Snoring

[ Snoring ]

With snoring ( snoring med ) is called a rattling noise that is generated in the upper airway of a sleeping man. The normal snoring is also called compensated snoring and is in low grade a normal variant without clinical significance. With age snore around 60 % of men and 40 % of women. About 10 % of children snore. At very pronounced snoring can cause a decrease in oxygen supply and consequently to a disturbance of sleep. This is called obstructive snoring.

• 5.1 Surgical procedures
• 5.2 Further surgical measures
• 5.3 training

Relevance to health

If a person is regularly affected by obstructive snoring and suffers or is impaired in everyday life, is diagnosed according to the International Classification of Sleep Disorders ( ICSD -2 ) is a sleep-related breathing disorder. We also speak of a snoring or from upper airway resistance syndrome ( UARS ), which in contrast to the obstructive sleep apnea syndrome (OSAS ) is only a temporary closure of the upper airway is present, but also to hypoxia ( lack of oxygen), arousals ( Aufweckreaktionen ) and may in consequence lead to daytime fatigue and impaired concentration. In the literature it is discussed whether it is in the upper airway resistance syndrome and obstructive sleep apnea syndrome during two different sleep disorders or merely different degrees of severity of the same sleep disorder. The International Classification of Sleep Disorders summarizes the upper airway resistance syndrome as a mild form of obstructive sleep apnea syndrome. Epidemiological studies have shown that people who suffer from untreated obstructive snoring, have an increased risk for developing high blood pressure ( hypertension), stroke, and heart attack. There is strong evidence that distinct snoring on the vibrations to a local neuropathy can result, which in turn may increase health problems.

Causes

The snoring sound is caused by fluttering movements of the palate and the uvula, in part, base of the tongue and throat breathing. It may be caused in some cases by nasal breathing disabilities.

When snoring is generally before a blockage of the airways. Most swinging due to the relaxation of the body in sleep limp soft palate flapping in the wake of the air we breathe. However, it can also fall back to the rear portion of the tongue in the mouth. So there is not only a factor that is used as the cause of the symptom in question.

For most sufferers, snoring occurs depending on the patient's position. So it often comes in the supine position for snoring, when the lower jaw of the sleeper is not supported, and he breathes through his open mouth. Join the body one caused by the labored breathing lack of oxygen, it triggers a change in position.

Also overweight or genetic predisposition may be responsible for ensuring that an anatomical feature is present, the snoring ultimately causes: The respiratory system of the sleeper can not be maintained in any body position, the necessary tension that would prevent snoring.

Also encourage alcohol consumption or taking sedatives, hypnotics, tranquilizers and psychotropic drugs, the relaxation of the soft palate and thus the process of snoring.

Snoring occurs in various forms. So there are people who only snore occasionally, eg during a cold. Other people snore almost every night, coupled with some very loud, strong disruptive snoring sounds. A constantly stuffy nose, for example, chronic inflammation, allergies or a crooked nasal septum is another possible cause of snoring.

The sleep apnea syndrome is often accompanied by violent nightmares. In sleep apnea, the sleeper suffers a massive lack of oxygen. The body activates a protective reflex. The respiratory effort, and the voltage of the respiratory and respiratory muscles rises, so that a breath is possible. Here, a stress response is triggered that leads to blood pressure and heart rate increases. Also adrenaline release occurs. The person may wake up gasping for air and with strong heart palpitations, but the vast number of stress reactions occur unnoticed during sleep.

Follow

With a strong expression of snorers can even wake up by his own snoring noise.

Consequences for the snorer

Often snoring do not have restful sleep because the snoring cycles, especially in the important dream and deep sleep phases occur. Fatigue, nervousness and fatigue, even after long sleep are the result of the waking state. More serious snoring suffering, if they occur in the long term and are not recognized impairments on the heart and circulatory system ( hypertension ) with increase in the infarct and stroke risk entail.

A U.S. study suggests that snoring during early childhood could potentially adversely affect cognitive development: In the group of surveyed seventh and eighth graders were among those who had poorer school performance, above average number of children who had snored with 2 to 6 years. A study among 4 - to 5 -year-olds showed that when parents reported snoring and disturbed sleep of their children, these children actually had insomnia and also showed behavioral problems; this correlated with maternal smoking, but not of the Father. A cause -effect chain of the effects of childhood snoring does not follow, however conclusive evidence. In addition, child-like snoring can not be distinguished by the clinical history alone of a sleep apnea syndrome.

Sleep Apnea Syndrome

It can respiratory arrest due to complete collapse of the throat or neck soft tissues occur. These pauses in breathing can be extremely numerous per night occur, causing sleep is severely impaired. An extreme form of snoring, associated with apnea, called obstructive sleep apnea syndrome (OSAS ); it is a serious sleep disorder.

Consequences for the partner

The noise of snoring is comparable at 20 decibels with the volume of rustling leaves, but it can also achieve much higher values. The Guinness Book of Records leads to snoring by 93 decibels, which corresponds to the noise level of a busy highway.

Snoring endangers the health of the partner and the stability of the relationship. Less than 25 pairs a study by the University of Surrey in 2005, according therefore took the men snoring of their partner often not true because her sleep was deeper; once the snoring bothered but woke most of their partner. Conversely tried the women especially, not to wake her snoring partner, even if it cost snoring sleep itself.

Code of Conduct

Through simple, self- performed actions you can try to combat snoring. Often it is achieved in at least to alleviate the snoring; However, these measures are not always successful.

Medical Treatment

In cases where a nasal obstruction could conspicuous are the cause for snoring, appropriate treatment should be carried out. Examples of these can be deviated septum ( septal deviation ), sinusitis, enlarged turbinates and allergy list. Often there is some combination of these causes. The cause must be determined under certain circumstances a Somnoendoskopie.

