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Why Do Men Snore More Than Women?

For all of us, snoring is a fact of life. Either you snore, your bedpartner snores, or you've been rudely awakened by a loud snore at some time or another. Most of the time, the snorer is a man, but sometimes, it can be the woman. So why is it that men snore more than women?

 

Ultimately, it has to do with your upper airway anatomy. One of the main reasons why humans are susceptible to snoring and obstructive sleep apnea is because of the fact that we can talk. For complex speech and language, the voice box has to drop down from behind the tongue to below the tongue. This opens up a space behind the tongue called the oropharynx, which only humans have. As a result of this "laryngeal descent," the tongue can fall back relatively easily, especially when on our backs, and during deep sleep when our muscles relax. Men's voice boxes also drop lower in the neck, thus the lower pitched voices. 

 

I remember hearing during a plastic surgery lecture during residency the fact that aesthetically, the ideal woman's lower jaw has to be slightly recessed, whereas with men, the jaw should be more prominent, and more defined. What this means is that the smaller the jaw, the less room there is for the normal sized tongue, and the more susceptible for the tongue to fall back and obstruct your breathing while in deep sleep.

 

If you start off with a larger space behind the tongue (in men), then some degree of muscle relaxation during deep sleep will cause a partial obstruction behind the tongue. With the same inspiratory forces created by the lungs, air is forced by the soft palate at a much faster rate, and with additional muscle relaxation, the free edge of the soft palate begins to flutter. 

 

With women, since the space behind the tongue is smaller to begin with, the same degree of tongue muscle relaxation causes you to stop breathing, leading to an arousal from deep sleep. This is why in general, the man snores, and the woman, being a "light" sleeper, is bothered by the man's snoring. 

 

This may be an overgeneralization, but I see it happening over and over. Does your spouse or bedpartner snore? If so, does it keep you from getting a good night's rest? 

7 Simple Ways To Get Rid of Your Snoring For Good

If your spouse or bed-partner snores and keeps you up at night, then you're not alone. Most people snore at least occasionally, while about 25% snore all the time. Snoring is a major problem that not only can affect your relationship, but your health as well (snorer and snoree).

Snoring may be a sign that you have obstructive sleep apnea, a condition where you literally stop breathing repeatedly while sleeping. Untreated obstructive sleep apnea can cause or aggravate depression, anxiety, hypertension, diabetes, heart disease, heart attack, and stroke.

Even if you don't have sleep apnea officially, studies have shown that snorers have a much higher risk for relationship problems, car accidents, and cognitive impairment.

One important thing to note is that you don't have to snore to have sleep apnea. Even young, thin women who don't snore can have significant sleep apnea.

Here's a checklist of the 7 “musts” of snoring cessation. Try these simple strategies before you resort to more invasive and expensive options:

1. Don't eat within 3-4 hours of bedtime.
If you snore, chances are, you'll stop breathing once in a while. When you do stop breathing, you'll create a vacuum effect in your throat which suctions up your normal stomach juices into your throat, causing you to wake up partially or fully. This also causes more swelling and inflammation which narrows your throat and nose even further. This leads to less efficient sleep, leading to weight gain, which narrows your throat even further.

2. Don't drink alcohol within 3-4 hours of bedtime.
Alcohol is a strong muscle relaxant, so it will make your throat muscles more slack and more apt to collapse and obstruct. And any obstruction around your airway as you sleep means more snoring.

3. Don't sleep on your back.
Due to gravity, everyone's tongues can fall back when on our backs. This narrows the space behind the tongue and along with muscle relaxation during deep sleep, you'll snore more and stop breathing more often. The traditional recommendation for pinning a tennis ball to the back of your pajama shirt ma work for a few people, but there are a lot more sophisticated ways to keep you off your back.

4. Clear up your nose.
Make sure that you're able to breathe properly through your nose, since having a stuffy nose will create a slight vacuum effect in your throat, aggravating partial to total collapse of the soft palate and the tongue. Whether through over-the-counter remedies, prescription medications, or with surgery, get this taken care of first. Unfortunately, this works only sometimes and in many cases, nothing changes. Regardless, if you need further treatment, you need to be able to breathe through your nose for the other options to work. It's been shown that definitively optimizing nasal breathing through surgery cures obstructive sleep apnea in only 10% of cases.

An interesting study published about 10 years ago showed that when given a nasal decongestant as well as a medicine that helps to empty the stomach faster, about 80% of snoring was significantly improved.

