Snoring during pregnancy can be bothersome to the bedpartner, and can be a sign of obstructive sleep apnea (OSA). Although a relatively low percentage of women snore, it is more common during pregnancy as women gain weight and their airways narrow. A pregnant woman who snores and has pauses in breathing could have OSA. A sleep study could be ordered to evaluate for snoring and OSA. Treatment is then started based on the patient’s symptoms and the severity of OSA.
Are you snoring during your pregnancy or know someone who is?
Are you tired or frustrated by the snoring?
We agree that this is a problem and we would like to help provide more information.
Snoring can be embarrassing for the snorer, and they may feel guilty and helpless for bothering their bed partner, especially since the snoring is involuntary.
Although many people find snoring to be funny or just annoying, it can actually be a sign of more serious problems and may warrant additional exploration.
Snoring is common during pregnancy, especially during the third trimester.1
This snoring during pregnancy guide was created over three months with the intent of being a helpful, yet comprehensive resource for women who are pregnant and snore.
This guide may also be helpful for the snorer’s bed partner and for the snorer’s family.
Frequently asked questions and questions posted on the internet were collected and answered. There are 35 topics covered, with over 6000 words.
This information guide helps explain why women snore during pregnancy, what problems the snoring can cause and what can be done to help improve the snoring.
Additionally, references and resources are provided to help provide information for snoring during pregnancy.
Snoring during pregnancy overview:
Disclaimer: This is an educational blog site. The content is meant for educational purposes only. There is no affiliation with any organization or company. Although we do our best to provide accurate and true information, it is possible that there may be mistakes or errors. The information is not meant to provide specific medical advice and if you rely on any information on this website, it is at your own risk. Even though the writer(s) on this blog site is/are healthcare provider(s), the information is for educational purposes only and you should consult your own healthcare provider for specific information for you. We reserve the right to update, change and manage the blog site at any point.
Snoring is a common problem in adults. Although a relatively low percentage of women snore, it is more common during pregnancy as women gain weight and their airways narrow.
Snoring is due to the vibration of soft tissues in the throat (soft palate and uvula in most cases). Snoring can be a sign of obstructive sleep apnea, which is a disorder in which patients have decreased airflow or no airflow for 10 seconds or more per episode on a repeated basis during sleep.
If the snoring is concerning at all, then a visit to a healthcare provider is recommended.
Frequently asked questions – 35 topics grouped by category below:
Why do pregnant women snore?
Five common reasons for snoring during pregnancy include:
- Weight gain (fat can deposit into the tongue and throat),
- Hormone changes (hormones can cause increased nasal congestion),
- Fluid from the legs can shift to the neck and upper airway while lying down,
- The abdomen and uterus enlarge and press against the diaphragm, and
- The overall increase in body mass can cause a smaller space for air to flow from the nose or mouth or throat into the lungs.
Is snoring caused by the vibration of the soft tissues of the upper airway?
Yes, snoring is due to the back and forth movement (vibration) of the soft tissues of the upper airway during sleep.
The most common locations for the vibration includes the soft palate and uvula (tissue that hangs down from the soft palate). 2
Other tissues that can vibrate include the tonsils, the tongue, the epiglottis (the flap that covers the upper airway when you eat, drink or swallow to protect you from choking) and the supraglottis (soft tissue just above the vocal cords).2
Can anyone snore?
Almost anyone can snore depending on the situation. For example, if an adult man or woman drinks alcohol, then his or her throat can relax and obstruct the flow of air during sleep and therefore can cause snoring.
It has been demonstrated that even in a non-pregnant woman, sleep-disordered breathing has been associated with high blood pressure, diabetes and cardiovascular disease.3
Can pregnancy decrease the size of the upper airway?
Yes, weight gain during pregnancy causes an increase in the body mass index, and the increased body mass can contribute to a smaller upper airway.
If the weight gain includes an increase in the body fat, then the fat storage also can deposit into the throat and tongue, again narrowing the upper airway.
An increase in the size of the neck and mass within the neck can also hypothetically contribute to narrowing the upper airway when she lies on her back as the tissue would push against the front of the neck, and this could potentially make snoring worse.
How common is snoring during pregnancy?
Snoring during pregnancy in early pregnancy (before 20 weeks gestation):
A large study of 1,303 pregnant women found that 7.3% had habitual snoring in early pregnancy.4
How does snoring compare in non-pregnant women vs. women in the third trimester of pregnancy?
Another study found that 4% of non-pregnant women snored, while 14% of women in the third trimester of pregnancy snored.5
Snoring during pregnancy in the first vs. the second vs. the third trimester:
In a study evaluating snoring during pregnancy, 18.1% of women snored in the first trimester and 25.7% of women snored in the late second trimester and early third trimester. 6
Are obese women at a higher risk of having sleep-disordered breathing compared to non-obese women?
