Q. My husband snores each night. He wakes up refreshed, and I wake up exhausted. How can I get some sleep?
--S.F., Boston, Mass.
A. First educating yourself and your husband about his condition and then treating it is the best way to start. Snoring is one of the most common sleep problems in the United States--approximately 25 percent of men snore and about 12 percent of women. It tends to increase during and after middle age, and there is usually an anatomical reason why some people snore and some don't.
The physical reasons include obstructed nasal passages; elongation of the uvula (the tissue that hangs down in the back of the throat); poor muscle tone in the soft palate, throat and tongue; and excessive girth of the neck due to obesity. In children snoring can be caused by enlarged tonsils or adenoids.
Many devices are designed to treat snoring. They range from dental appliances to neck collars to electrical devices that cause painful stimuli.
But the most effective treatment of all is to lose weight. The typical snorer is overweight, and snoring becomes more frequent because the girth of the neck has increased and the muscle tone of the tongue and throat has declined.
The best advice I can give a chronic snorer is to lose weight and start an exercise program. A person may snore less frequently just by shedding 10-15 pounds.
Because many snorers have nasal congestion, clearing or opening the nasal passages can be helpful. For this, I suggest a nasal decongestant, a nasal steroid spray or an adhesive strip placed on the outside of the nose to open the nostrils.
Avoid alcohol, muscle relaxants, tranquilizers and sleep medications because these tend to relax the muscles of the throat, which can worsen snoring. Cigarette smoke can cause throat tissues to swell and thus encourage snoring.
If, after following all of these recommendations, your husband continues to snore, I advise he use a dental appliance that prevents the tongue from sagging against the back of the throat. It helps about 60 percent of snorers.
Or he could try a snore alarm, such as one sold at Sharper Image stores. It is a wristwatch that vibrates as soon as a person begins to snore.
For you, the nonsnoring spouse, I recommend a background-noise machine that makes the sound of a waterfall or raindrops. It may help you sleep better. Or you could try soft earplugs until your husband has been treated.
Q. Are there physical dangers or specific health risks that generally are associated with snoring?
--M.C., Veradale, Wash.
A. There is a very serious medical problem called obstructive sleep apnea that is associated with snoring. It causes the upper airway to become completely obstructed for 10 seconds or longer and occurs in about 2 percent to 4 percent of middle-age adults. It may occur a few times or hundreds of times during sleep.
In sleep apnea, there is a decrease of oxygen in the blood and an increase of carbon dioxide. This change in blood gases alerts the brain and causes it to awaken the body, even though a person may not realize he or she is waking up.
This leads to excessive daytime drowsiness, depression, and learning and memory problems. It is linked to irregular heartbeats, high blood pressure, heart attacks and strokes.
However, even though everyone with sleep apnea snores, all snorers do not have sleep apnea. Sadly, though, as many as 80 percent of apnea sufferers don't know they have the disease.
At least 60 percent of patients with sleep apnea are obese. If a man or woman has a large neck, a double chin and obesity around the abdominal region, then there seems to be an increased correlation with obstructive sleep apnea.
If you suspect that you or your spouse has sleep apnea, see your doctor and undergo a sleep-lab study. The most important thing to do is lose weight and avoid alcohol, muscle relaxants, tranquilizers or sleep aids.
Donald Colbert, M.D., is a family physician and nutrition expert. His latest book What You Don't Know May Be Killing You! is available from Siloam Press at www.charismawarehouse.com. Send your questions about health and nutrition to Doctor's Orders, 600 Rinehart Road, Lake Mary, FL 32746.