Surgical procedures

The success of surgical interventions is controversial; a disadvantage is that they are often irreversible.

Thus it is possible to tighten the palate and the pharyngeal mucosa and substantially remove the uvula. Away In this procedure, you generally also additionally the tonsils ( palatine tonsil ). This procedure is called a uvula - palato - pharyngo - plastic ( UPPP ). This operation may cause the snorer to an improvement. This intervention must be stationary performed under general anesthesia. Complications are rare; next rebleeding within the first week can also be caused long-term problems such as swallowing and leakage of fluid from the nostrils, pain in swallowing or open nasal speech.

Another method, the use of a laser. These parts of the palate and the uvula are removed. This surgical technique is called laser-assisted uvula - palato - plastic ( LAUP ). The procedure can be performed on an outpatient basis under local anesthesia; surgery under general anesthesia, however, is recommended. Complications of this laser procedure are relatively rare.

In recent years also the radio frequency (RFITT ) has established itself: It is pierced with probes in the pharyngeal tissue and at relatively low temperatures (approx. 80 ° C) by means of high frequency in the ISM band, the tissue may cause melting. Scarred by shrinkage of the palate, it may cause a stabilization of the fabric and thus a reduced sound of snoring.

In the radiofrequency assisted uvulopalatoplasty (RF - UPP ) excess tissue to the palatal arches (webbing ) and the uvula is removed in combination with the coagulation of the soft palate. This combined treatment of snoring can be reduced considerably. Since the temperature in the radio -frequency treatment is typically significantly lower than in the laser, and as opposed to LAUP is not cut in the soft palate muscle, post- operative pain in this method are relatively small.

Soft palate implants: Under local anesthesia of the soft palate is stabilized by inserting plastic pins. If the pins come loose, they are simply replaced. The treatment is suitable only for about ten percent of all snorers, because if the soft palate of a patient is too large, this could stifle the implant.

UvulaFlap: The raised uvula ( uvula ) is sewn on the palate. The mucous membrane is not impaired. Discomfort when swallowing and speech disorders are possible.

Tonsil removal: In adults the tonsils have no important function. When too large, the distance almonds can be combined with an engagement of the soft palate. Postoperative bleeding are possible.

In Nasenscheidewandverkrümmungen and turbinate enlargement surgical straightening of the nasal septum and a reduction of the turbinates is to be performed.

In maxillary sinuses and nasal sinus infections, a wide range of treatment options depending on the extent of the maxillary sinuses or sinusitis provides: This ranges from the administration of mucolytics, antibiotics and sinus rinses to maxillary sinuses and Siebbeinoperationen.

Further surgical measures

The surgical intervention measures described below are partly controversial in German-speaking countries, they are mainly propagated in the United States. You have some absolutely justified, especially in congenital relocations back of the tongue and lower jaw. There is often a multi -level obstruction before, this is reacted with a multi -level surgery.

• Maxillomandibular advancement: mandibular advancement by cleavage of the mandible

• Tongue suspension: tongue is drawn through non-resorbable yarn, which is fixed to a bolt on the lower jaw, forward

• Hyoid suspension: In order to prevent the base of the tongue from falling back hyoid ( hyoid ) and larynx wired, so that opens the throat. Swallowing and voice changes are possible. Change of feeling in the larynx.

Training

Due to several pilot studies have shown that active muscle training for the back of the mouth, palate, throat can also lead to some successes against the night Atemwegserschlaffungen.

Anti snoring devices

Compared slight disturbances of nasal breathing, a nasal strips are used. If there is no nasal obstruction or has a blocked nose already removed surgically or otherwise, then only the following measures remain:

There are various pieces of equipment on the market, offered for sale, wake the snorer in stronger snoring at night and they should educate them not to snore. Typically, such devices are not promising, since they can not prevent the ultimate collapse of the throat; the snorer is also rather disturbed by this apparatus in his sleep.

A mandibular advancement device holds the lower jaw during sleep in a fixed position, so that the tongue can not fall back and block the airway. Most patients come it well, and the efficiency should be high.

An atrial disk (also atrial rail) is set in the outer oral vestibule between the lips and front teeth, and thus blocks the mouth breathing. The contours on the inside of the rail atrial / atrial disk serve as toys for the tongue. Due to the resulting swallowing reflex, the tongue is pressed against the front teeth and the atrium bar / vestibular plate and is placed by the resulting vacuum there. The clearance of the windpipe is expanded and blocked the vibration of the soft palate. The snoring sounds are to be prevented. The bioplastic material by heating in the mouth yet elastic and individually adapts to the oral vestibule at.

Another possibility is the soft palate to fix with a simple clasp: Inserting a clip palate into the oral cavity, the air duct behind the soft palate is mechanically prevented from closing. Thus, a low-resistance air passage is sought in the sleep state and noise -generating vibrations are to be prevented at its source.

Another way of anti-snoring is - in case of a situation of dependence symptoms - the storage training dar. Some patients snore only in the supine position, so that they can be helped by a strapped on his back positioning aid. This positioning aid, eg in the form of a filled with towels backpack with waist belt makes the supine position so uncomfortable that they can not be taken subconsciously at night.

Nocturnal positive pressure ventilation with a mask ( CPAP ) is adapted to increase the pressure in the respiratory tract, to prevent collapse of the airway, and thereby to suppress snoring. This method is, however, associated with the inconvenience of a nocturnal breathing mask, so that it is normally only when specifically impairment of the patient in the form of daytime fatigue and impaired concentration, as well as nocturnal breathing pauses, so the sleep apnea syndrome, for application.