If you snore or know someone who does, there is a wide range of treatment options that can help. My practice is dedicted to the surgical evaluation and treatment of snoring and obstructive sleep apnea, and anyone should feel free to contact me via e-mail or finding more information about seeing me as a patient here. In addition to conservative treatment options, there are procedures such as the Pillar Procedure and palate radiofrequency that have relatively little pain and can make major improvements in snoring in certain patients. The keys to achieving good results with these treatments are experience with performing the procedure and–just as important–the evaluation to determine whether they are good choices for an individual patient.
Snoring can be a major issue, as those who snore can present major problems for anyone in the bedroom–or anyone within earshot–who might be awakened from sleep by the loud, irregular sound that can occur. However, I have always been struck by patients who report that they wake up because of the sound of their own snoring. The accepted thinking among sleep experts is that there could be a number of reasons that patients who snore may awaken from sleep but that the snoring sound itself was likely not one of them. This seemed unlikely based on studies suggesting that during sleep the brain becomes used to one’s own snoring (a process called habituation) and based on the experience with countless patients with sleep studies and no obvious awakenings with snoring unless there was also blockage of breathing, as in obstructive sleep apnea. But the widespread rejection of snoring sound as a cause of sleep arousals was simply an educated guess, based on years of experience but not much concrete evidence.
First study to address this question systematically
A study published in this month’s issue of the medical journal SLEEP included a study specifically examining whether snoring sound wakes up the snorer. Researchers at the University of Michigan Sleep Disorders Center enrolled 400 patients who were getting sleep studies in their laboratory. One-half of them randomly received earplugs to wear during their sleep study (and before, to get used to them) in order to reduce the loudness of their own snoring. The sophisticated part of the study was their use of a previously-tested complex analysis of brain waves to determine subtle awakenings from sleep not visible to the naked eye. They were able to analyze periods of snoring without obstructive sleep apnea events (apneas and hypopneas) using an electronic algorithm they had previously developed and tested. This allowed them to determine 5 different types of respiratory-cycle related electoencephalographic changes (RCREC), with arousals from sleep reflected most in 2 types (increase in 1 and decrease in the other).
Sound of snoring may be waking up snorers
The group wearing the earplugs had slightly less of the latter key type of RCREC, suggesting that the sounds of snoring may wake up snorers themselves. The effect was mainly seen in men, and there was the suggestion that it was more of a factor in those who were not obese (body mass index less than 30 kg/m-2) and those who also had some degree of obstructive sleep apnea (apnea-hypopnea index > 10 events/hour). The study had a number of other limitations that the authors raised in the paper, such as the lack of comparing the same person on 2 different nights, with and without earplugs. Importantly, the effect was only seen in 1 type of RCREC, albeit 1 of the 2 types that appears to be most important for sleep quality. The authors also point out that the arousals may not be due to the snoring itself but may be related to the increased breathing effort that often occurs with snoring.
The bottom line: more research is needed to examine the impact of the sound of snoring
To some extent, it may not matter if snoring wake you up from sleep because of the snoring sound, increased work of breathing, or something else. If snoring without sleep apnea interferes with the ability to obtain refreshing sleep, it could explain sleepiness and fatigue and would argue for more-aggressive treatment of snoring. However, this initial study does not prove that we need to be over-aggressive in treating all snoring, as physicians must consider whether individual patients have snoring that affects themselves and/or others. Nothing has changed there. Nevertheless, this study is the first to examine whether the snoring sound might be waking up the snorers themselves and should lead us to question what had been the conventional wisdom that overlooked this possibility.