Yes. Obese women gain weight and mass during their pregnancy, which makes an already narrow airway even narrower as the pregnancy progresses.
A study evaluating obese women and non-obese women found that the obese women gained on average 13 kg, while the control women gained 16 kg.7
Despite the non-obese women gaining more weight (relatively speaking), when compared to obese women, the non-obese women had significantly less snoring (1% of the night compared to 32% of the night) and had less oxygen drops.7
How much snoring is too much?
Is the snoring heard on a nightly basis, or just a few nights a week? Snoring is considered to be frequent when there are ≥3 nights of snoring per week.
That is not to say that heavy snoring two nights a week is not a problem since it could affect the bed partner significantly on those two nights.
How accurate is the self-reported snoring score with objective recordings of patients’ snoring in their own homes?
One study evaluating the differences in snoring from night to night found that at least four nights of recording the snoring sounds is the best to help determine how bad the snoring is.8
How can you measure the snoring at home?
Nowadays, snoring can be measured at home with a smartphone. This is no replacement for a sleep study but can help to demonstrate just how bad of a problem the snoring is.
Because smartphones have a microphone, there are apps that have been developed that used to track snoring. This will allow you to try different interventions on snoring and then see how they do for you.
How can a smartphone with a snoring app help you reduce snoring?
As an example, if you snore about 200 times per hour and then start using a wedge pillow and your snoring decreases to 20 times per hour, that would be a highly successful intervention.
You can track different interventions and see what works. Often, a combination of medical interventions may be needed in order to achieve success.
If you would like to read a peer-reviewed study on the topic, you can go to PubMed and read the study “Smartphone apps for snoring” which gives the results after reviewing 126 apps.9 The study found that the snoring app called “Quit Snoring” received the highest rating overall.9
How loud does snoring get, and how loud is too loud?
Snoring is commonly defined by noisy breathing that is ≥50 dB.10 One study found that loud snoring is 65 dB sounds.8 In some people, snoring can reach 80 to 90 dB.11
Generally, the visual analog scale is used and snoring is graded from 0 to 10, using 0 as a reference for completely quiet and 10 as a reference for snoring so loud that:
- it can be heard through a closed door,
- the people around them cannot sleep,
- the bed partner asks the snorer to roll over,
- the bed partner leaves the room or asks the snorer to leave the room, or
- a variation of the above.
Could snoring during pregnancy be a sign of obstructive sleep apnea?
Yes. Snoring can be present during pregnancy with or without obstructive sleep apnea. If the snoring is nightly and she is awakening throughout the night with choking, gasping or there are pauses in breathing, then there is an increased amount of upper airway blockage or obstruction.
The increased upper airway obstruction could potentially reduce the oxygen that is delivered to the woman and her unborn child when she sleeps.
What is obstructive sleep apnea?
Obstructive sleep apnea is when there is obstruction or blockage of airflow during sleep that can cause the brain to have to repeatedly wake up at night (also known as a brain arousal).
These blockages are counted if they last 10 seconds and are associated with a moderate decrease in airflow (hypopneas) or a severe decrease in airflow (apneas).
What is a RERA?
A respiratory effort related arousal (RERA) is when there is a respiratory event that doesn’t meet criteria for a hypopnea or an apnea but is associated with a brain arousal (brain awakens, but the patient doesn’t necessarily need to awaken to the point of alertness).
Sleep-disordered breathing is a spectrum, with very quiet snoring on one end of the spectrum and severe, repeated blockage of the airway on the other end of the spectrum (severe obstructive sleep apnea).
What are the severity categories for normal breathing compared to obstructive sleep apnea?
- Normal: 0 to <5 blockages per hour of sleep,
- Mild:5 to <15 blockages per hour of sleep,
- Moderate:15 to <30 blockages per hour of sleep; and
- Severe:30 or more blockages per hour of sleep
How do you treat obstructive sleep apnea?
Generally, obstructive sleep apnea is treated with CPAP (continuous positive airway pressure) machines. The machines blow air into the airway and masks commonly are in the form of nasal CPAP or full facemask CPAP.
Click on this link for a Snoring School post about CPAP masks:
What factors have the highest prediction for determining if there is obstructive sleep apnea?
A study evaluating objective and subjective signs and symptoms found that the three strongest predictors of obstructive sleep apnea in women include:
- loud snoring,
- had tiredness upon awakening, and
- obesity (with a body mass index ≥32 kg/m2).12
When should a sleep study be performed in a snoring patient?
If your healthcare provider determines that you may have obstructive sleep apnea or has other concerns about your sleep, then they may order a sleep study.
The determination will be made based on the amount of snoring, the snorer’s body mass index, sleepiness, tiredness, witnessed obstructions or breathing difficulties and other factors.
