Snoring: A Nuisance or Something More?

With serious conditions ruled out, many snorers can find relief through OTC treatment.

Snoring occurs when the flow of air to the lungs is disturbed during sleep, usually due to a blockage or narrowing of the airway in the nose, mouth, or throat.¹

As a result, the tissues of the airway vibrate and rub against the back of the throat, resulting in a noise that can be described as soft, loud, raspy, harsh, hoarse, or fluttering.¹ Snoring can occur nightly or intermittently, and many snorers are unaware that they snore.

According to the National Sleep Foundation, snoring affects an estimated 90 million adults in the United States occasionally and an estimated 40 million regularly.¹ Although snoring affects both genders, it is more common among men and those who are overweight.^1,2 Snoring also tends to increase with age in both men and women.^1-4

Snoring is often considered a mere nuisance, but it can be an indication of obstructed breathing or a condition such as sleep apnea that requires medical evaluation and treatment in order to avoid serious health consequences.^1-4 Pediatric patients who snore may have a problem with tonsils and adenoids or sleep apnea and should be referred to their primary health care provider for further evaluation.²

Risk Factors for Snoring

The cause of snoring in some cases may be indeterminable. Risk factors that can increase the incidence of snoring include^3-5:

• Male gender
• Being overweight or obese
• Having a narrow airway
• Having a low, thick soft palate or enlarged tonsils or adenoids
• Consumption of alcohol, which relaxes the throat muscles
• History of smoking
• Having nasal problems such as a deviated septum, nasal polyps, or nasal allergies
• Use of sedatives or antihistamines before bedtime
• Poor muscle tone in throat
• Undiagnosed or untreated sleep apnea

It is important to note that although obese or overweight people are at greater risk of snoring, it can also occur in people of normal weight.

Treatment

Most people who snore are unaware of their snoring and learn about it from the observations of others. When counseling a patient on the various anti-snoring products on the market, pharmacists should determine the frequency and severity of their snoring as well as inquire whether the patient is experiencing daytime sleepiness, difficulty concentrating, headaches, or interrupted sleep throughout the night.

Pharmacists should encourage patients to consult their primary health care provider when warranted. In particular, patients who exhibit symptoms of sleep apnea should always consult a physician for further evaluation and appropriate treatment.

The nonprescription products available for reducing the incidence of mild snoring include drug-free nasal dilator strips such as Breathe Right Nasal Strips (GlaxoSmithKline) that open up the nasal passages. Throat rinses and sprays are also available. These formulations work by lubricating the tissues of the throat, which minimizes vibrations, thereby eliminating or reducing the incidence of snoring. Patients with sleep apnea should avoid using these products and should always seek proper treatment from their primary health care provider.

There are also a number of oral appliances that maintain an open, unobstructed airway in the throat during sleep.⁷ Studies have found that custom-made oral appliances are more effective than OTC devices.⁷

Patients who suffer from episodes of mild-to-moderate snoring may also benefit from nonpharmacologic measures such as weight loss, smoking cessation, changing sleeping positions (ie, sleeping on one’s side instead of one’s back), avoiding alcohol intake before bedtime, and treating nasal congestion due to colds and allergies to increase airflow.

Examples of key indications that an individual should seek further medical advice for their snoring are presented in Table 1.^1,2,4

Final Thought

When recommending any nonprescription anti-snoring product (Table 2), pharmacists should counsel patients to ensure that they use them correctly. Patients should seek medical care if the degree and frequency of snoring negatively impacts their quality of life and should be encouraged to discuss sleep apnea with their primary health care provider.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References:

1. Snoring and Sleep. National Sleep Foundation website. http://www.sleepfoundation.org/article/sleep-related-problems/snoring-and-sleep Accessed May 20, 2012

2. Snoring. American Academy of Otolaryngology--Head and Neck Surgery website. http://www.entnet.org/HealthInformation/snoring.cfm Accessed May 19, 2012

3. Snoring and Nasal Congestion. American Rhinologic Society website http://care.american-rhinologic.org/snoring_nasal_congestion Accessed May 19, 2012

4. Snoring. Medline Plus website. http://www.nlm.nih.gov/medlineplus/ency/article/003207.htm Accessed May 18, 2012

5. : Risk Factors for Snoring Mayo Clinic website. http://www.mayoclinic.com/health/snoring/DS00297/DSECTION=risk-factors Accessed May 18, 2012

6. Snoring. American Academy of Dental Sleep Medicine website. http://www.aadsm.org/snoring.aspx Accessed May 19, 2012

7. Oral Appliances. American Academy of Dental Sleep Medicine website. http://www.aadsm.org/oralappliances.aspx Accessed May 18, 2012