Siamak T. Nabili, MD, MPH
Siamak T. 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
What are different levels of snoring?
Mild resistance to airflow for any of the above reasons in the upper airways may result in some snoring that is not associated with any sleep disturbance.
If resistance to airflow increases, the efforts to maintain adequate ventilation and breathing may cause transient arousal from sleep that is typically not severe enough to cause the level of oxygen in the blood to decrease (hypoxia). This is called the upper airway resistance syndrome (UARS).
When the resistance increases even further, the ventilatory efforts cannot keep up with the degree of resistance to maintain adequate levels of oxygen. This causes a decrease in the level of oxygen in the blood. As a result, arousals are more frequent, and sleep becomes more fragmented. This is termed obstructive sleep apnea-hypopnea syndrome.
How should someone with snoring be evaluated?
To thoroughly evaluate someone with a snoring problem, it is important to also talk to that person's bed partner or family members. A complete history and physical examination is often performed.
In addition, more detail about their snoring and sleep problems needs to be obtained. The patients may be asked about their sleep pattern and sleep hygiene, daytime symptoms of sleepiness, daytime napping, and frequency of awakening at night.
A thorough physical examination may also be performed including assessing the patient's body weight and body mass index (BMI), assessment of the neck circumference (area around the neck), and visualization of the throat, nasal, and oral cavities to determine how narrow the oral and nasal passages are.
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 like sleep apnea (see below) or 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.
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
A home (unattended) sleep study can measure some basic parameters of sleep and breathing. Often, it will include pulse oximetry (a measurement of the level of oxygen in the blood), a record of movement, snoring, and apneic (stop in breathing) events. A home study can prove that there are no sleeping problems or suggest that there may be a problem.
If a home sleep study suggests a problem, a full sleep study (polysomnography) often is performed in a clinic. (For a complete description of sleep studies, 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 0-3 below, patients rank their risk of dozing in the chart below. (This chart can be printed out and taken to the doctor.)
After ranking each category, the total score is calculated. The range is 0-24, with the higher the score the more 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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