What are two major categories for sleep studies?
- A home sleep study, and
- An in-lab sleep study.
What is a sleep study?
A sleep study is either done at home or in the sleep lab (monitored hotel room, university, or another building).
The goal of a sleep study is to see if there are problems or disorders during sleep to include problems with breathing (i.e. snoring and obstructive sleep apnea), sleepwalking, sleep talking, narcolepsy, seizures, leg movements, arm movements, sleep terrors or other disorders.
Risk factors and causes for snoring during pregnancy:
How does a growing abdomen worsen snoring and obstructive sleep apnea during pregnancy?
The growing abdomen and uterus can put pressure on the diaphragm.
As the abdomen and uterus grow, there is an increase in the amount of pressure placed onto the diaphragm, thus there is a potential for the lungs to not get as much air as they normally do. This air restriction could hypothetically contribute to the obstruction of airflow during sleep.
How does leg swelling increase snoring and potentially worsen obstructive sleep apnea?
When humans lie down, there is a fluid shift from the legs to the neck and upper airway, known as rostral fluid shift. Studies have demonstrated that the upper airway can narrow with fluid shifting and therefore there is a predisposition for snoring.13
So, it is logical that a woman with increased leg swelling can have an increase in rostral fluid shift, which could narrow the upper airway and worsen snoring.
Does alcohol affect snoring?
Absolutely, alcohol causes snoring to worsen in most people since it can relax the throat.
Studies have found that even in non-snoring individuals, alcohol can induce snoring and obstructive sleep apnea. The standard recommendation is that pregnant women should avoid alcohol because of the potential developmental problems it can cause the fetus. Additionally, given that alcohol can worsen breathing during sleep, this fact further emphasizes the importance of avoiding it during pregnancy.
Is there a healthy way to manage weight gain during pregnancy?
Yes, a healthcare provider and dietitian can help guide weight management during pregnancy.
There is a normal amount of expected weight gain throughout the pregnancy. If there is an excessive amount of weight gain, then the extra weight can potentially worsen snoring and breathing during sleep.
Because of the importance of providing key nutrients to the developing fetus, women should consult their healthcare provider and dietitian if they plan to manage their weight.
Can a blocked nose cause snoring in pregnant women?
Yes, in some cases. Although the nose does not generally vibrate during sleep, it is known that hormone changes (such as estrogen, progesterone, and others) during pregnancy can increase nasal congestion and obstruction and that can contribute to snoring.14
The theory behind why nasal congestion can worsen snoring is that the smaller nasal airway causes the air coming into the nose to travel at a higher velocity and that causes the vibrations in the upper airway to increase and therefore the snoring sound increases.
What are side effects and complications on the mother and developing baby due to snoring during pregnancy?
Do some women snore only through their noses, but not through their mouths?
One study found that some patients snored exclusively during nasal breathing (patients had primary snoring or mild obstructive sleep apnea) and they had complaints of significant nasal obstruction and has swollen tissues in their nose (inferior turbinate hypertrophy).15
Is snoring during pregnancy harmful to the mother or baby?
The answer as to whether snoring during pregnancy is harmful depends on whether it is causing or worsening other problems such as sleepiness, high blood pressure, diabetes, insomnia or weight gain.
Snoring can be a sign of obstructive sleep apnea, which can cause many problems to include sleepiness, retention of carbon dioxide and a drop in oxygen throughout the night.
Snoring during pregnancy and medical problems:
According to a review of the literature and evaluation of the international data (a meta-analysis)1, Dr. Li and colleagues evaluated and compared outcomes for women from three groups:
- those who did not snore or have obstructive sleep apnea,
- women with snoring alone (no obstructive sleep apnea), and
- women with obstructive sleep apnea (blocked breathing during sleep) and found:
Women with snoring alone or obstructive sleep apnea (when compared to women without these disorders) had an increased risk of:
- Gestational diabetes mellitus,
- Pre-eclampsia, and
- Pregnancy-induced high blood pressure.1
Women with snoring alone or obstructive sleep apnea (when compared to women without these disorders) have no significant difference in:
- Pre-term birth, and
- APGAR scores at 5 minutes.1
A difference between women with snoring alone when compared to women who have obstructive sleep apnea is that the women with obstructive sleep apnea had an increased risk of pre-term birth.1
How does sleep-disordered breathing (snoring and obstructive sleep apnea) affect the developing baby?
The fetus receives oxygen and nutrients from his/her mother. Therefore, the oxygen and nutrients that the mother takes in will affect the fetus.
How does the fetus get oxygen and nutrients?
The mother’s uterus supplies blood and nutrients and hormones to the fetus through the placenta.
How does the mother’s breathing during sleep affect the fetus?
