Snoring and sleep apnea occur when the upper airway is either partially or fully blocked. They can cause problems such as repeated drops in oxygen levels during sleep, frequent awakenings during sleep, tiredness, sleepiness, daytime fatigue, unrefreshing sleep, high blood pressure, and other problems. A sleep study is often recommended and treatments are usually medical first and then surgery second, depending on the situation.

Do you snore or have sleep apnea or know someone who does? It can be a challenge to find comprehensive and reliable information and we would like to help you.

This snoring and sleep apnea information guide was written by sleep medicine provider.

In order to make this more helpful and as part of the research for this information guide, we searched the internet for frequently asked questions

First, this information guide provides general information about snoring and sleep apnea, what the causes of snoring and sleep apnea are, and what treatments are available for snoring and sleep apnea. There are 10 major topics and 15 additional minor topics (25 total topics) covered in this guide.

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.

Woman with normal breathing, normal exchange of oxygen and carbon dioxide at SnoringSchool.com
Woman with normal breathing, normal exchange of oxygen and carbon dioxide.

Background information about snoring and sleep apnea:

Summary:

Snoring and obstructive sleep apnea (OSA) are common disorders. It has been estimated that men are twice as likely to snore as women.1 The estimated prevalence of loud snoring is about 33% in men and 19% in women.2

Table of Contents hide

What is the difference between snoring, obstructive sleep apnea and sleep-disordered breathing?

Sleep-disordered breathing is a spectrum of breathing disorders during sleep, 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). 

Woman sleeping, open airway, no obstructive sleep apnea at SnoringSchool.com
Woman sleeping. Airway with no obstruction. Air can flow normally and breathing should be quiet.
Woman sleeping, airway blocked by the soft palate during snoring or obstructive sleep apnea at SnoringSchool.com

Woman sleeping, airway blocked by the soft palate. This can be seen in patients with snoring and/or obstructive sleep apnea.
Woman sleeping, airway blocked by tongue in obstructive sleep apnea at SnoringSchool.com (2)

Woman sleeping, airway is blocked at the tongue and epiglottis. This can be seen in patients with obstructive sleep apnea.
Woman sleeping, airway blocked by tongue in obstructive sleep apnea at SnoringSchool.com

Woman sleeping, airway is blocked at multiple sites. The soft palate, tongue and epiglottis are blocking the airway. This can be seen in patients with obstructive sleep apnea.

What is snoring alone compared to snoring with obstructive sleep apnea?

If the patient has only snoring and has no evidence of obstructive sleep apnea during the sleep study, then it is called “snoring alone” or “primary snoring.”

Although it is a good thing when a snorer has a sleep study and is found not to have obstructive sleep apnea, the snoring is still a sign of partial blockage of airflow and can cause sleepiness and other symptoms in some patients and also can disturb the bed partner as well.

Snoring with obstructive sleep apnea

Snoring is a sign of partial blockage of the upper airway.

What are the signs of obstructive sleep apnea?

If the snorer stops breathing, has choking, gasping, repeated awakenings during sleep, then they could also have obstructive sleep apnea.

Woman with normal breathing, normal exchange of oxygen and carbon dioxide at SnoringSchool.com
Woman with normal breathing, normal exchange of oxygen and carbon dioxide.

Snoring can be present with or without obstructive sleep apnea. If the snoring is nightly and the snorer 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 snorer.

For those who have obstructive sleep apnea, the diagnosis can cause the snorer to have a significant number of questions and concerns about the disorder.

What is obstructive sleep apnea?

Obstructive sleep apnea is a common sleep disorder.  As the name implies, “obstructive” refers to partial or complete blockage of the upper airway during sleep.

When there is obstruction or blockage of airflow during sleep, the obstruction can cause the brain to repeatedly wake up at night (also known as a brain arousal).

These airway obstructions are counted during a sleep study if they last 10 seconds and are associated with a moderate decrease in airflow (hypopneas) or a severe decrease in airflow (apneas).

Apnea refers to a period of time in which there is no airflow or there is a significant decrease in airflow (90% decrease).

A respiratory effort related arousal (RERA) is a partial upper airway obstruction that is counted during a sleep study 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).

Woman lying with blocked airway, no exchange of oxygen or carbon dioxide at SnoringSchool.com
Woman lying with blocked airway, no exchange of oxygen or carbon dioxide. So, oxygen in her body can decrease and carbon dioxide in her body can increase.

What are the severity categories for normal breathing compared to obstructive sleep apnea?

  • Normal: 0 to <5 obstructions per hour of sleep,
  • Mild: 5 to <15 obstructions per hour of sleep,
  • Moderate: 15 to <30 obstructions per hour of sleep; and
  • Severe: 30 or more obstructions per hour of sleep.

