What's With Snoring?

Here is a clever poem, which apparently hits home to many families:

Night Blight
The Burden of the Unfortunate Who Sleep
With Those Whose Noses are Blocked

The bad thing about a snorer,
In fact the very worst,
Is, with two people in the room,
He always drops off first.

Yes, snoring is a very common problem. As a specialist in cosmetic and reconstructive nasal surgery, I see many for "nose jobs" who also report snoring (noisy breathing). They ask, "Can anything be done about it while you are fixing my nose?"

There may be one or more causes of snoring. It is important to know what the source of the snoring is.

Let me list, in order of frequency, what they are:

1. Blocked nasal passages. By far the most common cause of snoring, particularly in men. Either due to allergies, a previous broken nose or "the way you were born," the nasal passages do not carry enough airflow to satisfy the body's need, and the patient is forced to breathe through the mouth. Not an ideal second choice; such mouth breathing is noisy, particularly at night, because when laying on one's back, the relaxed soft palate flops back and forth as the airflow goes in and out via the mouth.
   
   As medical students we were taught that "normal breathing is quiet and unheard; abnormal breathing is noisy." Remember that nature created the nose to be the route for the body's incoming air. The nose has three specific functions that are not fulfilled when one becomes a "second choice" mouth breather:
   

   1. Humidification
   2. Filtration
   3. Warming

   Many medical studies have proven that airflow through the nose provides optimal lung function. Incoming air, by-passing the nose and hence not availing itself of the above three services, is a less-ideal present to the lungs.
   
   People who have a blocked nose due to deviated septum, enlarged turbinates, nasal polyps, or allergies give their body no choice but to breathe through the mouth.
   
   The good news is that patients whose snoring is due to blocked nasal passages can be significantly improved or cured. To be certain that the blocked nose is the culprit requires a complete exam of the nose, sinuses, throat, and neck by a qualified specialist. Indeed, since nasal obstruction is the most common cause, in some patients the correction of the deviated septum and enlarged turbinates saves the day for the patient. As one happy patient said, "Doctor, you took my nose from a two-lane highway to a four-lane highway."
   
   In our practice, half the patients coming in for cosmetic surgery have breathing problems and, if appropriate, both cosmetic nasal surgery and a breathing operation can be done at the same time. Both are done from within the nose; no external incisions.


2. An enlarged adenoid. The common cause of children's snoring. The adenoid, a large mass of lymphoid tissue, part of Nature's defense system against infection, is located at the back of the nasal passages, high in the throat, behind the palate. Often it cannot be seen without special mirrors.


3. A down-hanging, swollen uvula, commonly the result of allergies. It flips back and forth causing that snoring sound.


4. Body build. Typically, an overweight man with a short, stocky neck. Think wrestler. After age 40 or so, the tissues inside the throat begin to lose some of their strength. They get a bit soft and floppy. In men with this triad of thick, short, wide neck, the soft tissues of the walls of the throat literally fall into the air passage causing the noisy breathing that one sleep-deprived wife called "the sound of a freight train rolling through our bedroom."


5. An enlarged tongue. Perhaps due to an under-active thyroid gland or other medical condition. Here, the over-sized tongue falls back into the throat when sleeping causing blockage, hence snoring.

To properly ascertain the cause of snoring, be sure to have a thorough examination by a head and neck (ear-nose-throat) specialist.

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