If a pregnant woman has obstructive sleep apnea and drops in her oxygen level, then this can lead to a lower oxygen level in the fetus.3
Additionally, during the obstructive breathing events, the mother can also retain carbon dioxide and this can cause increased carbon dioxide in the blood and this can lead to the fetus developing a lower blood pH (respiratory acidosis).3
It has been shown that decelerations of the fetal heart can occur during the obstructive events when there is a decreased oxygen level.3
Does sleep-disordered breathing in the mother affect how a child is delivered?
A review16 found that sleep-disordered breathing during pregnancy can affect the delivery of the baby.
Women with sleep-disordered breathing during pregnancy were:
- Less likely to have a vaginal delivery,
- At higher risk of having an assisted vaginal delivery,
- At higher risk of having a cesarean delivery.
What is the relationship between snoring during pregnancy and high blood pressure (hypertension)?
High blood pressure during pregnancy is defined by having ≥140 millimeters of mercury for systolic blood pressure and having ≥90 millimeters of mercury for diastolic blood pressure.17
Frequent snoring (≥3 nights of snoring per week) has been associated with a two-fold increase in high blood pressure disorders of pregnancy.17
What is the relationship between snoring during pregnancy and diabetes?
It has been found that there is an association between habitual snoring during early pregnancy and the risk of:
- Gestational diabetes, and
- Impaired glucose tolerance.18
A study found that women who snored most of the time or all of the time had a 2.5-fold increase in the odds ratio for having gestational diabetes and a 2.1-fold increase in the odds ratio for having impaired glucose tolerance.18
Healthcare providers should perform glucose testing during the pregnancy, and they may select to monitor blood glucose levels on a scheduled basis and should notify the patient of the results, especially if the glucose elevated as this may lead to more testing.
How is an oral glucose tolerance test performed?
The Carpenter and Coustan criteria19 is the commonly accepted standard for performing the oral glucose tolerance test. The testing includes the following19:
- A 1-hour, 50-gram oral glucose loading test is given for screening,
- After the 1-hour oral glucose loading, a serum glucose value >200 mg/dL is considered positive for gestational diabetes without the need for an oral glucose tolerance test,20
- If the serum glucose value is 130-200 mg/dL, then: A 3-hour, 100-gram oral glucose tolerance test is given.
When the 3-hour, 100-gram oral glucose tolerance test is used, then two or more values meeting the following criteria are considered positive for gestational diabetes:
- Fasting glucose >95 mg/dL, or
- Oral glucose tolerance test values of: >180 mg/dL at one hour, >155 mg/dL at two hours or >140 mg/dL at 3 hours).20
Why is it important for gestational diabetes to be controlled?
For women who have gestational diabetes mellitus, it is important that the glucose is kept in the normal range as much as possible since gestational diabetes mellitus is associated with an increased risk of complications for the baby and the mother.
It is important to work closely with the healthcare provider to ensure the glucose levels don’t go too low (hypoglycemia) as that can also cause problems.
Are pregnant women who snore more likely to have depression than those who don’t snore?
A study comparing pregnant women with habitual snoring to pregnant women who did not have habitual snoring found that pregnant women with habitual snoring had about twice as likely to score high on the depression questionnaire(Edinburgh Postnatal Depression Scale which is a 10 item depressive symptom screening questionnaire for pregnant and post-partum women).21
In the study, 43% of women with snoring scored high when compared to 23% of non-snoring women who scored high on the questionnaire.21
What are treatment options during pregnancy?
Does snoring go away after pregnancy? When will the snoring stop?
If the woman had no snoring prior to the pregnancy and she returns to her pre-pregnancy weight, then it is possible that the snoring will go away at that point.
Obesity is a risk factor for sleep-disordered breathing prior to pregnancy, and with additional weight gain during pregnancy can make the snoring worse.
But are there barriers to weight loss during pregnancy?
There are barriers to weight loss after the delivery, for example: given the frequent awakenings that newborn babies experience, and the fact that the baby’s mother will likely be feeding the baby every few hours, these make it difficult to diet and exercise.
Despite the challenges that women face with snoring after delivering their baby, it is possible that the snoring will stop once effective treatment is started.
Will snoring while pregnant go away during the pregnancy?
It is difficult to predict if the snoring will go away. If the woman is gaining a significant amount of weight and she is entering the second or third trimester, then the snoring may actually get worse with time.
If there are other causes for the snoring, then they should be explored. A sleep study will help determine the need for treatment.
What are the goals of treating snoring?
The goal is always to reduce the snoring to a tolerable level. Many treatments aim to reduce the snoring from a 7-10 (severe) down to a 2-4 (mild) on the visual analog scale.
The visual analog scale is relevant because the snoring can affect the quality of life of the snorer and their bed partner.