What are signs that someone may have obstructive sleep apnea?

  • Repeated airway obstructions during sleep,
  • Repeated awakenings during sleep,
  • Choking during sleep,
  • Gasping during sleep,
  • Morning headaches,
  • Loud snoring,
  • Habitual snoring,
  • Needing to urinate multiple times at night,

What are physical risk factors for obstructive sleep apnea?

  • Obesity,
  • Large tonsils,
  • Large tongue,
  • Tongue scalloping (teeth indentations if the lower jaw is too small or tongue is too large for the space),
  • Long uvula,
  • Large neck circumference.

What are the symptoms of obstructive sleep apnea?

  • Sleepiness
  • Tiredness
  • Morning headaches
  • Neurocognitive impairment
  • Unrefreshing sleep

Can obstructive sleep apnea raise blood pressure?

Yes, during an apnea or hypopnea, some patients can have a physical response in which hormones are released such as metanephrines, which can cause the blood pressure to increase.

What problems can obstructive sleep apnea cause?

During sleep, air is supposed to move freely in and out of your body through your nose or your mouth. When someone has obstructive sleep apnea, then, by definition there is an obstruction in the airflow and the patient gets less oxygen and because they can’t breathe out as well either, they end up retaining carbon dioxide in their bodies. Because of these repeated blockages, the oxygen levels can drop. If the oxygen level in the mother drops, then it could potentially drop in the fetus as well.

Additional problems with obstructive sleep apnea:

Untreated obstructive sleep apnea can cause problems such as repeated drops in oxygen levels during sleep, frequent awakenings during sleep, tiredness, sleepiness, daytime fatigue, unrefreshing sleep, high blood pressure, and other problems.

What are sleep studies and how are they performed?

Sleep studies are studies in which the patient is observed during sleep with monitoring to determine if there is blockage of the airway and associated oxygen changes.

Home sleep study:

A home sleep study generally includes monitors for oxygen levels, breathing effort (generally a stretchy belt), heart rate monitors and a monitor for airflow (small tubing that is inserted into the nostrils). A home sleep study is advantageous in that it allows the patient to remain in their home environment, which can make it easier to fall asleep than an in-lab sleep study.

Are there disadvantages to the home sleep study?

The disadvantage is that unlike an in-lab sleep study, the home sleep studies don’t usually have brain wave monitoring or eye movement monitoring, therefore, the home sleep studies don’t show if the patient is asleep or awake, so overall a home sleep study is less sensitive in determining if a patient has obstructive sleep apnea than an in-lab study.

Note: If a home sleep study does not show sleep apnea, but the patient and healthcare provider believe that there may actually be sleep apnea, then the home sleep study can be repeated, or an in-lab sleep study could be ordered. Because the in-lab sleep study is more expensive, it can be difficult to get these approved by insurance companies.

In-lab sleep study:

An in-lab sleep study is performed in a monitored sleep room (with video recording) and includes the same monitors as a home sleep study, however, the difference is that there are more monitors during an in-lab sleep study.

Additional monitors include electroencephalography (EEG) for monitoring brain waves, electrooculography (EOG) for monitoring eye movements, electrocardiography (ECG) for monitoring the heart, electromyography (EMG) for monitoring various muscles in the face, arms and legs.  Even though there lots of wires and belts, the sleep study itself is not painful and patients should not fear to have the test done. 

How long before the results of the sleep study come back?

It can take 1-2 weeks for the results of a sleep study to come back. This is because the sleep studies are scored in 30-second increments and there are many items to evaluate in the sleep study. If it has been more than 2 weeks, then contact the sleep lab or the health care provider who ordered the study to discuss the findings.

Successful treatment of obstructive sleep apnea can improve the associated signs and symptoms. It is important to have close follow-up with the treating health care provider when patients start treatment since there can be difficulties with therapy that can be improved with the help of the healthcare provider.

Does the severity of obstructive sleep apnea matter?

It is important to note that the worse the obstructive sleep apnea, usually the worse the symptoms and problems. One study found that pregnant women with moderate to severe obstructive sleep apnea had worse oxygen saturations than women with just snoring or mild obstructive sleep apnea. 3 However, that doesn’t mean that snoring alone, or snoring with mild obstructive sleep apnea should not be treated.

How can you stop snoring or obstructive sleep apnea?

There is medical management and surgical management of snoring. Medical management is tried first in most cases.

Treatment also is dependent on whether or not the patient has obstructive sleep apnea.

Full facemask CPAP at SnoringSchool.com
Full facemask CPAP that fits well and their is no unintentional leak.

