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Snoring: Nuisance or serious health problem?

Ever had complaints about your snoring? Then it's time to get checked as snoring can be a sign of a serious chronic sleep disorder called obstructive sleep apnoea. Here's what you need to know about this condition.

Snoring occurs when air is not flowing freely through your breathing pathways. The sound is caused by the tissues vibrating as the air passes through a narrowed passage way via your nose and throat. Snoring can sometimes progress to obstructive sleep apnoea (OSA) when there is partial or complete blockage of your airways causing pauses in breathing which leads to choking or gasping during sleep.

Being overweight, having a small chin or flat cheeks, having large tonsils, a blocked nose or large tongue can increase the risk of OSA. A local population study found that one in three Singaporeans suffer from OSA and that one in 10 have severe OSA.

According to Dr Phua Chu Qin, Consultant Sleep Surgeon, Department of Otolaryngology – Head & Neck Surgery at Sengkang General Hospital, people with OSA have higher risk of coronary heart disease, irregular heart rhythm, stroke, and high blood pressure. In addition, because you experience disrupted sleep from the snoring and choking at night, it can also cause poor concentration, sleepiness and fatigue during the day. 

OSA checklist

Not everybody who snores is suffering from OSA. Do the STOP BANG questionnaire to check your level of risk from OSA.


S — Do you SNORE loudly? 
T — Do you often feel TIRED or sleepy during the day? 
O — Has anyone OBSERVED that you stop breathing, choke, or gasp when you sleep? 
P — Do you have high blood PRESSURE

B — Your BODY mass index is more than 35kg/m 
A — Your AGE is above 50 
N — Your NECK size is more than 40cm 
G — Your GENDER is male 

If you answered "yes" to five or more questions, you are may be at high risk and it is advisable to see an ear, nose and throat (ENT) specialist, respiratory specialist, or sleep specialist for further evaluation.

Fortunately, there are various ways to manage OSA which includes both non-invasive and surgical options. For starters, your doctor may conduct a sleep study test to determine the severity of your condition and find out which therapy is most suitable for you.

Non-invasive treatment options

The first-line, non-surgical method is continuous positive airway pressure (CPAP) therapy which involves the use of a CPAP machine. You will wear a mask that covers and creates a seal over your nose, and sometimes, mouth while the machine gently pumps air into your airway to keep it constantly open while you sleep.

This can work on its own or in combination with other non-surgical treatments, such as the use of mandibular advancement devices, that reposition your jaw forward to open up your airways, changing your sleeping position, weight loss, treatment of nasal allergies, and oral myofunctional therapy which uses a combination of physical therapy facial exercises to manage OSA.

Want to know what facial exercises you can do to stop snoring? Check out this article from HealthXchange!

Surgical treatment options

Wearing a mask to sleep may not be palatable to all patients. In such cases, patients can undergo surgery as an alternative. If suitable, patients with OSA can opt for surgery to widen their upper airway by either removing excess tissue in the nose and throat, or doing jaw advancement surgery to widen the upper airway space.

According to Dr Phua, one of the latest advancements in surgical treatment for OSA is hypoglossal nerve stimulation implant surgery. It involves a small implant to the chest (like a pacemaker), along with an electrical stimulator which passes electrical stimulation to the hypoglossal nerve which is the nerve that controls tongue movement. The electrical stimulation triggers the tongue to protrude or jut forward during sleep, opening the airway behind the tongue and palate. For suitable patients, this implant surgery offers good outcome rates, and patients have found it easier to comply to hypoglossal nerve stimulation therapy.

To sum up…

It is important to note that OSA is a lifelong condition, and the treatment strategies recommended are for the long term. Dr Phua explains, "The concept of using a CPAP machine to sleep is akin to a short-sighted person wearing glasses — they are able to see when wearing the glasses and are unable to if they don't. Likewise, in order to keep your airway constantly open while you sleep, you have to wear the CPAP mask whenever you go to sleep."

Even with surgery, for example, if a patient does not control their weight, their snoring could still come back over time. That is why doctors would usually recommend a combination of strategies to effectively manage OSA.

Reduce your snoring with these tips!

A note on wearable technology

While wearable technology such as Garmin, Fitbit, and Apple Watch can measure and monitor blood oxygen levels while you sleep, the American Academy of Sleep Medicine has stated that these cannot be used to diagnose sleep apnoea. While these have potential for the future, it is currently still advisable to consult a doctor for a diagnosis.

If you are concerned about your snoring and wonder if you have sleep apnoea, do not be afraid to consult your GP or polyclinic doctor and ask for a Sleep unit referral. Early diagnosis and treatment are important to help you regain your quality of sleep and quality of life. Treatment strategies like CPAP, surgery, dental appliance and positional therapy have also advanced in leaps and bounds, meaning there can be a suitable solution to help with your needs. 

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