A healthcare provider may ask the patient’s bed partner to rate the snoring using the visual analog scale as part of the assessment of the severity and to monitor how well treatments are working.
It must be remembered that the snoring should get better after the delivery of the baby and that the snoring will likely improve and could go back to the pre-pregnancy frequency and loudness once the woman is back to the pre-pregnancy weight.
What are the medical treatment options for snoring during pregnancy?
Medical treatment options for snoring during pregnancy:
General recommendations that can help reduce snoring during pregnancy include:
- Avoiding sedating medications before sleep,
- Avoiding alcohol (which should be done regardless during pregnancy),
- Maintain a healthy weight,
- Treat nasal blockage,
- Try to stay off of your back during sleep, and
- Try to reduce eating foods within 3 hours of going to bed.
How is nasal obstruction treated in pregnancy?
Nasal sinus rinses (lavages) with over the counter and prescribed lavages can be performed.
Two concerns with nasal lavages would be:
- the buildup of organisms in the bottle and bottle cap used to rinse and
- the source(s) of the water.
Cleaning of the bottle and the bottle cap should be performed as directed on the manufacturer’s instructions.
Water placed into the lavage bottle should be distilled as to avoid organisms from water, especially if the tap water is not filtered.
Can nasal steroids be used during pregnancy?
Nasal medications have been shown to help improve nasal breathing, as with any medication during pregnancy, there are not many studies evaluating the effect of medications in humans.
The United States’ Federal Drug Administration (US FDA) used to have a Pregnancy Risk Category (A, B, C, D or X).
Hasn’t the US FDA removed the Pregnancy Risk Categories?
Yes. The US FDA removed the categories because millions of women take multiple medications and therefore, they switched to the Pregnancy and Lactation Labeling Rule
Using the previous US FDA Pregnancy Categories, most intranasal corticosteroids were listed as Category C (animal reproductive studies have shown adverse effects, but there are no adequate or well-controlled studies in humans, and if the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks).22
An exception to the FDA Pregnancy Risk Category C is budesonide, which was upgraded from Category C to a Category B (animal reproduction studies have failed to demonstrate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women) after a Swedish birth registry was studied extensively.22,23
We cannot emphasize this enough: It is important to discuss the risks, benefits, and alternatives to using nasal medications and any medications with a healthcare professional before starting any medications.
Do nasal strips reduce snoring during pregnancy?
A study evaluating the use of nasal strips for snoring and obstructive sleep apnea demonstrated that there was a 35% reduction in snores per hour as measured by a sleep study.24
Does the nasal blockage go away after delivering the baby?
Generally, if the mother did not have nasal blockage or nasal congestion prior to the pregnancy, then yes, the nasal blockage can go away after delivering the baby. It may take a few weeks for the mother to have an improvement in nasal breathing.
Can tongue and throat exercises reduce snoring?
Yes. Myofunctional therapy which is comprised of throat and tongue exercises is another treatment option for snoring. One study found that the exercises reduced snoring intensity by 51% (from 8.2 to 4.0) on a visual analog scale that extends from 0 (totally quiet) to 10 (extremely loud).
When using a more objective measurement, such as a sleep study, there was a reduction in snoring time by 31% (snoring 26.3% of the total sleep time before myofunctional therapy and this went down to 18.1% of the total sleep time after myofunctional therapy).25
How often do you need to perform the tongue and throat exercises (myofunctional therapy)?
In general, studies have described exercises on both the tongue and the throat.26 A study that summarized the myofunctional therapy exercises found that in general the exercises were performed twice daily for five to ten minutes for each session.27 Studies noted an improvement after three months of exercises, but it is unclear if doing the exercises for a shorter time could also provide some improvement.
How do you perform the myofunctional therapy exercises?
A study that summarized myofunctional therapy to treat snoring found that the exercises were primarily focusing on the soft palate, the face, the throat, and the tongue.
Tongue exercises generally include moving the tongue in different directions such as pushing the tongue to the roof of the mouth, the bottom of the mouth, to the left, to the right, straight out and doing multiple sets and repetitions.
A helpful website that shows the tongue and throat exercises, step-by-step can be found at the link:
Can dentist designed oral appliances help improve snoring?
An oral appliance is a device that is inserted into the oral cavity and moves the lower jaw (mandible) forward.
By moving the lower jaw forward, the tongue moves forward and helps open the airway during sleep.
Oral appliances can be good options for snoring or patients with mild obstructive sleep apnea.
Close follow-up is needed as the appliances can cause temporomandibular joint (TMJ) pain and if used for a prolonged time period without follow-up, can cause teeth to shift.
Are home-made oral appliances helpful for snoring?
In general, a homemade oral appliance is not generally recommended as it is less effective than a dentist designed oral appliance.