Medical Treatment

Nose

  • Breathe rite strips
  • Nasal steroids (fluticasone, mometasone, flunisolide)
  • Sinus rinses (Neil med sinus rinses, Netti Pot, etc.)
  • Nasopharyngeal airway devices (nasal trumpets)
  • Positive airway pressure therapy (CPAP or APAP)

Tongue

  • Myofunctional therapy (tongue, mouth and/or throat exercises)
  • Tongue retaining devices
  • Winx
  • Mandibular advancement devices (oral appliances)
  • Positive airway pressure therapy (CPAP or APAP)

Soft palate

  • Myofunctional therapy
  • Winx
  • Mandibular advancement devices (oral appliances)
  • Positive airway pressure therapy (CPAP or APAP)

Uvula

  • Myofunctional therapy
  • Winx
  • Mandibular advancement devices (oral appliances)
  • Positive airway pressure therapy (CPAP or APAP)

Tonsils

  • Positive airway pressure therapy (CPAP or APAP)

Epiglottis

  • Positive airway pressure therapy (CPAP or APAP)

Supraglottis

  • Positive airway pressure therapy (CPAP or APAP)

Skeletal

  • Mandibular advancement devices (oral appliances)
  • Maxillary expansion (using a device to expand the upper jaw, usually in children)

Surgical Treatment

Nose

  • Septoplasty
  • Turbinoplasty
  • Rhinoplasty
  • Functional endoscopic sinus surgery (FESS)
  • Implants

Tongue

  • Tongue suspension
  • Tongue reduction surgeries

Soft palate

  • Implants
  • Stiffening procedures
  • Modification and suspension procedures
  • Excision techniques
  • Ablation techniques

Uvula

  • Partial excision (partial uvulectomy)
  • Complete excision (complete uvulectomy)

Tonsils

Tonsillectomy surgery with bovie complete at SnoringSchool.com
Tonsillectomy surgery on the left tonsil which has been completely removed using electrocautery (tool that uses electricity).
  • Partial excision (tonsillotomy)
  • Complete excision (tonsillectomy)

Epiglottis

  • Partial excision (partial epiglottectomy)
  • Suspension (epiglottoplasty)

Supraglottis

  • Partial excision (supraglottoplasty)

Skeletal surgeries

  • Genioglossus advancement (moving the mid portion of the chin forward)
  • Sliding genioplasty (sliding the lower chin forward)
  • Transpalatal advancement pharyngoplasty (moving the hard palate forward)
  • Mandibular advancement (moving the lower jaw forward)
  • Maxillary advancement (moving the upper jaw forward)
  • Maxillomandibular advancement (moving the upper and lower jaw forward)
  • Maxillary expansion (splitting the upper jaw in the midline and expanding it)
  • Maxillomandibular expansion (splitting the upper and lower jaw in the midline and expanding them)

How common is snoring in college students?

It is estimated that almost 1 out of every 3 college students snores (42% of college men and 25% of college women), with the highest prevalence of self-reported snoring being in Asian students (37%).4

How many times per hour does a patient need to obstruct their airway in order to be at higher risk for cardiovascular (heart problems)?

A study evaluating mortality found that patients with an apnea index of 20 or higher were at a greater risk of dying from untreated obstructive sleep apnea.5

Will snoring harm you?

A study evaluating 77,000 patients found that in patients who do not have obstructive sleep apnea syndrome, with a body mass index under 30 kg/m2 there was an increase in all-cause mortality (odds ratio 1.16, p<0.001).6 

However, the cause of mortality is not clearly defined and it is currently debatable as to whether or not there is an increase in mortality in snoring patients who do not have obstructive sleep apnea. Because the equipment did not have electroencephalograms, it is possible that respiratory effort related arousals were missed, which are also currently used to diagnose obstructive sleep apnea.

Why do some patients with obstructive sleep apnea develop hypertension?

When humans sleep, there is normally a decrease in blood pressure.7 However, with obstructive sleep apnea, patients could have an increase in blood pressure due to the  increased sympathetic activity due to the repeated oxygen drops that cause the release of catecholamines (epinephrine, metanephrine, norepinephrine, and normetanephrine).7

Will nose surgery stop snoring?

Snoring is generally due to the vibration of the soft tissues in the airway such as the soft palate, the uvula, the tonsils, the tongue, the epiglottis and the supraglottis.

The most common location for snoring by far is the soft palate and uvula.

However, when there is an improvement of the airflow coming from the nose, then the velocity of the airflow is slower and this can help reduce snoring.

Will CPAP stop snoring?

CPAP should stop snoring in almost all cases. By design, if CPAP machines are doing their job, then the machine will hold your airway open and because the airway is help open, the palate should stay off of the back wall of the throat (posterior wall of the pharynx).

So, if the pressure on the machine is set properly to prevent upper airway obstruction during sleep, then the snoring should stop.

Does snoring cause a sore throat?

