Siamak N. Nabili, MD, MPH
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
In this Article
- Snoring facts
- What is snoring?
- How common is snoring?
- What causes snoring?
- The function of the nose in normal breathing
- How do medications and alcohol affect snoring?
- Why is snoring a problem?
- What is the clinical importance of snoring?
- What are different levels of snoring?
- How should someone with snoring be evaluated?
- How is it determined if snoring is a medical problem?
- What are some objective tests to measure sleepiness?
- What are the treatments for snoring?
- What are some non-surgical treatments for snoring?
- What are the surgical options for snoring?
- What is the success of surgery for snoring?
- Find a local Sleep Specialist in your town
How is it determined if snoring is a medical problem?
People who sleep (or lie awake not sleeping) near a snorer often report signs that may indicate a more serious problem. Witnessed apnea (stopping breathing) or gasping can suggest a breathing problem (sleep apnea, see below) or resulting heart problems. Leg kicking or other jerking movements can indicate a problem such as periodic limb movement disorder or restless leg syndrome. Referral to a sleep specialist may be recommended if obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder are suspected. Multiple studies have shown that simple clinical evaluations cannot determine if a person only snores, or if he or she has a more significant sleep disturbance. Therefore, a sleep study is often needed to determine if obstructive sleep apnea is present prior to initiating any treatments.
If someone's sleep is disrupted because of snoring, the person may also notice other symptoms. Frequently, people complain of difficulty waking up in the morning or a feeling of insufficient sleep. They may take daytime naps or fall asleep during meetings. If sleep disruption is severe, people have fallen asleep while driving or performing their daily work.
Daytime sleepiness can be estimated with a sleepiness inventory, and a sleep study can be performed if a sleeping problem is suspected. There are two general types of sleep studies:
- Home sleep study (portable sleep study)
- Full sleep study (polysomnography in a laboratory with a technician)
Home sleep study
A home (unattended) sleep study can measure some basic parameters of sleep and breathing. A pre-test evaluation by a sleep medicine specialist to determine if home testing is appropriate is recommended. Often, the home sleep study will include pulse oximetry (a measurement of the level of oxygen in the blood), a record of movement, snoring, and apneic (pause in breathing) events. A home study can prove that there are no sleeping problems or suggest that there may be a problem. Some types of home sleep studies may monitory blood vessel reactions or tone as well as detecting respiratory events. Improved technology has expanded the ability to perform testing in the person's own sleep environment.
If a home sleep study suggests a problem, treatment is often initiated. If the results are not clear, repeat testing with a full sleep study (polysomnography) may be performed in a clinic. (For a complete description of a full sleep study, see below).
If the sleepiness inventory and sleep study suggest there are no sleeping or breathing disorders, a person is diagnosed with primary snoring. Treatment options then can be discussed.
Epworth Sleepiness Scale
The Epworth Sleepiness Scale is a "test" based on a patient's own report that establishes the severity of sleepiness. A person rates the likelihood of falling asleep during specific activities. Using the scale from 0 to 3 below, patients rank their risk of dozing in the chart below. (This chart can be printed out and taken to the doctor.)
- 0 = Unlikely to fall asleep
- 1 = Slight risk of falling asleep
- 2 = Moderate risk of falling asleep
- 3 = High likelihood of falling asleep
|Situation||Risk of Dozing|
|Sitting and reading|
|Sitting inactive in a public place|
|As a passenger in a car riding for an hour, no breaks|
|Lying down to rest in the afternoon|
|Sitting and talking with someone|
|Sitting quietly after lunch, without alcohol|
|In a car, while stopped for a few minutes in traffic|
After ranking each category, the total score is calculated. The range is 0-24, with the higher the score the more sleepiness.
- 0 to 9 = Average daytime sleepiness
- 10 to 15 = Excessive daytime sleepiness
- 16 to 24 = Moderate to severe daytime sleepiness
Breaking it down further, excessive daytime sleepiness is greater than 10. Primary snorers usually have a score less than 10, and individuals with moderate to severe sleep apnea usually have a score greater than 16. (One woman filled out the sleepiness scale and had a low score. Sitting in the physician's office, however, she was falling asleep while waiting. The physician asked her why her score was so low. She replied, "I don't ever read books, watch TV, or ride in a car, so the likelihood that I would fall asleep doing those things is very low.")
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