Can wedge pillows or sleeping in a recliner improve snoring?
Gravity pulls down, therefore, when you lie on your back, gravity is pulling your soft palate, uvula, and tongue straight back in a way that can block your normal breathing.
By using a wedge pillow, your head is at an inclined angle, and this changes the way gravity is pulling on your soft palate, uvula, and tongue by pulling these structures slightly more toward your feet, which makes it less likely that the upper airway will obstruct.
How can women stay off their back (positional therapy) during sleep?
Try side sleeping, which is also called positional therapy. There are a few techniques to help keep you off your back.
What is the tennis ball technique to keep you off your back?
When you are sleeping, it can be difficult to stay off of your back, therefore, consider using the tennis ball technique.
In this technique, you take a t-shirt that has a pocket, and then place a tennis ball into the pocket and sew it shut.
Once the tennis ball is sewn into the pocket, you then put the t-shirt on backward, so that the ball is located on your back.
Then, once you fall asleep, the tennis ball will prevent you from rolling onto your back.
What are body pillows and how do they help reduce snoring?
Body pillows come in various designs.
Using a body pillow that has front and back support could potentially help keep you on your side during sleep since the back support will help prevent you from rolling over (or will help keep you at mostly on your side).
An additional benefit is that the lumbar support can help relieve some pressure points and could help improve comfort during sleep.
Are there other reasons pregnant women should stay off their back during pregnancy?
Additionally, because the inferior vena cava is located inside the abdomen and a fetus can compress it when a pregnant woman lies on her back.
Thus, by lying on her back there is the possibility of reduced blood flow; therefore, lying with the left side down can help to increase blood flow and nutrients to the placenta and the fetus.
How can positive airway pressure therapy help a snoring woman?
Snoring with obstructive sleep apnea is commonly treated with positive airway pressure therapy.
If you had a sleep study and were found to have obstructive sleep apnea, then positive airway pressure therapy (PAP) is a good treatment option.
The devices are commonly referred to as CPAP (continuous positive airway pressure) or APAP (auto-titrating positive airway pressure) devices. PAP treatment needs to be monitored and PAP pressures need to be adjusted appropriately by an experienced healthcare provider.
The sleep healthcare provider will prescribe the PAP treatment according to multiple factors, such as whether there was a titration portion to the sleep study (where the PAP therapy was started at night during the sleep study).
Sometimes the sleep healthcare provider may base your prescription using variables such as your age and size.
Is close follow-up necessary after starting positive airway pressure therapy?
Yes, it is important to follow-up closely after starting PAP therapy in order to ensure it is working well and so that adjustments to the pressures, humidification, mask, etc. can be made in order to improve the overall use and effectiveness of the PAP treatment.
By design, PAP treatment should eliminate snoring, in fact, if it does not eliminate the snoring, then likely the pressure on the device is set to low. This makes sense because if the pressure is too low, then the airway can still obstruct at night and this can allow the snoring to persist.
What if the woman has snoring alone? Can she use PAP therapy?
Generally speaking, insurance doesn’t cover the cost of PAP therapy if the snorer does not have obstructive sleep apnea.
If she wants to try PAP therapy anyway, then she should discuss this with her sleep physician or healthcare provider.
What are the surgical treatment options for snoring during pregnancy?
Medical management should be exhausted prior to considering any surgery.
How does snoring surgery work?
For snorers who undergo snoring surgery, the tissues most often targeted include the soft palate and the uvula since they are the most likely cause of the snoring sounds.
Snoring procedures themselves often involve stiffening the soft palate (such as with radiofrequency ablation) or trimming the uvula (partial uvulectomy).
The stiffening that occurs in the soft palate and uvula is usually secondary to the scar tissue that forms at the surgical site.
For example, if there is radiofrequency ablation of the soft palate, then as the tissue heals, scar becomes a part of the surgical site and the tissue becomes stiffer.
Since the tissue becomes stiffer, there is less vibration and therefore, less snoring. The goal of surgery is to reduce the amount of snoring so that the bed partner’s sleep is improved.
Snoring surgery in the operating room:
It is unlikely that elective surgery for snoring during pregnancy would go to the operating room as this would expose both the mother and the unborn child to general anesthesia.
Snoring surgery in the clinic under local anesthetic:
Snoring surgery in a pregnant woman would more likely take place in a clinic and with the use of local anesthetic.
Considerations regarding the local anesthetic include that the unborn child’s organs are actively being formed in the first trimester and teratogenic effects are a concern.
But if a pregnant woman has local anesthetic, won’t the medication go to the baby too?
Yes. Medications that are in the mother travel through the bloodstream into the placenta and then into the fetus. Therefore, caution needs to be exercised.
