Snoring loudly could be an indication of sleep apnea, a disorder in which breathing stops and starts repeatedly during sleep.
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea.
The main types of sleep apnea are:
If you think you might have sleep apnea, see your health care provider. Treatment can ease your symptoms and might help prevent heart problems and other complications.
The symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common symptoms of obstructive and central sleep apneas include:
Loud snoring can indicate a potentially serious problem, but not everyone who has sleep apnea snores. Talk to your health care provider if you have symptoms of sleep apnea. Ask your provider about any sleep problem that leaves you fatigued, sleepy and irritable.
This type of sleep apnea happens when the muscles in the back of the throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate called the uvula, the tonsils, the side walls of the throat and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses that you can't breathe, and briefly wakes you so that you can reopen your airway. This awakening is usually so brief that you don't remember it.
You might snort, choke or gasp. This pattern can repeat itself 5 to 30 times or more each hour, all night. This makes it hard to reach the deep, restful phases of sleep.
This less common form of sleep apnea occurs when your brain fails to send signals to your breathing muscles. This means that you make no effort to breathe for a short period. You might awaken with shortness of breath or have a difficult time getting to sleep or staying asleep.
Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off.
Sleep apnea can affect anyone, even children. But certain factors increase your risk.
Factors that increase the risk of this form of sleep apnea include:
Risk factors for this form of sleep apnea include:
Sleep apnea is a serious medical condition. Complications of OSA can include:
Daytime fatigue. The repeated awakenings associated with sleep apnea make typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue and irritability likely.
You might have trouble concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.
You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.
High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during OSA increase blood pressure and strain the cardiovascular system. Having OSA increases your risk of high blood pressure, also known as hypertension.
OSA might also increase your risk of recurrent heart attack, stroke and irregular heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
Complications with medicines and surgery. Obstructive sleep apnea is also a concern with certain medicines and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs.
Before you have surgery, tell your doctor about your sleep apnea and how it's being treated.
Complications of CSA can include:
Fatigue. The repeated awakening associated with sleep apnea makes typical, restorative sleep impossible. People with central sleep apnea often have severe fatigue, daytime drowsiness and irritability.
You might have difficulty concentrating and find yourself falling asleep at work, while watching television or even while driving.
Cardiovascular problems. Sudden drops in blood oxygen levels that occur during central sleep apnea can adversely affect heart health.
If there's underlying heart disease, these repeated multiple episodes of low blood oxygen — known as hypoxia or hypoxemia — worsen prognosis and increase the risk of irregular heart rhythms.
Your health care provider may make an evaluation based on your symptoms and a sleep history, which you can provide with help from someone who shares your bed or your household, if possible.
You're likely to be referred to a sleep disorder center. There, a sleep specialist can help you determine your need for further evaluation.
An evaluation often involves overnight monitoring of your breathing and other body functions during sleep testing at a sleep center. Home sleep testing also might be an option. Tests to detect sleep apnea include:
Home sleep tests. Your health care provider might provide you with simplified tests to be used at home to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns. Your provider is more likely to recommend polysomnography in a sleep testing facility, rather than a home sleep test, if central sleep apnea is suspected.
If the results aren't typical, your provider might be able to prescribe a therapy without further testing. Portable monitoring devices sometimes miss sleep apnea. So your health care provider might still recommend polysomnography even if your first results are within the standard range.
If you have obstructive sleep apnea, your health care provider might refer you to an ear, nose and throat specialist to rule out a blockage in your nose or throat. An evaluation by a heart specialist, known as a cardiologist, or a doctor who specializes in the nervous system, called a neurologist, might be necessary to look for causes of central sleep apnea.
For milder cases of sleep apnea, your health care provider may recommend only lifestyle changes, such as losing weight or quitting smoking. You may need to change the position in which you sleep. If you have nasal allergies, your provider may recommend treatment for your allergies.
If these measures don't improve your symptoms or if your apnea is moderate to severe, a number of other treatments are available.
Certain devices can help open a blocked airway. In other cases, surgery might be necessary.
Continuous positive airway pressure (CPAP). If you have moderate to severe obstructive sleep apnea, you might benefit from using a machine that delivers air pressure through a mask while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.
Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Some people give up on the CPAP machine. But with practice, most people learn to adjust the tension of the straps on the mask to obtain a comfortable and secure fit.
You might need to try more than one type of mask to find one that's comfortable. Don't stop using the CPAP machine if you have problems. Check with your health care provider to see what changes can be made to increase your comfort.
Additionally, contact your provider if you're still snoring or begin snoring again despite treatment. If your weight changes, the pressure settings of the CPAP machine might need to be adjusted.
Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances might be easier to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.
A number of devices are available from your dentist. You might need to try different devices before finding one that works for you.
Once you find the right fit, you'll need to follow up with your dentist repeatedly during the first year and then regularly after that to ensure that the fit is still good and to reassess your symptoms.
You'll likely read, hear or see TV ads about different treatments for sleep apnea. Talk with your health care provider about any treatment before you try it.
Surgery may be an option for people with OSA, but usually only after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for a small number of people with certain jaw structure problems, surgery is a good first option.
Surgical options might include:
Tissue removal. During this procedure (uvulopalatopharyngoplasty), a surgeon removes tissue from the rear of your mouth and top of the throat. Your tonsils and adenoids usually are removed as well.
This type of surgery might be successful in stopping throat structures from vibrating and causing snoring. It's less effective than CPAP and isn't considered a reliable treatment for obstructive sleep apnea.
Removing tissues in the back of the throat with radiofrequency energy (radiofrequency ablation) might be an option for those who can't tolerate CPAP or oral appliances.
Creating a new air passageway, known as tracheostomy. You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe.
You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.
Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:
Adaptive servo-ventilation (ASV). This more recently approved airflow device learns your typical breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to regulate your breathing pattern and prevent pauses in your breathing.
ASV may be an option for some people with treatment-emergent central sleep apnea. However, it might not be a good choice for people with predominant central sleep apnea and advanced heart failure. And ASV is not recommended for those with severe heart failure.
To eliminate snoring and prevent sleep apnea, your doctor may recommend a device called a continuous positive airway pressure (CPAP) machine. A CPAP machine delivers just enough air pressure to a mask to keep your upper airway passages open, preventing snoring and sleep apnea.
In some cases, self-care might be a way for you to deal with obstructive sleep apnea and possibly central sleep apnea. Try these tips:
If you or your partner suspects that you have sleep apnea, contact your primary care provider. In some cases, you might be referred immediately to a sleep specialist.
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as modify your diet or keep a sleep diary.
Make a list of:
Take a family member or friend along, if possible, to help you remember the information you receive. Because your bed partner might be more aware of your symptoms than you are, it may help to have your partner along.
For sleep apnea, some questions to ask your doctor include:
Your health care provider is likely to ask you questions, including: