Heavy snoring in women in sleep: what to do, treatment

A rattling, vibrating sound in sleep, coming from the larynx, is called snoring. It is more common in men than in women. When a representative of the stronger sex snores, it is considered quite normal, but for women it is a complete faux pas. What do these night sounds indicate and how can you fight them?

Epidemiology

Research shows that every fifth person on the planet over the age of 30 snores. The prevalence of snoring among men is 35%-45%, among women from 15% to 28%, and is the main symptom of sleep-disordered breathing. Sleep apnea, which causes excessive sleepiness, is also a common condition with prevalence rates from 3% to 7% in men and from 2% to 5% in women. [ 1 ], [ 2 ], [ 3 ]

The difference between men and women in the prevalence of snoring decreases with age, largely as a result of a marked increase in the prevalence of sleep snoring in women after menopause.[ 4 ],[ 5 ]

Causes female snoring

Snoring occurs due to the relaxation of the muscles of the palate and tongue under the influence of the air flow passing through the respiratory tract. However, not all sleepers snore, which indicates the presence of certain causes of this phenomenon. These include:

• congenital pathologies (deviated nasal septum, polyps);
• malocclusion; [ 6 ]
• nasal trauma;
• anatomical features: narrow nasal passages, long uvula; [ 7 ]
• Neck circumference, as a predictor of obesity, is a well-known risk factor for obstructive sleep apnea and cardiovascular disease; [ 8 ]
• neoplasms;
• age-related changes (in women after 40, 50 years, muscles lose elasticity, including a decrease in the tone of the pharyngeal muscles);
• endocrine disease acromegaly; [ 9 ], [ 10 ]
• thyroid dysfunction (hypothyroidism); [ 11 ]
• studies have clearly shown a family history of snoring.[ 12 ],[ 13 ]

It has been suggested that female sex hormones have some protective effect on upper airway patency and/or respiratory drive.[ 14 ] The hormone progesterone is a known respiratory stimulant that enhances the chemoreceptor response to hypercapnia and hypoxia and increases upper airway muscle tone. Progesterone levels decline after menopause. Hormones may also play a role in body fat distribution. Postmenopausal women have higher fat mass compared to premenopausal women, and fat distribution is greater in the upper body and trunk region compared to the lower body.[ 15 ],[ 16 ]

Risk factors

The occurrence of snoring can be influenced by factors such as:

• bad habits (smoking [ 17 ], alcohol [ 18 ]);
• excess weight;

Some studies have shown that the prevalence of habitual snoring in women is strongly related to age and BMI, with alcohol dependence being associated with snoring in thin women, while physical inactivity is a risk factor for snoring in women with a high BMI.[ 19 ]

• taking sleeping pills; [ 20 ]
• fatigue, excessive daytime sleepiness; [ 21 ]
• chronic sleep deprivation.

Pathogenesis

Obstructive sleep apnea (OSA) is characterized by recurrent collapse of the pharyngeal airway during sleep, resulting in significant reduction (hypopnea) or complete cessation (apnea) of airflow despite continued respiratory effort. These respiratory disturbances result in intermittent abnormalities of blood gases (hypercapnia and hypoxemia) and surges in sympathetic activation. Loud snoring is a typical feature of OSA, and in most cases the culmination of the respiratory event is associated with a brief awakening from sleep (arousal). These events result in cyclic breathing and fragmented sleep, with the patient oscillating between wakefulness and sleep. In severe cases, respiratory events may occur more than 100 times per hour, and each event typically lasts 20–40 seconds.[ 22 ],[ 23 ]

The pathophysiological causes of snoring vary considerably among individuals. Important components are likely to be the anatomy of the upper airway, the ability of the upper airway dilators to respond to respiratory challenges during sleep, the propensity to be awakened by rapid breathing during sleep (arousal threshold), the stability of the respiratory control system, and the ability of state-related changes in lung volume to influence these factors.

Since the muscles lose their tone during sleep, the mobility of the pharyngeal walls increases. When inhaling, the respiratory tract is deformed, and pulmonary ventilation ceases. Lack of oxygen is a distress signal to the brain and activates it.

It restores control over the muscles, opens the way for air to enter, which leads to snoring. The following sounds are a repetition of the cycle, of which there are 400-500 per night, which translates into 3-4 hours.

Symptoms female snoring

Usually, loud snoring occurs when women sleep on their backs as a result of sagging soft palate muscles. But if this is also observed when lying on the side or stomach, then this is a serious reason to worry and consult a doctor.

Obstructive sleep apnea (OSA) is characterized by recurrent nocturnal complete collapses (apneas) or partial collapses (hypopneas) of the upper airway during sleep. These events are associated with oxygen desaturation and/or arousal from sleep.

Women with sleep snoring report symptoms such as insomnia, restless legs syndrome, depression, nightmares, palpitations and hallucinations, while men are more likely to report snoring and episodes of apnea.

Women complain of frequent mood disorders such as anxiety and depression, report low quality of life on a range of questionnaires, and demonstrate increased daytime fatigue, decreased sleep quality, and worsening neurobehavioral symptoms.

Snoring during sleep through the nose in women often occurs with a runny nose, getting rid of which stops it. A quarter of pregnant women also experience this phenomenon, since the trachea and lungs are pressed by the enlarged abdomen, and in this position, women often gain weight. Snoring during sleep is very common during pregnancy and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, which is one of the main risk factors for sleep-disordered breathing, along with physiological changes during pregnancy. [ 24 ]

The prevalence of habitual snoring among pregnant women has been estimated to range from 11.9% to 49% in the third trimester in cross-sectional studies.[ 25 ] Longitudinal studies have shown that habitual snoring (three or more nights per week) increases from 7–11% [ 26 ] in the first trimester of pregnancy to 16–25% in the third trimester [ 27 ].

Psychosomatics of snoring in women

The occurrence of snoring in women is significantly influenced by psychological factors. They have such a wide range of emotions, from anxiety and anger to depression, [ 28 ], [ 29 ] and sources of experiences that they often hide away, that when they lose control over their feelings during sleep, this results in snoring.

Psychologists advise learning not to hold grudges in your soul, to let go of the past, to tune yourself to positive thoughts, to fight complexes and to feel the importance of your existence in this world. With harmony in your soul, with getting rid of the emotional burden, sleep without snoring will improve.

Complications and consequences

Snoring is not as harmless as it seems. In addition to being an inconvenience to others, it can be dangerous to health, as it can lead to dangerous complications and consequences.

We are talking about obstructive sleep apnea syndrome (sleep apnea). 6-10% of snorers die from it, and after 50 years of age, such patients are twice as likely to have heart attacks and strokes. Snoring is associated with a significantly increased risk of cardiovascular disease in women [ 30 ], regardless of age, smoking, BMI and other cardiovascular risk factors. [ 31 ], [ 32 ] Snoring is associated with an increased risk of developing type 2 diabetes, [ 33 ] arterial hypertension [ 34 ].

Diagnostics female snoring

Suspecting one or another cause of snoring, the therapist will refer you for various laboratory tests and consultations with specialists: an otolaryngologist, an endocrinologist, a dentist.

Data from the University of Wisconsin Sleep Lab showed that lower snoring recognition rates in women compared to men were due to women's failure to recognize snoring symptoms and reluctance to seek medical attention or failure of health care providers to respond to snoring symptoms in women.[ 35 ],[ 36 ]

Difficulties in correctly diagnosing female patients also include symptoms such as depression and anxiety, which are also more common in women than in men without snoring.

Currently, there is such a modern method of recording various functions of the human body during sleep as polysomnography. With its help, the work of the brain (electroencephalogram), eye movement (electrooculogram), cardiac activity (electrocardiogram), nasal-oral air flow, blood oxygen saturation, leg movements, snoring are recorded.

Instrumental diagnostic methods help differentiate the diagnosis among all possible ones.

Treatment female snoring

Personalized medicine has not achieved significant effectiveness in treating snoring in women, despite gender differences in symptoms.

Sleep problems are dealt with by a somnologist, and the science of sleep and its various disorders is called somnology. This is a fairly new area of medicine and perhaps not every clinic has such a specialist. Therefore, you should first contact your local or family doctor, who will refer you to the right specialist if necessary.

Treatment usually consists of a combination of methods, the choice of which depends on the causes and severity of the sleep disorder. General in the therapy of all patients is a number of activities, usually carried out at home. Let's list them:

• sleeping only on the side (on the back the tongue falls back) - it is impossible to control your position in sleep, therefore, in order to accustom yourself to this position, they resort to trickery - between the shoulder blades of the pajamas they sew a pocket, into which they put, for example, a ball;
• sleep with your head elevated - it is good to use contour pillows that provide an optimal position relative to your body;
• avoiding taking sleeping pills and sedatives that relax muscles;
• limit alcohol consumption, especially in the evening;
• smoking cessation;
• getting rid of excess weight;
• ensuring free nasal breathing, using vasoconstrictor drops for runny nose, surgical removal of polyps and curvature of the nasal septum;
• use of anti-snoring devices (mandibular advancement devices (MADs) and tongue retaining devices (TRDs), special pacifiers, sleep masks, Good Night rings); [ 37 ], [ 38 ], [ 39 ]
• supplying the respiratory tract with air, creating continuous positive airway pressure (CPAP) using a special device. [ 40 ]

Anti-snoring remedies for women

There are various medications that claim to make breathing easier at night, such as by affecting the muscles in the airway or by increasing breathing control. Because no medication has been proven to help reduce snoring during sleep, they are not currently used as part of treatment. However, these medications may be used to treat certain conditions that may cause snoring during sleep or worsen existing apnea. [ 41 ], [ 42 ]

The use of pharmacological means for snoring is not always effective, but in simple situations it can help. One of these is the nasal spray Asonor.

It increases the elasticity and flexibility of the soft palate muscles, moisturizes the mucous membrane. The period of its action after application is 7-8 hours (enough for the whole night). The maximum effect is achieved by the second week.

Slipex is made from essential oils of medicinal plants (eucalyptus, peppermint) dissolved in a water-glycerin mixture. Increases the tone of weakened muscles, relieves swelling of the pharyngeal tissues, thus preventing the tongue from sinking. It is used by inhalation (2-3 sprays) no earlier than 30 minutes after eating. The interval between procedures is 8 hours. There are isolated cases of hypersensitivity reactions.

Silence is a mint-flavored spray with a bioadhesive formula. The can is equipped with a dispenser. Before use, shake, remove the cap, put on the spray nozzle and press until foam appears. Direct the stream to the back of the throat and swallow, then again.

The volume of snoring decreases from the first night, and after a month it becomes very weak.

One of the most intriguing (and perhaps most controversial) aspects of future snoring therapy in women involves hormone replacement therapy (HRT). To date, there has been one small clinical trial that has shown that estrogen use appears to have a significant effect on measures of sleep-disordered breathing. [ 43 ] However, HRT has been shown to be associated with notable risks, including an increased risk of cardiovascular disease, stroke, and cancer. [ 44 ]

Vitamins

Recently, a link has been shown between obstructive sleep apnea syndrome and fatigue and vitamin D deficiency. [ 45 ], [ 46 ]

Nasal congestion and colds that cause snoring can be overcome by using vitamins that increase the body's defenses: A, C, E, group B, D. They can enter the body both with food and as vitamin-mineral complexes.

Physiotherapy treatment

The most common methods of physiological treatment of snoring include electrical stimulation of the muscles of the pharynx and neck, as well as a series of exercises aimed at strengthening them. [ 47 ], [ 48 ]

Folk remedies

Nasal saline irrigation (SNI), a therapy with roots in Ayurvedic medicine that involves irrigating the nasal mucosa with a spray or liquid saline solution,[ 49 ] as well as herbal rinses[ 50 ] can be used as an adjunctive treatment for upper respiratory tract conditions.

From folk remedies, you can use recipes whose ingredients coat the mucous membrane, for example, cabbage juice combined with honey. Gargling with a solution of sea salt or olive oil is effective. The nose is instilled with sea buckthorn oil.

For gargling, decoctions of medicinal herbs are also used: oak bark in combination with calendula flowers. Internally, you can take infusions of a collection of such plants: horsetail, cinquefoil root, elderberry.

Surgical treatment

Surgical treatment is usually reserved for severe snoring or when other treatment strategies have failed. However, surgical outcomes are often suboptimal, with some patients requiring more than one operation and others experiencing persistent snoring. Surgery is most effective in patients with 4+ tonsils, nasal polyps, or other obstructive anatomical lesions.[ 51 ]

In uncomplicated cases, laser or radiofrequency treatment is used, directed at the soft palate. The reaction to the procedure is a burn, during the healing of which the tissues are compacted, tension is created in the palate, and vibration is reduced. [ 52 ], [ 53 ]

A more radical method - uvulopalatopharyngoplasty is used in cases of sleep apnea with various pronounced anatomical defects. It consists of increasing the lumen of the airways at the level of the pharynx by removing the tonsils, palatine arches, etc. [ 54 ] In 50% of patients, the reduction in the snoring index was more than 95%. [ 55 ]

Gymnastics for snoring in women

Systematic repetition of the same exercises for a long period of time in the morning and evening leads to strengthening of the throat muscles. The following are recommended, performed 20-30 times in a row:

• stick your tongue out as much as possible for a few seconds and hide it;
• move your jaw back and forth, resisting with your palm;
• Hold a pencil or stick tightly between your teeth, then relax.

During physical activity, the respiratory muscles, especially the diaphragm, work at an increased rate. This leads to metabolic and structural adaptations that improve resistance. Endurance exercise can strengthen the upper airway muscles, increase the diameter of the upper airway, and reduce airway resistance. [ 56 ]

Prevention

Preventing snoring in women will help to follow the points that make up the treatment. This is a healthy lifestyle, fighting extra pounds, [ 57 ] a comfortable orthopedic bed, strengthening the muscles of the throat with the help of gymnastics, and at the same time the oval of the face can significantly reduce obesity rates and reduce the signs of snoring in women.

Forecast

It is possible to get rid of snoring, if not completely, then at least reduce its intensity.