March 02 2017

Is Snoring Really a Health Problem?

By Mark Sisson
39 Comments

Young woman can not sleep through the snoring of her husband in her bedroomThere’s a saying that people who snore always fall asleep first. My days of overnight sports chaperoning and group camping trips have frequently confirmed that notion. Most people would say that snoring is less a problem for the snorer than anyone lying awake in the vicinity, and on those specific nights in memory I probably thought as much. But the health researcher in me knows there’s more to the story.

We know sleep apnea is a big deal. No one wants that. But regular, run-of-the-mill snoring? Is it really an issue? Everyone has someone in their family who does it. It’s often a running joke, in fact. Some estimates suggest more than half of us snore (although that might be an exaggeration, given that the estimated range is so extensive). How concerned should we really be? And what is there to do about it anyway?

What exactly is snoring?

Snoring is simply a case of air moving over the relaxed tissues of the throat, causing those tissues to vibrate during sleeping. That vibration creates the sound.

The causes of snoring vary but include swollen nasal tissues due to allergies, upper respiratory infections, or a misaligned nasal passage. Certain meds also contribute (especially those that cause drowsiness), as does knocking back a few too many drinks.

Sleep apnea, however, takes snoring to a whole new level, with a physical closing of the airway along with the usual snoring. If you’ve ever been witness to sleep apnea, you’ll probably agree it’s a little alarming. The closing of the airway means a person literally stops breathing for what seems like an eon, until he/she wakes momentarily, sucks in a noisy gulp of air, and then resumes snoring. It may happen every 2 minutes, or it may only happen a couple of times per night. Either way, it’s a classic case of obstructive sleep apnea.

The most common cause of actual obstructive sleep apnea is excess weight and obesity. The tissues of the throat and tongue literally get fat, meaning that air has a hard time passing through when they relax during sleep. Sleep apnea might also be caused by engorged tonsils or a hefty overbite.

The thing is, the majority of all these causes shouldn’t really be much of an issue for the avid Primal enthusiast. Or…?

Snoring is more than a nuisance.

Let’s push sleep apnea to the side for a minute. No one would argue that sleep apnea is just a mild inconvenience. The medical establishment already treats it as a serious condition.

The same can’t be said for snoring. Very few people seek help for their snoring, regardless of how vehemently their partner complains every morning. Sure, snoring can be a symptom of sleep apnea, but most people who snore don’t actually suffer from apnea itself. Does that mean they’re in the clear? Unfortunately, no.

Research shows that snoring can exact a serious physical toll, even when it’s not classified as sleep apnea. A 2014 study found that snorers had a greater risk of developing a thickened carotid artery. This is a thickening in the lining of the two primary blood vessels that supply the brain with oxygenated blood—in other words, a big deal for cardiovascular health risks like heart attack and stroke. The increased risk from snoring was even greater than that for smokers or those who were overweight.

Even more alarming is the effect it has on children. In one study, children who suffered from primary snoring experienced more issues with attention, social skills, anxiety and depression. Overall cognitive ability and certain language and visuospatial functions were lower in children who snored compared to those who didn’t.

Sleep apnea, on the other hand, ups the ante considerably. Research shows it’s strongly associated with metabolic syndrome, cardiovascular disease, hypertension, cancer, and diabetes. Because excess weight is the primary cause, for many people it becomes part of a self-perpetuating cycle. Strangely enough, it seems that women are perhaps even more seriously affected by snoring and sleep apnea than men, at least when it comes to greater risk of heart failure and diabetes.

What are the options?

If you’ve ever asked your doctor for treatment ideas, you’ve likely heard a few of the following:

  • using nasal strips to pull your nasal passages open
  • using oral inserts (essentially glorified mouth guards) to keep the airways open
  • using a continuous positive airway pressure (CPAP) device
  • undergoing surgery to remove the soft tissue from the throat

You’ll notice that I listed those recommendations from least alarming to most alarming. Ideally, you shouldn’t need to employ any of those conventional “band-aid” methods, and you especially shouldn’t need to go slicing out bits of your throat. Unless you have true obstructive sleep apnea, you probably don’t want to rely (at least long-term) on a CPAP either, which can sound eerily like Darth Vader.

Other CW dictates avoidance of alcohol and sedatives, sleeping on your side, and staying well away from smoking. These are all good recommendations that essentially speak for themselves.

Next, what lifestyle changes can do…

A 2012 study showed snoring and sleep apnea improvements during REM sleep in those who made the shift from a “prudent diet” (a.k.a. one rich in “whole grains” and, presumably, low in fats) to a Mediterranean diet. I’ve spoken before about how I give a half-hearted thumbs up the the Med diet because, in many ways, it strikingly emulates the Primal diet—plenty of healthy fats, lots of veggies, less junk.

However, researchers also increased the physical activity of both groups, so it’s fair to say that a Mediterranean diet combined with more exercise was responsible for the improvements. But then again, was it the weight loss that improved the snoring, the increase in nutrient-dense and anti-inflammatory foods, or the exercise? It’s hard to say which was the catalyst (or if all of them together played a part).

That leads us to exercise as a form of snoring treatment.

A small 2014 study examined the effect of an “individualized exercise training program” on 22 patients with severe to moderate obstructive sleep apnea syndrome. Over the course of the month, those who undertook the exercise program experienced significant improvements in their sleep apnea compared to the control group, who just got “education activity sessions” (whatever that means). They also showed reductions in weight, fasting glucose, and blood pressure.

Once again, it’s a bit of a chicken or the egg scenario. Were the sleep apnea improvements due specifically to the personalized exercise program, the weight loss that resulted from this, or the participants simply being more “zonked out” when they hit the hay each night? Once again, maybe a combination of all 3 or maybe not.

What is clear, however, is that not all exercise is good exercise when it comes to treating your snoring problem. Grok was all about regular exercise, but he also knew when enough was enough—over-exerting the body by working out too long or too hard means exposing your body to excess stress. More stress means more inflammation, and we’ve already established that one of the root causes of snoring is inflammation of the upper respiratory system.

A couple additional/anecdotal options…

A friend of mine recently invested in a humidifier as he was concerned about excessively dry air in his apartment during the winter months. He began switching the unit on every night and letting it run until the morning, and found an interesting correlation. His partner’s snoring intensity and frequency dropped with increasing humidity, implying that excessively dry air may also play a role in snoring. It’s just one person’s story, but worth looking into if you’re already eating well, moving frequently and managing your weight.

But then there’s a wholly different kind of exercise for those with simple snoring issues—specifically exercise involving the mouth and tongue. In one small study, a regular practice of certain oropharyngeal exercises over three months time resulted in significant improvements for both snore frequency and snore “power” (there’s a concept).

Final thoughts…

Weight loss can be an effective tool for mitigating the effects of snoring, but as we’ve seen it may be difficult to achieve weight loss without first improving sleep. And how do you improve sleep without solving your weight issue?

If you’re a healthy weight, you might still suffer. It’s at this point you should look to your diet. Are you getting enough anti-inflammatory foods? Have you considered adding anti-inflammatory herbs and spices? Are you sure there aren’t any unaddressed allergies?

If you’re full Primal, you’re probably already investing in these choices, but it doesn’t hurt to do a little investigation. If necessary, get your partner to jot a few observations every morning regarding the night before. Maybe a rating system, with 10 being “I didn’t realize we lived on a fault line” and 1 being “ah, all’s quiet for once.” See if there’s a pattern with anything you did (or didn’t do) the day before.

Start experimenting with your diet and exercise routine, maybe throw in some pre-bed meditation, condition yourself to only sleep on your side, and try a humidifier to loosen mucus. Talk to your doctor about any medications you’re taking and if they might be contributing to the issue. Experiment with different pillows (there are so-called “anti-snore” options that tilt the head back slightly to keep the airway more open). Try the oropharyngeal exercises. Maybe try the nose strips. Take notes, recognize linkages between snoring reduction and certain lifestyle or dietary changes, and you may just become the next authority on snoring solutions.

Thanks for reading, everyone. Have I missed any Primal-friendly snoring treatments? Share your experiences and solutions. Take care.

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39 thoughts on “Is Snoring Really a Health Problem?”

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  1. Snoring has been around as long as people have been around, and probably poses far more of an annoyance for a co-sleeper than an actual health hazard for the snorer. Certainly there are always exceptions, but I doubt that sleep apnea is as dangerous in most cases as our alarmist medical profession leads us to believe, unless there are other serious health issues going on as well. Regardless, weight loss and a healthier lifestyle often solve both problems, or at least moderate them enough to be tolerable.

    1. I am a skinny woman with moderate to severe apnea (due simply to the size and shape of my throat), and I don’t know if the apnea would have killed me, but it was certainly destroying my quality of life. I had constant aches and pains and a bone-deep feeling of exhaustion, I couldn’t concentrate on anything, and I was having increasing problems with anxiety. Sleeping with a CPAP has cured all of those issues. It’s been absolutely life-changing.

      I strongly encourage anyone with unresolved fatigue problems to get a sleep study done, particularly if you have any history of snoring.

    2. Shary, you do understand that sleep apnea is more than just snoring, right? And, while it’s not well known, some people with sleep apnea do not snore. For a person to be diagnosed with sleep apnea, they have to have a certain number of apneas (episodes of stopping breathing and partially waking to start breathing again) during the night. If memory serves, it takes 10 or more apneas to be diagnosed with sleep apnea. One site I saw said that mild sleep apnea is less than 15 apneas an hour, moderate is 15-30/hour, and severe is 30+/hour. All the literature I’ve seen says that sleep apnea causes an “increased risk” of a whole host of health problems, ranging from depression or headaches to stokes and heart disease. I didn’t see anything that listed a specific percentage of increased risk, but I’d wager that the level of risk depends on how severe the sleep apnea is. But you think the risks are blown out of proportion? So someone whose sleep apnea is at low end of moderate about 15 apneas an hour, is partially waking about every 4 minutes. That’s not going to have much effect on their health unless they have other issues going on, right?

      1. One of my kids snored rather alarmingly, so we had him checked out. The doctor recommended my other son get checked, too. Turns out the loud snorer had obstructive apnea (we expected that dx) but the other one had central apnea. Totally silent. His brain just forgot to breathe every now and then while he was sleeping. We would never have known but for his brother keeping the whole house awake at night! And yes, both of them had other health issues that we traced back to lack of breathing through the night.

    3. Uh no, sleep apnea can be VERY dangerous to your health and while weight is typically a major factor it is not always the case.

        1. So, just to be clear, you’re saying that, with some exceptions you “doubt that sleep apnea is as dangerous in most cases as our alarmist medical profession leads us to believe,” even though it’s a condition which causes people to stop breathing multiple times an hour, which makes them partially wake up to start breathing again, which interferes with their quality sleep,

          Remember that a person with MILD sleep apnea may stop breathing as many as 14 times an hour. Sure, at it’s mildest, it’s as few as 10 times a night, but I doubt there are that many have their sleep apnea caught that early. And those would be the cases with the lowest health risks associated with it.

          But you doubt that, in most cases, sleep apnea contributes to health problems in people? That in most cases, it’s more of an annoyance for the co-sleeper, than an actual risk for the person with sleep apnea? Am I getting that right?

  2. I have mild sleep apnea despite my 8% body fat. Mark is right about inflammation as it is worse for me if I overtrain. The other thing I avoid is cheese late in the day. I can eat it at lunch without issue but not in the evening. Other than that I try to avoid sleeping on my back.

  3. I worked with a naturopath once who told me she’d seen a study (don’t remember where) that found having participants chew each bite of their food at least 50 times decreased snoring and apnea more effectively than surgery. Makes super paleo sense to me when I think about how soft our modern foods are as opposed to the very likely much tougher game meat and fiberous plants our forebearers worked their teeth on. Wish I could point you to the study.

  4. I think in some cases the chronically sleep-deprived co-sleeper actually suffers more healthwise than the actual snorer. Difficulty concentrating, inattentive driving, irritable mood, insulin resistance…I went through a lot until we started sleeping in separate beds. It sucks but it’s also not worth it to give up my own well-being because of someone else’s unmanageble condition. Especially when said snorer is not motivated to do anything about it because he is not the one who is bothered by it.

