RE: Un-stuffing Your Stuffy Nose [copied from old forum]
Chapter 7: The Truth About Snoring: What Works (copied from old forum)
What most doctors don't know about snoring
Which procedures work and which ones don't
Three myths about snoring that can kill you
What Most Doctors Don't Know About Snoring
Snoring is probably one of the most frustrating conditions not only for the snorer, but for spouses and bed-partners as well. It's also one of the least understood medical conditions by most doctors. One of the main reasons for this is that snoring is portrayed in the media and pop culture as something to be laughed at. The truth is that snoring reveals that the person who snores is most likely struggling to breathe at night, and is at a much higher risk of having a heart attack or stroke. Most textbooks and internet resources describe snoring as coming from the soft palate, since that's where most of the vibrations occur. However, the soft palate doesn't flutter all by itself: the nose as well as the tongue can be involved. Even most doctors focus way too much attention on the
The challenging part of eliminating snoring is in figuring out what's actually causing the snoring. The vibrations of the soft palate is only the end result. Imagine your upper airway as a long, thin tube with three main areas that can either narrow or collapse when a slight vacuum pressure is applied. Think of a flimsy straw as you suction in through one end: as you pinch the tip (the nose), the middle part collapses. If you pinch the middle part, the tip collapses. Your upper airway is a lot more complicated with various turns, crevices, narrowing, as well as certain areas that are collapsible to various degrees depending on your sleep stage (determining muscle tone), gravity, and factors that cause inflammation (colds, allergies, etc.).
One major factor that determines how well you breathe at night is the size of your jaws. It's been shown that modern human's jaws are slightly smaller than what we had hundreds of years ago. Various reasons are proposed, but one major reason is thought to be due to a major change in our diets. (For a more complete description of this process, take a look at my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired.) If your jaw is slightly smaller, then your tongue which grows to its' normal size, takes up too much space, sitting higher and more backwards in your throat. When you lay flat on your back, due to gravity, your tongue will fall back partially, and when you breathe in, a mild vacuum effect is created upstream at the palatal level, which constricts the soft palate closed, and then the free edge of the soft palate flutters. If your nose is stuffy for any reason, then a vacuum effect is created downstream, and the palate and tongue can collapse even more. So this is how a simple cold or an allergy attack can aggravate temporary snoring
Furthermore, if your muscles relax more than usual (like after alcohol ingestion), then you may stop breathing once in a while. If these pauses last longer than 10 seconds,then it's called an apnea. If you have 5 or more apneas every hour on average, then you have obstructive sleep apnea. Untreated obstructive sleep apnea can lead to depression, anxiety, weight gain, diabetes, sexual dysfunction, high blood pressure, heart disease, heart attack and stroke.
It's been shown that a significant number of heavy snorers have obstructive sleep apnea (about 30-40%, and much higher as you get older or heavier). Not all snorers have sleep apnea, and not all people with sleep apnea snore. If you're not snoring, then you may not be breathing. It's also been shown that neither you nor your bed-partner can tell if you stop breathing—it can just be silent pauses, without gasping, coking or snorting sounds. When some people say, I used to snore a lot, and now I don't anymore, but I'm still tired, then I get very suspicious. Others say with confidence, "I know I don't have sleep apnea." More often than not, they're wrong.
One major myth that's perpetuated by most doctors and with the general public is that you have to be an older, middle-aged, snoring man with a big neck to have sleep apnea. Now it's been shown that even young thin women who don't snore can still have significant sleep apnea. I remember seeing one young, thin, petite woman who stopped breathing over 110 times every hour!
Some of you will tell me, "I sleep fine. I sleep like a rock. I can sleep for 10 hours without waking up." This is a potential warning sign. If you fall asleep too quickly or can sleep for 10 hours without feeling refreshed, what this means if that you're not able to sleep efficiently. This goes along with studies that show that if you sleep less than 5 hours or sleep more than 9-10 hours, then you'll have a higher chance of developing depression, diabetes, and heart disease.
What Can I Do To Stop The Snoring?
Most internet sites on snoring or brochures from doctors offices list a routine series of tips on what you can do:
don't drink alcohol before bedtime
don't take any medications that are sedating or relaxing
sleep on your side
sew a sock stuffed with a tennis ball to behind your back to prevent sleeping on your back.
use nasal dilator strips.