Snoring can cause a sore throat in some people for two reasons: vibration and dryness.

Snoring is due to the repetitive motion of the soft palate and the uvula as they hit the back of the throat (posterior pharyngeal wall). This repeated trauma could cause a sore throat.

The second way that patients can develop a sore throat is the dryness in the throat from the chronic mouth breathing.

Can snoring cause a swollen uvula?

Yes, the repeated trauma to the uvula as it vibrates and hits the back of the throat can cause swelling.

Over time, the repeated trauma can cause the uvula to become wider and longer.

Does a long uvula mean that you snore or have obstructive sleep apnea?

A long uvula does not necessarily mean that you have obstructive sleep apnea or snoring, but the risk is definitely higher.

A study by Dr. Chang and colleagues found that patients with a uvula that is longer than 1.5 cm are more likely to have snoring and obstructive sleep apnea.8

Can snoring cause acid reflux?

Snoring occurs at the level of soft tissues in the upper airway. The vibration of the soft tissues of the upper airway should not cause acid reflux.

Acid reflux occurs due to the lower esophageal sphincter opening and allowing acid to travel from the stomach back up to the throat.

Acid reflux has been shown to be more common in patients with obstructive sleep apnea than snoring alone. 9

Can snoring cause weight gain?

Snoring does not directly cause weight gain. However, snoring has been associated with sleepiness. Patients who are sleepy may find that they are too tired to exercise and the lack of exercise can lead to weight gain.

Can snoring or obstructive sleep apnea cause a headache?

Yes. When a patient’s airflow is obstructed, they could have a decrease in oxygen and an increase in carbon dioxide in their bodies.

When carbon dioxide increases in the body, it can cause a headache. Typically, the headaches are worse when the patient wakes up and tend to get better as the day goes on.

Can snoring be caused by allergies?

Yes, in some people, allergies can contribute to snoring. Allergies (or allergic rhinitis) can cause swelling in the nose and this can lead to nasal obstruction.

Nasal obstruction can lead to mouth breathing. With mouth breathing, snoring can be triggered for people who do not normally snore and snoring can worsen in people who are already snorers.

Which doctors treat snoring?

Generally, snoring in patients who do not have obstructive sleep apnea is treated by ear, nose and throat surgeons.

However, there are dentists, oral surgeons, primary care physicians and sleep physicians who also treat snoring.

If a patient has obstructive sleep apnea, then a sleep medicine physician manages the patients before surgery is considered.

Can snoring negatively affect relationships?

Unfortunately, bedpartners of snorers can be severely affected by the snoring.

Bothersome snoring can lead to the snorer and their bedpartner sleeping in separate bedrooms, or one of the two sleeping on the couch.

Are pregnant women at risk of snoring?

Yes, pregnant woman have a higher risk of snoring, especially during the second and third trimesters of snoring.

Treatment is typically more challenging in pregnant women because of the weight gain and changes in hormones tend to make snoring worse with each week of pregnancy.

A comprehensive blogpost (here at snoringschool.com) that took a few months to write and has several images to teach about pregnancy snoring and obstructive sleep apnea can be found at the link below: https://snoringschool.com/pregnancy-snoring-guide/

Woman in third trimester of pregnancy with snoring at SnoringSchool.com
The above image shows a woman in third trimester of pregnancy with snoring.

References:

  1. Chan CH, Wong BM, Tang JL, Ng DK. Gender difference in snoring and how it changes with age: systematic review and meta-regression. Sleep & breathing = Schlaf & Atmung 2012; 16:977-986.
  2. Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ. Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep 1996; 19:531-538.
  3. O’Brien LM, Bullough AS, Chames MCet al. Hypertension, snoring, and obstructive sleep apnoea during pregnancy: a cohort study. BJOG : an international journal of obstetrics and gynaecology 2014; 121:1685-1693.
  4. Patel M, Tran D, Chakrabarti A, Vasquez A, Gilbert P, Davidson T. Prevalence of snoring in college students. Journal of American college health : J of ACH 2008; 57:45-52.
  5. He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988; 94:9-14.
  6. Rich J, Raviv A, Raviv N, Brietzke SE. An epidemiologic study of snoring and all-cause mortality. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2011; 145:341-346.
  7. Fletcher EC, Miller J, Schaaf JW, Fletcher JG. Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension. Sleep 1987; 10:35-44.
  8. Chang ET, Baik G, Torre C, Brietzke SE, Camacho M. The relationship of the uvula with snoring and obstructive sleep apnea: a systematic review. Sleep & breathing = Schlaf & Atmung 2018; 22:955-961.
  9. Teramoto S, Yamamoto H, Ouchi Y. Gastroesophageal reflux common in patients with sleep apnea rather than snorers without sleep apnea. Chest 2003; 124:767; author reply 767-768.