    1. This in now way solves anything, however, I put some blue blocker sunglasses on, turn on the TV to a boring station (some show with no plot) and then turn the sound up enough that it fills in the quiet time between “snarffs” so it is more of a monotone that the brain considers boring enough to shut off.

      The brightness of the TV helps me to keep my tired eyes closed and then usually that’s enough for me.

      1. So glad you found a solution! Unfortunately I can’t sleep with the TV on, I seem to lack that shut off mechanism for boring sounds…

    2. Indeed! About two years ago I had constant migraines, aches and pains, foggy brain, mild depression, food cravings etc. I even went to see my doctor and had several blood tests to try and figure out what was going on, to no avail. Finally I found out I was just severely sleep deprived due to my partner’s snoring, grinding of teeth and occasional screaming (!) in his sleep. Only my memory declined so much that I never remembered NOT having slept through the night… earplugs “cured” all my complaints within three days. Most dramatic shift in well-being I have ever experienced!

  5. “It may happen every 2 minutes, or it may only happen a couple of times per night. Either way, it’s a classic case of obstructive sleep apnea.” According to the doctor that read my sleep study last year, a few apneas, less than 10, a night are normal. I snore lightly, and grind my teeth, and talk in my sleep, and sometimes engage in mild parasomnia behaviors. I had 3 apneas in a 6 hr. period, which puts me well within normal parameters. According to my study, my sleep patterns were perfectly normal. However, during the week, I don’t get enough of it – which can be a cause of all of my sleep behaviors except snoring. I still have year round allergies which have improved, but not gone away since going Primal. Unfortunately, I’m probably more 70/30, than 80/20, and sleep, or lack thereof, is a huge issue. I know it’s the main reason I haven’t lost weight, and may exacerbate the allergy issue as well.. So sleep – I need to get more of it.

    1. Less than five apnoeas or hypopneas an hour is normal. Five to fifteen per hour is classed as mild sleep apnoea. A misleading title as there should be NO sleep apnoea ( like being told you only have mild cancer, don’t worry!), 15 to 30 per hour is moderate and over 30 per hour is severe. You can snore and NOT have sleep apnoea and you can NOT snore and have sleep apnoea. Either way the snoring shows the air is having trouble getting through the airway. The only way to diagnose sleep apnoea is with an overnight sleep study. Weight is a huge factor but as someone previously mentioned fit thin people suffer too. There is also a condition called Upper Airway Resistance Syndrome where there is no sleep apnoea with a high amount of what is termed ” respiratory related related arousals ” RERAs. Very common in young ( pre menopausal ) fit women. They are controlling their airway at night and preventing airway collapse but this results in fragmented sleep and muscle pain, headaches and particularly neck pain. It is often dismissed as the apnoea score is less than 5 per hour but it can be detected if the RERAs are recorded in the study plus by studying the pulse results which show spiky activity representing big sympathetic nervous system activity at night. The UARS patients are very much under diagnosed and under treated. Teeth grinding and clenching at night are a classic presentation.
      My advice is to get a sleep study so you have objective data and seek treatment as the health risks are immense as Mark pointed out so WellAnd

      1. Thank you, that was very informative. I did mention that I had had a sleep study done. It looks like I misremembered what he said about what classifies as normal for the frequency of hypopneas.. Really, I had two sleep studies done, because they were home sleep studies. I went and got hooked up most of the way, and told how to finish attaching things and start the whole system. Apparently, first time I did not securely attach the pulse rate monitor, so the record was spotty. I used extra tape the second time. According to the doctor, my sleep patterns are very normal, only something like 3 hypopneas in the entire night, no spikes in my pulse rate. I just don’t get enough sleep during the week, which I am working to correct. Lack of sleep likely explains most of my indicators of a sleep disorder. The snoring is the result of year round allergies / nasal congestion, which is better since going primal, but not gone.

  6. I started taping my mouth shut with athletic tape, based on the recommendation by Patrick McKeown in his book the Oxygen Advantage. The tape not only helps reduce snoring (although not always), it also eliminates the dry mouth problem I used to deal with frequently while sleeping. Now that I’m used to it, I actually prefer it when my mouth is taped, but it’s not always an option, depending on sinuses etc.