5. Lose weight.
Needless to say, this is easier said than done. One of the reasons why you may be overweight is because you don't sleep well. Less efficient sleep promotes weight gain, which not only cause you to expand on the outside, but also narrow in on the inside of your upper airways. But how about some of you who are not overweight, or even very skinny? Snoring and sleep-breathing problems occur due to a structural narrowing of the entire upper airway, from the tip of your nose to your voice box.

6. Try any of the various over-the-counter anti-snore gadgets, devices, and pills.
But don't expect dramatic results. Yes, sometimes, it'll help with your snoring, but even if it works, the effects don't usually last. The reason why you snore is due to your jaw anatomy and additional inflammation. Covering it up with any of these options is only a temporary solution. A study showed that compared with controls, the throat spray, nasal dilator strips, and anti-snore pillow was not any better.

7. Seek medical help.
If all the above don't work, it's time to see an ear, nose and throat doctor. A comprehensive exam is needed to find out which areas of your upper airway (from the tip of the nose to the voice box). We know that for most people it's the soft palate that flutters, making the annoying, chainsaw sounds. Usually, snorers will have a combination of areas that contribute to snoring, with the tongue being the most common culprit, due to having small jaws.

In most cases, a sleep study is needed to check to see if you have obstructive sleep apnea. If you do have sleep apnea, then treating this condition will help your snoring. Even if you don't have obstructive sleep apnea, all the different treatment options for sleep apnea can be used. As I mentioned in Step #4, you must first optimize nasal breathing and then deal with your tongue. The timing for eating and drinking alcohol is something that you should continue for a lifetime.

Unfortunately, things only tend to get worse as you age. The soft tissues in your throat tend to sag and collapse, especially after decades of repeated strong inspiration. This is why it's important to get your snoring taken care of, first using the conservative steps outlined in his article, and later by seeing a physician that can help you with this condition.
 

Tongue Scalloping: A Simple Marker for Sleep Apnea?

Besides the typical descriptions of physical features for someone at risk for obstructive sleep apnea (such as male, overweight, obnoxious snoring, and a big neck), one physical finding that's rarely mentioned is tongue scalloping (click here for picture). This is when you have impressions or ridges on the sides of your tongue where it sits against your molars. One past study showed that having tongue scalloping can positively predict the presence of apneas or hypopneas and oxygen desaturation in 89% of cases. Overall, having scalloping is about 70 sensitive in picking up obstructive sleep apnea. 

The traditional explanation is that the tongue is too big, but for sleep apnea patients, the jaw is too small for the normal sized tongue. If you add additional inflammation due to chronic reflux from the stomach with each obstruction, the swelling of the tongue will only aggravate the dental impressions on the tongue. Along with the small jaws and scalloping, you'll also have a high-arched hard palate, and the tongue sits very high in the mouth, preventing you from seeing the back of the throat more fully.

 

This condition is also described in hypothyroid patients, but as I've stated before sleep apnea can cause hypothyroidism.

 

Take a look at your tongue in the mirror right now. Do you have scalloping? Do any of your family members or friends have it? Please enter your responses below in the comments box.

Bedwetting And Sleep Apnea

Bedwetting (enuresis) is a very common problem in young children, with many psychological, emotional and social implications. A New York Times article describes this condition and its' various theories about why it happens and the different treatment options. Surprisingly, Dr. Klass doesn't mention sleep apnea, since it's one of the major causes of enuresis. 

A study published last year showed that about 1/3 of children with obstructive sleep apnea have enuresis, with the vast majority being cured or partially cured after adenotonsillectomy. Another study showed that rapid maxillary palatal expansion (which has a similar effect on upper airway breathing as adenotonsillectomy) resulted in significant improvement in nearly 50%. A study from the Journal of Pediatrics showed that an AHI of great than 1 had a higher risk of enuresis compared with children whose AHI was less than 1.

 

Dr. Rack, in his sleepdoctor blog describes 3 possible explanations regarding why children with sleep apnea may wet their beds:

 

1. These children don't wake up easily since sleep apnea may decrease the arousal response

2. Increased abdominal pressure during apnea events may increase bladder pressure

3. OSA affects hormones that produce urine, including atrial natriuretic peptide and antidiuretic hormone.

 

Granted, there are many other reasons for bedwetting, but if your child has this problem, at least consider the possibility of obstructive sleep apnea. If you as a parent snore or have obstructive sleep apnea, then it's even more likely that your child may this condition.

 

If you have sleep apnea, did you wet your bed as a child? You can remain anonymous with your answer in the comments box below.

The Sleep Apnea Switch

What’s the best treatment for sleep apnea? Believe it or not, it’s not weight loss, CPAP, oral appliances, or even surgery. It’s your mind.