During the second and third trimesters, the fetus could still have reactions to the local anesthetic, even at low doses.
Additional risks of snoring surgery include the risk of bleeding and infection.
Healing from snoring surgeries can take weeks, and the scar tissue formed after healing can take about 3 months to stiffen, therefore, the beneficial effects of any surgery may not be seen until after the delivery.
So what are the options for surgery vs medical management for snoring?
Because of the potential of the local anesthetic to travel to the fetus and the potential for infection, medical management should be the primary treatment for snoring during pregnancy.
**It is key to note that ultimately, any decision for doing any testing or pursuing any treatment is between the snorer and her healthcare provider.
Can snoring affect the bed partner?
Snoring can cause problems for both the snorer and their bed partner. Bed partners may develop insomnia from the snoring and the interrupted sleep can cause sleepiness, fatigue, headaches, and irritability.
Generally, snoring that occurs more often and is louder can cause more problems for the snorer and also their bed partner.
Snoring sounds can induce insomnia for the bed partner and in some cases can lead to them sleeping in a separate room which can cause marital disharmony and dissatisfaction.
Aren’t bedpartners awakened by the snoring?
One study found that the main culprit for the snorers’ bed partner problems was not that the snoring awoke the bed partner, but rather was due to the bed partner waking up for other reasons and then needing a quiet environment in order to fall back to sleep.28
At that point, if the bed partner cannot fall back to sleep, then they will often nudge, elbow, push or awaken the bed partner.
If it is significantly bothersome, then the bed partner may leave the room altogether (that’s not good but may be necessary for them to get better sleep).
In some situations, such as snoring with obstructive sleep apnea, the breathing during sleep could potentially be harmful to the developing baby.1
Is there a way to determine how much snoring is too much?
There is no formal classification for the number of snores per hour in determining how much is too much; therefore, the bed partner is going to be the main way to determine if the snoring is a problem.
The visual analog scale is a common way of tracking the severity of the snoring and how effective the treatments are.
How can we help the bed partner of a snorer stay in the room?
The snorer can fall asleep after the bed partner, white noise can be played in the background and ear plugs can be worn.
Having the snorer’s bed partner go to bed first will help prevent the sleep onset insomnia that can happen secondary to the bothersome snoring.
How can white noise help the snorer’s bed partner?
Once asleep, the bed partner may awaken spontaneously and it is at this point when it becomes difficult to fall back to sleep.
Therefore, having white noise or background noise can help dampen the snoring sound. You can find alarm clocks or smartphone apps that provide background noise.
Do earplugs help the bed partner of a snorer?
If the snorer is found to have snoring alone, and the bed partner wants to remain in the room and other options have failed, then ear plugs are a good option.
Remember that if a snorer has obstructive sleep apnea, then treatment for the obstructive sleep apnea is important and should be the goal.
However, if the problem is snoring alone and the healthcare provider determines that there is no other problem, then ear plugs for the snorer’s bed partner can be beneficial.
One study evaluated 21 couples and found that when the bed partner of a snorer used earplugs there was a significant improvement in the quality of life and sleepiness for both the snorer and the bed partner.29
It makes sense that the snorer themselves would also have improvement in their quality of life because they are not being awoken throughout the night and being told to roll over or stop snoring.
Therefore, in select couples, the bed partner of a woman with snoring alone during pregnancy could consider trying earplugs as part of a short-term treatment plan.
Wait, isn’t it important for a snorer’s bed partner to hear her at night?
This is true, that it can be important for the bed partner to hear the snoring because it is possible that the snorer could have a worsening in their breathing and what was initially snoring alone could develop into obstructive sleep apnea.
Is it bad to silence a snorer?
This depends. If the snorer is quieter because they no longer have blockage in their airway after appropriate treatment, then that is a good thing.
But, if the bed partner has taken measures to not hear the snoring, then they may not become aware that the patient has long pauses, is choking, gasping or is otherwise obstructed during sleep.
Can snoring during pregnancy predict whether the baby is a boy or girl?
The prediction of gender-based on snoring is a myth. There is no scientific evidence in the literature (PubMed/MEDLINE or Google Scholar) that demonstrates an increased incidence of boy or girl deliveries based on whether the mother snored during pregnancy.
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Resources and references for snoring during pregnancy:
Helpful Online Resources:
What are reliable resources for snoring, sleep apnea, insomnia, and other sleep disorders?
For more information on sleep medicine in general, visit the patient information section at The American Academy of Sleep Medicine at the link: https://aasm.org/about/patient-info/
For sleep education resource from at The American Academy of Sleep Medicine that describes common sleep disorders, support for patients, videos and sleep products go the link below:
What are reliable resources for diabetes during pregnancy?
The American Diabetes Association:
What is a good resource for pregnancy information?