    1. Great idea. Nasal breathing is physiologic breathing and mouth breathing is stress breathing. This is an easy and powerful tool for improved sleep

    2. Good to see somone telling about this. Patrick McKeown is a Buteyko breathing therapist. Buteyko training is about learning to breath less. Because a lot of people breath to deep/much. Buteyko breathing is a very good way to treat snoring and apnea.
      It helped making my (light) snoring get less/disappear and I’m still working on improving my breathing to get rid of other health problems.
      Google it, it can help if diet changes did not help you deal with all your health problems this might be something you can try.

  7. Very interesting (and timely in my case) post.
    I have been a lifelong snorer. I notice that it is much worse if I indulge in any food with the slightest amount of wheat starch. No other grain or food seems to make as much of a difference as wheat. I can go from making no sound at all on some nights to snoring so loudly on others that it clears the building of anyone who is unlucky enough to be sharing it with me.
    I actually spent a night in a cabin with 6 other women at a workshop/retreat many years ago and I awoke in the middle of the night to find 4 of them literally standing over me trying to decide what to do about the noise. Very embarrassing and distressing for all concerned. Naturally they were all relocated to another cabin the following night.
    I warned the coordinator ahead of time about my snoring issue but I guess he didn’t take me seriously. I went through many years of trying to isolate the cause before I figured out the wheat connection. I think the condition is hereditary in my family because my grandmother who lived to be 85 never had any cardiovascular issues that we know of, snored so loudly that she and grandpa had nightly wars over who was sleeping where. Also my 95 pound sister snores as much as I do. We are not terribly overweight people, but still have the condition. I always know that if I eat anything wheat based, my poor husband will have a less than tranquil night so I try to avoid it at all costs. I don’t want to get a CPAP, but I seem to be developing higher blood pressure than I like to see….don’t know if it is related to the snoring. Anyway, I hope more information about this subject will be forthcoming. Thanks Mark and all who comment about this.

    1. I was diagnosed with sleep apnea, but couldn’t tolerate the cpap machine. I bought a very expensive mouth guard from my dentist, $400, that only misaligned my teeth. Then I bought a small mouth guard device, https://goodmorningsnoresolution.shop and it’s made a huge difference. A quarter of the price and it works! Plus, it’s easy to take with you when you travel!

  8. I was a snorer, because of having to sleep on my back due to a neck injury. As that has finally resolved – largely due to an efficient osteopath – and I have been able to sleep on my side, the snoring has disappeared.

  9. I have read several articles and recently listened to an integrative dentist speak on how our western diet has led to underdeveloped dental arches causing, of course, dental crowding (that’s why most people need braces) and weakness of the muscles of the mouth and airway predisposing people to obstructive sleep apnea. I believe in this as a nurse practitioner practicing pulmonary medicine I see many people of all shapes and sizes with sleep apnea. Most have dental crowding and small upper airways. From the time we are born and then become toddlers we are given soft foods as opposed to tearing flesh from a bone with our teeth, chewing cartilage, gnawing on raw veggies, etc as our ancestors did, providing them a broad face from a well developed dental arch and strong facial muscles. I wonder, and I am not aware of any studies looking at this, if focusing on a diet, such as Primal diet, that includes frequent chewing of items such as raw veggies, nuts, meat and just eating food in it’s natural state would improve snoring and/or sleep apnea symptoms instead of the usual SAD diet of mostly soft processed foods where the crunchiest thing consumed is the bowl of cereal every morning!

    1. I can tell you this: A rapid palatal expander ended my son’s snoring. The whole Weston Price thing is what got me into the dental field…now if I could just find a doctor to work for who understood everything you posted!

    2. Food chewing is an interesting point of view… What I recalled from WAP regarding underdeveloped dental arches was the actual issue of lack of proper nutrition during pregnancy and in childhood years, which creates that condition where the bones never fully develop but the cartilage does, hence obstructing the airways and creating this crowded teeth situation. I’ll sure look into this deeper!