Sometimes, any of these options may work to various degrees, but for most, the problem will usually come back. The most important point that I want to make here is that if you snore heavily, you have to make sure you do or don't have obstructive sleep apnea. Even if you are successful in covering up your snoring, you could still have untreated obstructive sleep apnea. The best way of finding out what's happening is to see a sleep doctor and undergo an overnight sleep study. More recently, simpler homebased studies are starting to be used. If you are found to have obstructive sleep apnea, then treating this condition definitively should take care of your snoring. Not only will your snoring improve, you'll also feel much better in the morning, and have much more energy during the day. In addition, your increased risk for heart disease, heart attack and stroke will be improved as well. You may also lose weight. Treatment for obstructive sleep apnea is a whole other discussion, which I address in a separate report.
So lets say that you don't officially have sleep apnea. What can you do? Before I go into this discussion, sleep apnea is not something that you either have or don't have. Everyone is on a continuum. As mentioned before, if your AHI is 5.1, you're told you have it, whereas if your score is 4.9, do don't have it, and because you don't officially meet the formal criteria, you won't be eligible for coverage by your insurance carrier, despite the fact that you feel lousy during the day, and your relationship with your wife or bed-partner is suffering.
Treatment Options For Snoring
There are over 300 patented devices and gadgets for snoring. Sometimes they work, but with a few exceptions, most of these devices either cover up your snoring without getting to the root cause of your condition, or keeps you awake so that you you don't snore. Three popular anti-snore aids were recently tested for effectiveness in a prospective study: a throat spray, nasal dilator strips and a pillow. None of these three were found significantly better than controls when tested prospectively. There are even devices that wake you up as you enter deeper levels of sleep to prevent muscle
relaxation. What I'll describe in this section is a comprehensive list of all the standard medical, surgical, and over-the-counter options that you'll hear and read about. If you see one that I've left out, please let me know and I'll give you my opinion. Remember, many of these devices (with a few exceptions) only cover up the snoring, without treating the real cause. If you try a variety of these options to find no relief, please see your medical doctor or a sleep specialist for a formal evaluation and treatment.
Medical Options For Snoring
Note: Many of the procedures below, although effective for snoring, are never 100 successful. Success rates range from 70% to 95%. There is also a small chance of relapse even if initially successful. Continuous Positive Airway Pressure (CPAP): This option may be overkill, and you'll
need to pay for it out of pocket if you don't officially have obstructive sleep apnea. But it does work, if you can get used to it.
Dental devices: There are multiple options with this type of treatment, with the formal mandibular advancement devices that are made by dentists. These devices pulls your tongue forward by pulling your lower jaw forward. There are many different models that all have various features that make it more likely to work depending on your anatomy. Different dentists have different preferences as well. A less expensive way to "test" whether or not these devices may work is to try one of the many over-the-counter (or over-the-internet) boil-and-bite models. These devices are softened in hot boiling water and the set as you softly clench down while simultaneously pushing your jaw forward.
Laser Assisted Uvulo-Palatplasty (LAUP): A laser is used to trim the free edge of the soft palate. It's somewhat painful, and usually must be performed 2-3 times. It can be performed in the doctor's office, and is relatively expensive.
Injection Snoreplasty: Any type of scarring agent (sodium tetradecyl sulfate, ethanol, etc.) can be injected just underneath the mucous membrane of the soft palate. Must be performed 2-3 times for maximum effectiveness, is less painful in general, and is the least expensive.
Pillar Procedure: Three thin woven braided polyester rods are inserted inside the muscle layer of the soft palate. It's usually performed under local anesthesia and is one of the least painful. Typically, only one treatment is needed, and is most expensive. Uvulopalatopharyngplasty (UPPP): Usually used for obstructive sleep apnea, but very effective for snoring. In general, it's only about 40% successful for obstructive sleep apnea.
Other Classic or Unusual Ways to Stop Snoring
Note: All the options listed below, although not proven to help snorers on a consistent basis, have been reported to work at least some times in some people. Most of the reports are anecdotal, with no objective supportive data. One major problem is that if it works, it may only delay diagnosing and treating any underlying obstructive sleep apnea.
Tennis balls: For some people, staying off your back can make a big difference. The problem is staying on your back. The most common recommendation is to sew a sock filled with a tennis ball to the back of your pajamas. This method has mixed results, and in general, although it sounds great, doesn't work that well. It just only annoys the snorer or they just sleep on top of it.