 

What I’m constantly amazed about is how some people are able to instantly turn on a switch in their minds, and decide that one way or another, they must be successful with sleep apnea treatment. Ultimately, a much more powerful motivator for achieving success is not my recommendation, or even then risk of not treating sleep apnea, but the person’s mindset. There has to be an important reason for succeeding beyond the medical consequences. Let me explain.

 

One close friend who’s in his late middle years was struggling with CPAP for his severe sleep apnea. Over time, many of his close friends succumbed to possible complications of sleep apnea: one had a stroke that left him blind, and another was incapacitated for weeks due to a blood clot that went to his lungs. He became determined to properly treat his sleep apnea, and is now doing well. 

 

I often see airline pilots, truck or bus drives for sleep apnea. What I’ve noticed is how well most are able to tolerate and benefit from CPAP compared with the rest of the population. When their jobs are on the line, there’s good motivation to get treated and be able to get back to work ASAP.

 

Another common situation is a newly diagnosed younger sleep apnea patient who happens to have a parent that snored heavily and died of a heart attack or stroke in their 40s. Clearly, he does not want to succumb to his father’s fate.

 

On the flip side, I have elderly patients that have severe sleep apnea (they stop breathing 75 times per hour), but since they feel fine, refuse any treatment. There’s no reason for them to even consider being attached to a machine every night. Eventually, they slowly come back to me many years later, as more and more of their friends die from heart attacks and strokes.

 

For some of these people, success comes easy, no matter which treatment option, and for others, it can be a challenge, trying multiple different options, but they all reach a point where they’re happy one way or another. Once you set a goal, supported by the right reasons behind it, you’ll get there, one way or another.

 

What’s your true motivation for addressing your sleep apnea? Please enter your reasons in the comments box below.

Which Comes First, Sleep Apnea or Stress?

Sleep apnea is a major cause of physiologic stress. External stress of any kind (especially the holiday season) only aggravates the internal, physiologic stress that I describe in people who don’t sleep well.

To help you better manage your stress this holiday season, I’ve invited Dr. Niloo Dardashti, an integrative psychologist and holistic healer for this month’s expert interview, and I hope you’ll dial in and join us.

During this free information-packed hour, you’ll learn:

- What’s the interaction between stress, sleep problems and heart disease?

- What are some techniques for quieting "inner chatter" when stress has its’ hold on us?

- How can I stop unwanted thoughts?

- Which comes first – the chicken or the egg – does lack of sleep cause stress, or does stress cause lack of sleep?

- How can stress be handled returning to work after holidays or vacations?

- What are Dr. Dardashti’s thoughts on ADHD, Adderall and stimulants, especially for someone who has both anxiety and sleep apnea?

- How can I quit smoking if I’m very stressed and exhausted?

- What’s the best way of controlling work related stress?

- How can one reduce stress during a very stressful situation, such as being stuck in a large crowd, for example?

- How can I deal with being short on cash?

Tuesday, December 15th, at 8PM Eastern.

Register here to receive the call-in details.

An Uncomfortable Situation Regarding Sleep Apnea

One of the biggest dilemmas in my personal life is how to deal with friends or family members that I’m sure have obstructive sleep apnea or upper airway resistance syndrome. Should I even mention this condition at all, outside of a professional relationship? Is it even ethical, not to mention practical, to give medical advice to close friends or family members?

 

Once your eyes are opened to how common sleep apnea is, you’ll see that almost every other one of your friends or family will have varying degrees of sleep apnea. Many more won’t have sleep apnea, but a lesser variation called upper airway resistance syndrome. As you get older, I guarantee that a significant number of your friends will have it. Sadly, only 10% of sleep apnea is ever diagnosed and treated by doctors, who instead tend to treat the complications of sleep apnea such as high blood pressure, depression, anxiety, heart disease, heart attack and stroke. 

 

Ultimately, I’ve decided to take these situations on a case by case basis. Invariably, we’ll get on the discussion of what I do at work, and the topic of sleep apnea comes up. Depending on how interested he or she seems, I’ll gently suggest getting evaluated for it. I’ve had various responses to this approach. A number of my close friends have their lives changed radically after being diagnosed and treated for severe obstructive sleep apnea. Others who I know have severe sleep apnea either don’t take it too seriously, and continue their lives thinking that their fatigue, high blood pressure, and weight gain is just a normal part of getting older. In many cases, spouses of these people are frustrated because he or she won’t listen and go see a sleep specialist about this problem.

 

The other day, I ran into the wife of a couple that I know in my apartment complex. She relayed that her husband is sleeping much better since getting his CPAP machine and wanted to thank me for my advice. A few months before, the topic of her husband’s severe snoring came up during a conversation about what I did for a living.

