Wake-up call

PUBLISHED : Monday, 15 December, 2008, 12:00am
UPDATED : Monday, 15 December, 2008, 12:00am

Six months after their wedding, George Douglas, 33, and his new bride holidayed with her parents at a beachside campsite in Western Australia. They arrived at the crowded site at dusk, pitched their tent and sat around the campfire relaxing over a bottle of tawny port with their neighbours.

When Douglas woke the next morning, he was startled to find his parents-in-law gone, and their corner of the campsite quite empty. His family and neighbours had decamped in the middle of the night to the site's far end to escape his deafening snoring.

It might be a funny story, but for sufferers such as Douglas - and those who share beds with them - chronic snoring is a distressing problem. Severe snoring can reach 92 decibels, as loud as a bus' diesel engine.

Dentist Dr Patricia Siu Fung-yee says snoring is common. 'Statistics tell us about 40 per cent of men and 30 per cent of women snore, and this percentage increases with age, peaking between 50 and 59 years.' As people age they typically gain fat around the throat and jowls, and lose muscle tone, making them more likely to snore.

'Snoring is the result of partial blockage of the upper airway,' Siu says. 'When you fall asleep, your muscles relax, including those that control the tongue and throat. The soft tissue in the back of your throat can sag and narrow the airway. Incoming air then makes the tissue at the rear roof of the mouth [the soft palate], the flap of skin hanging from the palate [uvula] and the throat vibrate, making the sound we know as snoring.'

At its most benign, snoring can cause sleep deprivation for both partners and sufferers, as well as fatigue, irascibility, an inability to concentrate, and social embarrassment. 'It affects every aspect of my life,' Douglas says. 'Although I travel regularly for work, I never allow myself to sleep on planes. I watch movies and drink copious amount of coffee, even if I'm flying long-haul.

'On a daily basis, I feel exhausted, my short-term memory is definitely affected, I'm lethargic, and I can easily sleep for 12 to 14 hours and still feel as if I haven't rested at all.'

Elaine Macey understands Douglas' frustration. She too is fatigued and finds it difficult to get a good night's sleep. But Macey is not a snorer - her husband is. 'If I'm woken up at 3am by Tom snoring, I can't go back to sleep,' she says. 'I just lie there, waiting for the next snore, feeling furious.

'He's tried everything on the market, from nasal strips to special pillows, to anti-snore herbal sprays. The spray he's using at the moment does seem to help a bit, but often one of us ends up sleeping in the spare room. It doesn't make for a harmonious relationship.'

Research undertaken at the Royal Infirmary of Edinburgh found snoring strains interpersonal relationships, and these concerns are often put above any potential medical issues.

Dr Amos Lo Chun-yip, a specialist in otorhino-laryngology (ear, nose and throat medicine), treats many snorers in Hong Kong. 'Most of the time it's the partner who complains, it affects relationships, they want something to be done,' says Lo. 'Often people sleep in separate rooms because the wife can't bear the sound her husband is making.'

Snoring was becoming such a problem for Douglas and those around him that he sought medical help. 'I underwent a sleep study at the Matilda Hospital,' he says. 'You are meant to sleep 25 per cent of the night in REM3 [deepest sleep] but I discovered I was only getting 5 per cent. My snoring was so severe, I was actually waking myself up. They found I had mild to medium sleep apnoea, which has health risks.'

Siu says when the muscles relax too much during sleep, the airway can collapse and become blocked, obstructing breathing. The brain detects the lack of oxygen and prompts a momentary arousal, causing the sleeper to gasp for air. Breathing can stop dozens to hundreds of times every night.

'This is a serious medical condition,' Siu says. 'It can cause excessive tiredness, memory problems, depression, increased high blood pressure and heart problems. This is obstructive sleep apnoea.'

Lo agrees, and says while simple snoring often causes more embarrassment than serious health issues, it can also be an indicator of disease such as apnoea.

So what do specialists recommend for sufferers, and how can you tell the difference?

'If a patient snores and/or has a mild degree of apnoea, then lifestyle changes can help,' says Lo. 'For example, if overweight patients lose fat, they will decrease the soft tissue around their necks, relieving the pressure.

'Patients should keep regular sleeping patterns, and avoid alcohol, cigarettes or sleeping pills, which decrease muscle tone and therefore increase the chance of apnoea.

'It is also advisable to sleep on the side and not on the back - with gravity the tongue falls down and closes the airway,' Lo says.

Siu recommends trying oral appliances such as Somno Med. 'This is a personalised splint that treats snoring by moving the lower jaw forward slightly, it has the effect of tightening the tissues and enlarging the airway to keep it open. The device is worn in the mouth when you sleep at night, and consists of a custom-made upper and lower acrylic plate. You can adjust the device incrementally so that the lower jaw is moved as far as required to alleviate snoring.'

Lo says those suffering from severe grade apnoea may have to consider surgery as an option. 'Reconstructive surgery [uvulopalatopharyngoplasty] involves taking away the tonsils and part of the soft palate, but will not correct any blockage at the tongue base. For obstruction at the tongue base, we would need to look at mandibular advancement surgery, which moves the jaw forward.' However, both are major operations and doctors can't guarantee they will work in all cases, so surgical techniques are not recommended as a first-line option.

Some newer and less invasive options include laser assisted uvulopalatoplasty. 'Most of the time snoring comes from a collapsible soft palate, so we can use this technique to try to stiffen it, we can use the laser to carry out the operation and reshape the soft palate,' says Lo.

'Another new technique is the pillar procedure, where we inject three small plastic pillars into the soft palate using a specially designed instrument. Some patients might not be comfortable with something inside the body, so an alternative is radiofrequency palatoplasty, which involves putting a small needle into the soft palate and heating the area around the needle to just over 70 degrees Celsius, to induce fibrosis or stiffening.'

Lo says snorers should know treatments are available. 'Most important is [for patients to find out] whether they have apnoea or not, which means they need to avoid hypertension, heart attack or stroke. Some patients know they are snoring, but they don't realise it is actually a health hazard.'