Sleep position devices: There are a number of gadgets and devices that prevents you from rolling onto your back. They range from triangular wedges to shirts filled with foam rods to prevent sleeping on your back. The only way to know whether or not they work is to try it. For some people, it can make a huge difference, even if you have obstructive sleep apnea. For many others, you may have a mixed response, or no response at all.
Side sleep position pillows: This one positions your arm above your head and somehow forces you to sleep on your side. Again, I've heard mixed responses from my patients. If you can sleep with your arm above your head for hours without it becoming numb, then this may work for you.
"Contour" pillows: This pillow works better if you prefer to sleep on your back. The lower end of this pillow is a bit higher than the middle part that the top of your head touches. This forces your head to be cocked back a bit, lifting up your chin somewhat, thereby opening up your airway somewhat. This the the same maneuver that you're taught to do during CPR to open up the airway before you give mouth-to-mouth. Notice that after you fluff up your pillow you go to bed, the pillow height diminishes slowly, and by the end of the night, your chin is closer to your head, which closes your airway. Another option is to either roll up a towel into a "log" or get one of the Asian husk-filled pillows that are shaped like a roll. You'll have to experiment to find the right height.
Diet and weight loss: This will help to various degrees for most people who are overweight, but what if you're already thin? Also, since poor sleep leads to weight gain hormonally and metabolically, it can be very difficult to lose weight no natter how much you diet or exercise. For some, losing 10-15 pounds may help a great deal with your snoring, but chances are, it'll return sooner or later as you get older.
Nasal dilator clips: Whether external (Breathe-Rite) or internal (Nozovent, Nasal Cones, or Breathewitheez), these work sometimes by pulling your soft flimsy nostrils apart, preventing nostril collapse when you inhale. During sleep, especially when your muscles relax, any degree of nasal congestion can aggravate higher vacuum pressures that can aggravate tongue collapse. Despite being touted to cure snoring, it only works about 10% of the time. Here's one simple test to see if you should invest any money on these products: take both you index fingers and gently press on your skin, right next to your nostrils. Press gently and pull your cheeks apart on each side towards the outer corners of the eyes. This is called the Cottle maneuver.
Wind instruments: Playing any type of wind instrument (flute, clarinet, trumpet, etc.) can in theory promote throat and tongue muscle tone. Reports of success are anecdotal.
Playing the Didgeridoo: Various studies have suggested that playing this ancient Aborigine wind instrument can help relieve snoring. The mechanism in how it works is similar to any wind instrument.
Singing: The mechanical act of singing promotes profound throat muscle tone and control. Similar to all the wind instruments, prolonged periods of singing promotes relaxation, since exhalation is activated by your parasympathetic nervous system.
Tongue Exercises: Has been found to be helpful for some people, but needs continuous exercises.
Throat sprays: Various mixtures of herbs and natural ingredients are promoted for snoring, but a recent objective study showed that they were not helpful.
Acupuncture: No consistent evidence, but helps with stress and fatigue.
Bedpartner's elbow: Works to wake you up to stop snoring, but never curative. This is called the "bruised rib syndrome". Electronic devices that wake you up when you snore: More expensive than a
bedpartner elbowing you in the ribs.
Ear plugs for the bedpartner: May help the bedpartner sleep, but not very effective for the very low-frequency snoring vibrations.
Sleeping in another room: Usually alleviates the problem, but bad for relationships, and not very helpful for "heroic" snorers where the sounds vibrate the bedroom walls 2-3 rooms down.
The Nose And Snoring
A few words about nasal congestion and sleep-breathing problems are in order. If you have sleep apnea and have nasal congestion, undergoing a septoplasty will not cure you of your sleep apnea in most cases. Studies have shown only about a 10% chance of sleep apnea eradication after nasal surgery only. Also, contrary to popular belief, snoring does not come from the nose. Snoring sounds come mainly from the soft palate, but can also come from the tonsils, the tongue, sidewalls of your throat, or the epiglottis.
Any degree of nasal congestion can aggravate soft palate or tongue collapse, leading to either snoring or breathing stoppages, especially in deeper levels of sleep due to muscle relaxation. Rarely, opening your nose can help with snoring, but even if it doesn't, it's a good thing to be able to breathe through your nose. If you have a sleepbreathing disorder, it's important to be able to breathe through your nose for many of the treatment options to work.