• Poor muscle tone in the tongue and throat: When muscles are too relaxed, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. Some relaxation is natural during deep sleep, but may become a problem if exacerbated by alcohol or drugs that cause sleepiness
• Excessive bulkiness of throat tissue: Children with large tonsils and adenoids often snore. Overweight people may have excess soft tissue in the neck that can lead to airway narrowing. Cysts or tumors are rare causes of airway narrowing.
• Long soft palate and/or uvula: A long palate narrows the opening from the nose into the throat. The excessive length of the soft palate and/or uvula acts as a noisy flutter valve during relaxed breathing.
• Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, and snoring results. So snoring may only occur during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Snoring can make the snorer an object of ridicule and can cause the bed partner to experience sleepless nights and fatigue.

It disturbs sleeping patterns and deprives the snorer of adequate rest. It may be a sign of obstructive sleep apnea (OSA), which can lead to serious, long-term health problems.

Snoring may be a sign of a more serious condition known as obstructive sleep apnea (OSA). OSA is characterized by multiple episodes of breathing pauses greater than 10 seconds at a time, due to upper airway narrowing or collapse. This results in lower amounts of oxygen in the blood, which causes the heart to work harder. It also causes disruption of the natural sleep cycle, which makes people feel poorly rested despite adequate time in bed. Apnea patients may experience 30 to 300 such events per night.

The immediate effect of sleep apnea is that the snorer must sleep lightly and keep the throat muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he or she may be sleepy during the day, which impairs job performance and makes him or her a hazardous driver or equipment operator. Untreated obstructive sleep apnea increases the risk of developing heart attacks, strokes, diabetes, and many other medical problems.

Heavy snorers should seek medical advice to ensure that sleep apnea is not a problem. Heavy snorers include people who snore constantly in any position or who negatively impact a bed partner’s sleep. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, often using a fiberoptic scope. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction, or enlargement of tonsils and adenoids. A sleep test in a laboratory or at home may be necessary to determine if snoring is due to OSA.

All snorers with any of the following symptoms should be evaluated for possible obstructive sleep apnea:

• Witnessed episodes of breath pauses or apnea during sleep
• Daytime sleepiness or fatigue
• High blood pressure
• Heart disease
• History of a stroke

Treatment depends on the diagnosis and level(s) of upper airway narrowing. In some cases, more than one area may be involved.

Snoring or OSA may respond to various treatments offered by many otolaryngologist—head and neck surgeons:

• Obstructive sleep apnea is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is called CPAP; it is currently the initial treatment of choice for patients with OSA.
• Uvulopalatopharyngoplasty (UPPP) is surgery for treating snoring and obstructive sleep apnea. It removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration. The size of the air passage may be further enlarged when a tonsillectomy is added to the procedure.
• Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base, and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser, and radiofrequency. These procedures may be done in the operating room or during an office visit. Several treatments may be required.
• Methods to increase the stiffness of the soft palate without removing tissue include injecting an irritating substance that causes stiffness in the injected area near the uvula. Another method is inserting stiffening rods (Pillar implants) into the soft palate.
• Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
• A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA. This should be fitted by an otolaryngologist, dentist, or oral surgeon with expertise in sleep dentistry.
• In some patients, significant weight loss can also improve snoring and OSA.

Injection snoreplasty is a nonsurgical treatment for snoring that involves the injection of a hardening agent into the upper palate. Army researchers from Walter Reed Army Medical Center introduced this procedure at the 2000 Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. Their early findings indicate that this treatment may reduce the loudness and incidence of primary snoring (snoring without apnea, or cessation of breath). The Academy neither endorses nor discourages the use of injection snoreplasty for the treatment of snoring.

Those seeking injection snoreplasty to reduce snoring should first be screened for obstructive sleep apnea or OSA (frequent cessation of breathing due to upper airway obstruction) by undergoing a sleep test. If sleep apnea is confirmed, other treatment may be recommended.

Injection snoreplasty is performed on an outpatient basis under local anesthesia. After numbing the upper palate with topical anesthetic, a hardening agent is injected just under the skin on the top of the mouth in front of the uvula (upper palate), creating a small blister. Within a couple of days the blister hardens, forms scar tissue, and pulls the floppy uvula forward to eliminate or reduce the palatal flutter that causes snoring.

In some patients, the treatment needs to be repeated for optimum benefits. If snoring occurs from vibrations beyond the palate and uvula and/or obstructive sleep apnea is suspected, further testing and alternative treatment options may be advised. A thorough examination by an ear, nose and throat specialist is recommended to diagnose the source and type of snoring, and determine whether injection snoreplasty may be helpful.

After injection of the hardening agent, patients are observed in the otolaryngologist's office and then sent home. Tylenol and throat lozenges or spray are suggested for pain management. Patients can return to work the next day. Though snoring may continue for a few days, it should eventually lessen. A post-procedure sleep test may be administered to fully evaluate the effects of the procedure.

A residual sore throat or feeling that something is "stuck" in the back of the mouth may occur. Suggestions for treatment of sore throat include Tylenol and/or throat lozenges or spray.

Sotradecol, a trade name for sodium tetradecyl sulfate, is the most common hardening agent used in injection snoreplasty. This agent is indicated by the Food and Drug Administration (FDA) for "intravenous use only" and "for small uncomplicated varicose veins of the lower extremities that show simple dilation with competent valves." Warnings include: 1) "severe adverse local effects including tissue necrosis," and 2) "allergic reactions, including anaphylaxis, have been reported that led to death."

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Thirty percent of adults over age 30 are snorers. By middle age, that number reaches 40 percent. Clearly, snoring is a dilemma affecting spouses, family members, and sometimes neighbors.

Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. When these structures strike each other and vibrate during breathing, snoring results.

Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea. Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of apnea (cessation of breath).Obstructive sleep apnea is a serious medical condition where individuals have frequent episodes of apnea during sleep, contributing to an overall lack of restful sleep and severe health risks including heart attack and stroke.

Various methods are used to alleviate primary snoring. They include behavior modification (such as weight loss), surgical and non-surgical treatments, and dental devices.

Surgical treatments for primary snoring include: laser assisted uvulopalatoplasty (LAUP), an outpatient treatment for primary snoring and mild OSA that involves use of a laser under local anesthesia to make vertical incisions in the upper palate, shortening the uvula and lessening airway obstruction; and radiofrequency volumetric reduction of the palate, a relatively new procedure performed in an otolaryngologist's office that utilizes targeted radio waves to heat and shrink tissue in the upper palate.