to stop snoring haven't been shown to be worth anything, Dr. Gouin says.

CPAP is a blue-ribbon gear. There's one exception to the no-devices tip, however. If you don't mind wearing to bed what looks a bit like skin-diving apparatus, continuous positive airway pressure (CPAP) machines are virtually guaranteed to end apnea and snoring. Upon retiring for the night, you don a small triangular nose mask that's attached by tubing to a small fan in a box that sits on your nightstand. The fan sends just enough air through your nostrils into your throat to keep the airways unobstructed and the night silent.

"People report feeling much better after the first night they use it," Dr. Mahowald says, "and it stops snoring, too." What about the cumbersome gear? "Wearing underwear is intrusive, too," Dr. Gouin says, "and nobody thinks about that. Once it becomes standard operating procedure, you don't think any more about it."

A CPAP machine, which can be obtained only from a doctor and usually only to prevent apnea, isn't cheap. Expect to pay upwards of $1,000.

Take a slice and roll the dice. To cure common snoring that is not a health threat, surgical procedures to open up the nose or remove excess tissue in the throat are iffy. Operations to straighten deviated septums (the bone and cartilage that separate your nostrils) or remove nasal polyps don't have uniform success, doctors say.

In children, however, enlarged tonsils and adenoids "are often a forerunner of things to come," Dr. Jaffe says, and removal at an early age often prevents snoring or apnea problems later in life.

One of the most complicated procedures is uvulopalatopharyngoplasty, in which the tonsils, the back of the soft palate and the uvula (that little "punching bag" in the back of the mouth) are removed. "It's like tucking up the skin of the throat," Dr. Gouin says. Again, though, success is "notoriously unpredictable."