The American College of Obstetricians and Gynecologists:
- Li L, Zhao K, Hua J, Li S. Association between Sleep-Disordered Breathing during Pregnancy and Maternal and Fetal Outcomes: An Updated Systematic Review and Meta-Analysis. Front Neurol. 2018;9:91.
- Quinn SJ, Daly N, Ellis PD. Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci. 1995;20(4):360-364.
- Izci-Balserak B, Pien GW. Sleep-disordered breathing and pregnancy: potential mechanisms and evidence for maternal and fetal morbidity. Curr Opin Pulm Med. 2010;16(6):574-582.
- Frederick IO, Qiu C, Sorensen TK, Enquobahrie DA, Williams MA. The prevalence and correlates of habitual snoring during pregnancy. Sleep Breath. 2013;17(2):541-547.
- Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM. Self-reported snoring in pregnancy. Association with fetal outcome. Chest. 1996;109(4):885-889.
- Louis JM, Koch MA, Reddy UM, et al. Predictors of sleep-disordered breathing in pregnancy. Am J Obstet Gynecol. 2018;218(5):521.e521-521.e512.
- Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA. Sleep-related disordered breathing during pregnancy in obese women. Chest. 2001;120(5):1448-1454.
- Cathcart RA, Hamilton DW, Drinnan MJ, Gibson GJ, Wilson JA. Night-to-night variation in snoring sound severity: one night studies are not reliable. Clin Otolaryngol. 2010;35(3):198-203.
- Camacho M, Robertson M, Abdullatif J, et al. Smartphone apps for snoring. J Laryngol Otol. 2015:1-6.
- Hoffstein V, Mateika S, Nash S. Comparing perceptions and measurements of snoring. Sleep. 1996;19(10):783-789.
- Nakano H, Hirayama K, Sadamitsu Y, et al. Monitoring sound to quantify snoring and sleep apnea severity using a smartphone: proof of concept. J Clin Sleep Med. 2014;10(1):73-78.
- Wilson DL, Walker SP, Fung AM, O’Donoghue F, Barnes M, Howard M. Can we predict sleep-disordered breathing in pregnancy? The clinical utility of symptoms. J Sleep Res. 2013;22(6):670-678.
- Saha S, Taheri M, Mossuavi Z, Yadollahi A. Effects of changing in the neck circumference during sleep on snoring sound characteristics. Conf Proc IEEE Eng Med Biol Soc. 2015;2015:2235-2238.
- Dzieciolowska-Baran E, Teul-Swiniarska I, Gawlikowska-Sroka A, Poziomkowska-Gesicka I, Zietek Z. Rhinitis as a cause of respiratory disorders during pregnancy. Adv Exp Med Biol. 2013;755:213-220.
- Hsia JC, Camacho M, Capasso R. Snoring exclusively during nasal breathing: a newly described respiratory pattern during sleep. Sleep Breath. 2014;18(1):159-164.
- Brown NT, Turner JM, Kumar S. The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis. Am J Obstet Gynecol. 2018;219(2):147-161.e141.
- Dunietz GL, Shedden K, Lisabeth LD, Treadwell MC, O’Brien LM. Maternal Weight, Snoring and Hypertension; Potential Pathways of Associations. Am J Hypertens. 2018.
- Qiu C, Lawrence W, Gelaye B, et al. Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy. PLoS One. 2017;12(9):e0184966.
- Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768-773.
- Köşüş N, Köşüş A, Duran M, Turhan NÖ. Effect of number of abnormal oral glucose tolerance test (OGTT) values on birthweight in women with gestational diabetes. The Indian Journal of Medical Research. 2013;137(1):95-101.
- O’Brien LM, Owusu JT, Swanson LM. Habitual snoring and depressive symptoms during pregnancy. BMC Pregnancy Childbirth. 2013;13:113.
- Alhussien AH, Alhedaithy RA, Alsaleh SA. Safety of intranasal corticosteroid sprays during pregnancy: an updated review. Eur Arch Otorhinolaryngol. 2018;275(2):325-333.
- Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol. 2003;111(4):736-742.
- Camacho M, Malu OO, Kram YA, et al. Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis. Pulm Med. 2016;2016:4841310.
- Camacho M, Guilleminault C, Wei JM, et al. Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology. 2017:1-7.
- Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962-966.
- Camacho M, Certal V, Abdullatif J, et al. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep. 2015;38(5):669-675.
- Blumen M, Quera Salva MA, d’Ortho MP, et al. Effect of sleeping alone on sleep quality in female bed partners of snorers. Eur Respir J. 2009;34(5):1127-1131.
- Robertson S, Loughran S, MacKenzie K. Ear protection as a treatment for disruptive snoring: do ear plugs really work? J Laryngol Otol. 2006;120(5):381-384.