INGELHEIM, Germany: Millions of people snore, some only occasionally, others every night. Snoring occurs because the body relaxes during sleep and muscle becomes slack.

Breathing causes the soft palate and uvula, and in part the base of the tongue and throat, to flutter, producing the snoring sound.

But snoring is no simple problem. In extreme cases, it is linked to a life-threatening condition called sleep apnea, which causes people to stop breathing altogether.

Typically, the observations of the snorer's spouse or partner are the first warning signs.

"Snoring can kill a relationship," said Hans Joachim Schneider of the German association for sleep apnea sufferers in Ingelheim. Single people don't have the benefit of these outside observers, and therefore they must take note of their own body signals.

"There are people who hear their own snoring as they fall asleep," said Ingo Fietze, chairman of the German society for sleep research and sleep medicine in Schwalmstadt-Treysa. Schneider added that important symptoms are morning exhaustion, headache and difficulty concentrating.

The symptoms occur because of a lack of oxygen due to the intermittent closure of the upper air passage. Sleep is disturbed for people with sleep apnea by more than five pauses in their breathing that last up to two minutes.

Oxygen deprivation is severe in these cases. It typically leads to a drop in blood pressure, which increases the risk of heart attack and stroke, Fietze said.

A screening device usually is used to determine the extent of snoring or sleep apnea. During the course of a night it charts pauses in breathing, the noise of snoring as well as the subject's position in bed, Schneider said. The subject might also be observed for a night in a sleep laboratory.

Serious cases of sleep apnea are treated using a therapy known as continuous positive airway pressure (CPAP), which requires patients to wear a mask.

A machine placed near the patient's head continuously sucks air from the room and blows it through a tube into the patient's throat so that the pharynx is kept open.

Less serious cases of sleep apnea can be treated with inserts that fit over the patient's teeth. The patient places the insert on his upper and possibly also lower teeth before going to bed, said Emil Krumholz, a dentist, sleep therapist and head of the centre for snoring therapy in Frankfurt.

The device helps adjust the lower jaw to a forward position so that the tongue cannot fall back and block the air passage.

An anatomical condition can be a factor behind snoring. An ear, nose and throat doctor must determine whether the tonsils are too large or the lower jaw is too small, said Fietze. In such cases surgery can help, but Krumholz said an operation usually results in only a slight improvement.

"Patients instead should try to reduce snoring risk factors," said Fietze. Most people affected snore less when lying on their sides or with their head slightly raised than when they are lying flat on their backs.

Weight loss can also help reduce snoring, which is more common among overweight people. Alcohol, sedatives and sleep medications also should be avoided, and it's also important to have regular sleeping hours.

(China Daily 08/16/2006 page13)