  10. Curious to know Mark’s thoughts on bruxism, or teeth clenching / grinding. The newish school of thought is that is a sign of sleep apnea. I can’t quite get my head around why clenching or grinding one’s teeth at night, especially to such an extent, would be a way to open up the airways

    1. My son has had bruxism practically since he’s had teeth. He also snored so badly that we had his tonsils and adenoids removed right before he turned 3. I thought that would be the magic bullet. It was not. He continued to grind his teeth; still does and he just turned 8. I’ve spent quite a bit of time observing his sleep. The bruxism is clearly connected to breathing difficulties and I’ve even observed brief apnea episodes. He has all kind of behavioral issues too. I’ve talked to our local dentist and brought him to the doctor several times. I tell them he is in fight or flight all night long, that he’s probably never had a restful night’s sleep in his life. They tell me kids outgrow bruxism, don’t worry. Now I’m driving 5 hours to the twin cities (Minnesota) so he can see someone who takes the situation seriously. Hopefully within the next month he will begin orthodontia, focused on palatal expansion and lower jaw development. I’m thrilled to be on this path, and angry that no one took me seriously locally because I’ve also learned kids can be treated as young as 3 or 4. Parents, please take seriously any snoring or bruxism in your kids. Go online, look up ALF or orthotropic orthodontia. Bonus, adults can be treated too. At 53, I am hopeful the dentist can help me, too.

    2. @Sue a briefer reply: the clenching and grinding moves the lower jaw forward and (briefly) improves breathing by opening the airway. Sleep is never restful, though.

    3. Clenching activates the accessory muscles of respiration and helps stabilise the airway from collapse.

  11. Before going primal I was snoring pretty loudly and had, what I believe anyway, mild sleep apnea. Every few nights I’d wake up feeling like I was suffocating and gasping for air. It was really scary.

    40lbs lighter it was all gone. My wife misses neither the gut nor the snoring.

  12. As Susan mentioned, some snorers do experience UARS with respiratory related arousals during snoring which interfere with your normal sleep cycle in a similar way full blow apnoeas in obstructive sleep apnoea do. Tired during the day with no explanation, and you snore? Getting yourself a sleep study with full EEG (gettin your brain wired up!), will get you diagnosed properly.

    Here are a couple of primal friendly anti snoring/sleep apnoea tips though:

    Stay away from the alchohol and other muscle relaxants as much as possible.

    Learn to play the didgeridoo! It exercises all those muscles that need to stay open during sleep in the throat. There’s actually some fair evidence out there on this.

    Avoid sleeping on your back.

    Final note, collar size rather than raw BMI is a big indicator of possible sleep apnoea, over 17 inches (16 for females) is considered a risk factor in many centers. Also if anyone is tired during the day, take the epworth sleepiness scale online, it’s suggested that anything more than 10, seek advice (or quit the late night video games!).

    1. I remember my sister complaining when we shared a room growing up of my snoring. I was not overweight, active, and played the clarinet so I don’t think playing a wind instrument would help me.!

  13. Another +1 for the humidifier! My partner struggles with snoring in the winter months when the heat goes on. We use a humidifier and it usually nips the snoring issue in the bud – much to my relief

  14. My husband has sleep apnea and have used a c-pap machine for 12 years, and has struggled with major weight issues during that entire time. We’re both on a healthy paleo eating plan but he has a self-perpetuating cycle where he hates his Cpap machine, so he just stays up and doesn’t go to bed until he’s exhausted, often 2 or 3 or 4 in the morning, so he only get 5 hours of sleep a night. Not so great for weight loss. I got him the blue blocker glasses but I don’t think he wears them.

    1. When I started using my CPAP, I didn’t think I would ever get used to it. I got a ton of useful advice from the people at this CPAP forum: http://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html

      There are so many tips and tricks for customizing mask fit, machine settings, etc. I hope he will look into it and start getting the full benefit of CPAP therapy! It has made such a big difference in my life.

  15. I forced myself to sleep on my back due to neck problems, so I snored..
    We have an adjustable bed and now I sleep ‘elevated’ which helps. I do miss sleeping on my side but for now this will have to do.

  16. Amazing Blog!!! This information is very helpful. snoring is the major issues but people are not taking it seriously. with this issue we increase the health problem and it will harm for you. These treatment seems me effective.The natural treatment is also help to get rid of.Thank you for sharing…

  17. If Grok snored. Wouldn’t he get eaten by the lion? How did the tribe stay safe if one snores or is this a relatively modern occurrence?