 

As long as I can make a difference in my personal, as well as my professional life, I’m still going to do everything that I can to make people aware that sleep-breathing problems are a major cause of illness, fatigue, disability, and even death.

 

Have you reached out to your friends or family about sleep apnea? What was their response? Please respond with your comments below.

Sleep Apnea and Nighttime Urination

We’ve know for many years that frequent bathroom trips at night are not due to bladder or prostate problems, but mostly due to breathing pauses that make you wake up and and think that you have to go. Numerous studies have shown that most men and women who have to go to the bathroom often at night or have overactive bladders during the day actually have sleep apnea. 

 

A new study confirms these findings again, but points out that the presence of frequent trips to the bathroom is as sensitive in predicting obstructive sleep apnea as snoring! 

 

Sleep apnea also makes the body produce more urine, and because you wake up every few hours, you’ll want to go, but you won’t have a completely full bladder. Sudden shifts in blood flow into the heart after an obstructive event increases production of atrial natriuretic peptide, which makes you produce more urine. One study found that diluted levels of urine during these episodes is also predictive of having obstructive sleep apnea. 

 

I often see complete or near total resolution of these sort of problems after definitive sleep apnea treatment. 

 

Do you suffer from frequent nighttime urination, or have an "irritable" or overactive bladder during the day? Please enter your responses in the box below.

What You Can Learn From Tiger Woods’ Snoring

Tiger Woods was found to be snoring while lying unconscious after his recent car accident. Many people snore, but snoring alone gives you anywhere from 30 to 80% chance of having undiagnosed obstructive sleep apnea. Obstructive sleep apnea is known to significantly increase your chances of developing hypertension, diabetes, obesity, heart disease, heart attack, and stroke.

 

I don’t want to speculate on the events of Tiger’s accident or even any possible medical conditions. I do want to point out, however, how common and prevalent this condition is, and that you can be a fit, elite athlete and still have this condition. Many of these top athletes compensate for their poor quality sleep using intense physical activity, and become very good at it. I alluded to a similar situation regarding Michael Phelps in a past post.

 

Take a look at Tiger’s profile photo here and here. Notice how recessed his lower jaw sits, compared to his wife’s jaw. If you see his face from the front, you’ll see that it’s relatively narrow. If you want to guess what Tiger may may look like in another 30 to 40 years, take a look at his father’s picture here. Notice the classic sleep apnea features (small, recessed jaw and big neck). Before dying of prostate cancer in 2006, he underwent multiple bypass procedures for heart disease.

 

This just goes to show how common sleep-breathing problems are in our modern society, almost to the point of being "normal" to have it to some degree. I talk about important reasons why this is the case in my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired.

 

For the rest of today, make it a point to analyze people’s jaws. You’ll be amazed how many people have small and recessed jaws, especially in younger people. Based on what I’ve presented and his photos, do you agree with me that Tiger may be at risk for sleep apnea? Please enter your responses in the comments box below.

Snoring As Your Internal Smoke Alarm

When we used to live in a house many years ago, our carbon monoxide alarm would keep going off in the basement. We checked the alarm and all the various possible sources of carbon monoxide leakage, with no obvious leaks. On a routine maintenance call for our furnace, the technician found that whoever installed the unit did it improperly, and it wasn’t vented properly. Needless to say, my wife and I were shocked.

 

Similarly, snoring is your internal alarm telling your spouse or bedpartner that there’s a problem. Snoring means that there’s partial or total obstruction with your breathing and that it could mean something much more dangerous lurking underneath that can literally kill you in your sleep. I commented in a previous blog how there’s no such thing as "benign snoring." If you snore, you have a 35% chance of having obstructive sleep apnea, which increases your chances of having a heart attack or a stroke by 3-5 times. Even if you don’t have official sleep apnea, you’ll still have a higher chance of suffering from depression, insomnia, or getting into a car accident.

 

In this country, we routinely screen for dozens of medical conditions that have 1-2% incidence that are much less riskier than having untreated obstructive sleep apnea. With up to 24% of middle-aged men and well over 50% of seniors having this condition, it’s a travesty that snoring is not taken too seriously by the medical community. The snorer’s health is potentially at risk, but what about the snoree that has to suffer and lose hours of sleep due to his or her snoring bedpartner?

 

Do you suffer from sleep loss due to a snoring significant other? If you are the snorer, and haven’t done anything about it, what are you waiting for? Please respond with your comments in the box below.

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Copyright © 2008 Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring · Design by Fervent