Snoring is a very common complaint. It has been estimated that between 25 to 40% of the adult population snores. Snoring does not usually trouble the snorer; it affects mainly the sleep partner or the family. We now know that loud snoring may indicate a more serious medical condition of obstructive sleep apnoea and its associated medical complications of high blood pressure, heart disease, stroke and diabetes. What Causes Snoring? Snoring is the sound pro-duced by the upper airway during sleep. The narrowing of air pass-ages during sleep results in vibrations of the soft palate, uvula and base of tongue. When these structures strike against each other, snoring results. The narrower the air passages, the more force is required to open the air passages, hence the snoring grows louder. What is Sleep Apnoea? In severe narrowing of the upper airway during sleep, apnoea or breath-holding takes place. If this happens frequently enough (more than 10 times per hour), obstructive sleep apnoea (OSA) results. The breath-holding episodes can go up to several hundreds of times per night with each episode lasting up to 30 seconds or so in servere cases.

30% Risk of Dying
When one holds one’s breath, the oxygen level in the blood drops and the body senses this. The heart will react by working harder to pump blood around the body. Over time this leads to significant stress of the heart and circulatory system resulting in high blood pressure and increased risk of heart attacks. After some time, the body reacts by lightening of sleep and taking deep breaths to replenish the oxygen. The chronic lack of oxygen also leaves the individual tired and inattentive during the day. Sleep is also disturbed, as the sufferer could not enter into deep sleep for significant periods due to lack of oxygen. A study in the US suggested that there is a 30% increased risk of dying in sleep apnoeic patients compared to normal
individuals when followed up over a period of 9 years.

Symptoms of Sleep Apnoea

• Loud snoring in most positions Observed apnoea (breath holding) by sleep partners or family members
• Awakened from sleep by gasping, choking or with sense of dread or anxiety
• Excessive daytime sleepiness e.g. falling asleep easily while reading, watching TV and drivingUnrefreshing sleep
• Abnormal nocturnal activities e.g. sleep walking, periodic limb movement, night sweats, reduced libido, and frequent visits to the toilet at night.

If You Suspect that You may have Sleep Apnoea:
Consult an Ear, Nose & Throat (ENT) physician. The ENT physician will take a detailed history and perform an examination that will include a nasal endoscopy to study the upper airway and identify correctable problems. A Sleep Study will also be arranged to determine the severity of the OSA. With technological advances, sleep study can now be performed in the comfort of your home or in your hotel with nonobtrusive recording devices. The Sleep Study report is prepared and your physician will review the result with you the next day.

Treatment for Snoring & Sleep Apnoea
In mild OSA and snoring individuals, simple clinic based procedures and medication may relieve the individual of the problem.
These measures include

• Radiofrequency stiffening of the palate
• Radiofrequency reduction of turbinate
• Radiofrequency reduction of the tonsil
• Radiofrequency reduction of the tongue base
• Laser treatment to the palate
• Reshaping of the palate using radiofrequency
• Pillar implant to stiffen the palate

For those with large tonsils, removal of the tonsils (tonsillectomy) may be necessary. Other procedures include

• Uvulopharyngoplasty
• Repose tongue suspension
• Hyoid bone suspension
• Jaw advancement
• Dental devices

For those that are not suitable for the above procedures, CPAP, which provides a positive pressure to prevent apnoea, may be worn during sleep. Compliance however is an issue. Weight reduction and lifestyle modifications will complement the above treatments. Snoring & Sleep Apnoea in Children Snoring and sleep disorder may affect up to 11% of children. The peak incidence is between 3 and 7 years. Equal number of boys and girls are affected. Children with large tonsils and adenoids, obesity, family predisposition and face and skull abnormalities are predisposed. Children with OSA are habitual snorers often heard outside the bedroom. Excessive sweating and unusal sleeping positions are also symptoms. An accurate diagnosis and in most cases, effective treatment of nasal allergies, removal of adenoids and tonsils will cure the problem.