Q:How can I stop my husband from snoring? Every night I wake up as he is sawing away. My only solution thus far has been to banish him to the spare room. Do you have any ideas which aren't so severe? K S, London........
The old saw (pardon the pun) about the middle aged man sleeping in the spare room because of his snoring isn't a myth. Snoring seems to affect many more men than women (almost three quarters of men, according to one study, compared with half of women). The usual profile of a snorer is a middle aged man who is slightly overweight. Dr Earl Dunn of the University of Toronto Sunnybrook Medical Centre Sleep Laboratory says that snoring is frequently related to being overweight. "We've found that if a moderate snorer loses weight, the snoring becomes less loud, and in some people it actually disappears."
In the view of Dr Philip Smith, director of the Johns Hopkins University Sleep Disorders Centre in Baltimore, Maryland, men who are just 20 per cent over their ideal body weight can develop snoring (Prevention Magazine (ed), The Doctors Book of Home Remedies, Bantam, 1991).
Its cause is the palatine uvula, the tissue that hangs in the back of the throat, which relaxes during sleep. When you breathe in, this tissue vibrates, which is similar to the action of a reed in a wind instrument.
Lately, doctors maintain that snoring may be something more than a nuisance. The louder the snore, the more it is likely to lead to a serious condition called obstructive sleep apnoea (OSA), where the pharynx collapses, the airways are obstructed and the patient has episodes where he literally can't breathe, a problem said to affect about 4 per cent of middle aged men and 2 per cent of middle aged women (Lancet, 1997; 350: 122; Lancet, 349: 201-2).
All the medical journals are aflutter about the supposed association between OSA and hypertension or stroke, based largely on a few studies (Lancet, 1997; 350: 495). The theory is that sleep apnoea may increase stroke risk by reducing blood flow in the middle cerebral artery (Stroke, 1998; 29: 87-93).
Nevertheless, careful review of the literature shows that the relationship between OSA, snoring and cardiovascular diseases is far from clear. One review by two independent assessors of 45 papers concluded that the link between OSA and hypertension, cardiovascular disease and increased mortality is poorly established. The only connection they would make with any certainty was that people with OSA tended to be obese and older (Lancet, 1997; 350: 122).
The latest drastic medical cure for snoring is a LAUP operation (laser assisted uvula palatoplasty), which removes the offending tissue in your throat, an in office procedure performed by an ear, nose and throat specialist. At least one study demonstrates a 95 per cent success rate without complication, although others report side effects such as hypernasal speech, permanent incompetence of the upper palate, narrowing of the nasal passages or throat, air way compromise and even death (The Lancet, 1997; 350: 78).
The other solution for OSA, which also cures heavy snoring, is the continuous positive airways pressure (CPAP). Patients are fitted with a nose mask attached to a pump supplying air slightly above the pressure of the atmosphere. This cumbersome gadget manages to keep the airways open. Nevertheless, the same review of 45 papers on OSA concluded that only a single study was truly scientific, and even there there were certain flaws, leading the researchers to conclude that the evidence about CPAP wasn't "sufficiently robust" (Lancet, 1997; 350: 122).
Whether you suffer from OSA or common or garden snoring, the evidence also shows that you should sleep on your side. OSA is often found to worsen when patients lie on their backs; in fact some patients have what is termed "positional" sleep apnoea, with episodes of decreased or shallow breathing at least twice as high when on their backs as when on their sides (Chest, 1997; 112: 629-39). This means that if your husband is snoring and on his back, you can push him gently onto his side and it should ease off. Another possibility is for you to sew an uncomfortable button or tennis ball on the back of his pyjamas, so if he rolls over onto his back in his sleep he will get annoyed by this large bump and roll back to his side. This, of course, assumes that he wears anything to bed.
One overlooked cause of snoring is allergies. Oftentimes, sleep experts find that sneezing and snoring occur in tandem, and that snoring often develops from frequent colds or nasal allergies. Further evidence is the fact that OSA and bedwetting sometimes go hand in hand (Lancet, 1997; 350: 221-2). This could be, as has been suggested, because of an interruption in sleep patterns, or it could be due to an allergy. Alternatives columnist Harald Gaier often finds that children with persistent bedwetting often become dry as soon as their allergies are located.
Other useful tips from sleep disorder experts include avoiding alcohol and sleeping pills, cigarettes and even pillows, which are known to make things worse. Dr Westbrook, director of the Mayo Clinic Sleep Disorders Center in Rochester, Minnesota, also says that elevating the bed by placing bricks or a batch of books under the legs at the head of the bed will help to stop snoring (The Doctors Book of Home Remedies).