Managing snoring

Australian Journal of Medical Herbalism, Winter, 2006 by Anne Cowper

Kotecha B. 2006. Managing snoring and severe OSA. Practitioner 250:1682;44-53.

It has been estimated that 40% of the UK population snores and 1-2% suffer from obstructive sleep apnoea (OSA). It is difficult to distinguish simple snoring from snoring associated with OSA without resorting to specialist investigations. Sufferers of sleep disordered breathing are at greater risk of developing high blood pressure, heart attack and stroke and may increase their risk of road traffic accidents.

Snoring worsens with age, obesity, alcohol intake, smoking and nasal obstruction. About 10% of men under 30 snore compared to 60% of men over 60. Men are almost twice as likely to snore as women. Simple snoring can cause marital disharmony and more seriously cause disruption of sleep with subsequent tiredness and lack of concentration during the day.

In evaluating the patient, information can be more accurately obtained from a bed partner and should include snoring crescendo, obstructive episodes, arousals, cognitive changes, morning headaches, unrefreshing sleep nocturia, nasal obstruction, alcohol intake, smoking, drugs, cardiovascular symptoms, respiratory symptoms, endocrine and shift work. Excessive daytime sleepiness can be evaluated using the Epworth sleepiness scale.

Epworth sleepiness scale

How likely are you to doze off or fall asleep in the situation described below, in contrast to feeling just tired?

0 = would never doze, 1 = slight chance of dozing, 2 = moderate chance of dozing, 3 = high chance of dozing

Sitting and reading

Watching TV

Sitting, inactive in a public place

As a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking to someone

Sitting quietly after a lunch without alcohol

In a car while stopped for a few minutes in the traffic.

Total /24. A score of 12 or more may be significant.

Management includes weight reduction (using neck circumference and BMI to monitor progress), medications for nasal obstruction, avoid evening alcohol and hypnotics, and cessation of smoking. Further treatment involving the respiratory physician, ENT surgeons and orthodontists may be required.

The gold standard treatment of patients with OSA is the use of nasal CPAP (continuous positive airway pressure) therapy. Surgical management is usually reserved for simple snorers or patients with moderate OSA after failure of CPAP.

Anne Cowper

PO Box 45, Concord West NSW 2138

Email ajmh@nhaa.org.au