What you hear during snoring is caused by an obstruction to the normal flow of air through the back of the mouth and nose. Some of the structures located back there can vibrate during breathing, causing the horrific rumble that gets you kicked out of bed at night. What can cause this vibration?

• Blocked nasal airways - a stuffed-up nose from hay fever or from a cold can disrupt normal airflow.
• Long uvula - an extra-long uvula (the boxing bag hanging from the back of your mouth) can dangle and make all kinds of noises; a deviated septum can also lead to obstruction and vibration.
• Excessive bulkiness of throat tissue - due to large tonsils or adenoids, fat, cysts or tumors (rare).
• Poor muscle tone in the throat and tongue - when muscles are overly relaxed, from alcohol or sedative drugs, for example, the tongue and throat can get into unnatural positions and make lots of noise. (Modified from "Snoring: Not Funny, Not Hopeless." American Academy of Otolaryngology)

Snoring has a number of disadvantages, as you probably don't need us to tell you. It has one advantage of course, and that is you get to sleep alone, so if you ever want to get out of a particular situation, just start snoring. Snorers can cause others to have sleepless nights, and they may become the object of jokes and general disfavor. In addition to the social problems, snoring can disrupt your sleep and deprive you of your needed rest. In those with a history of loud snoring, a condition known as obstructive sleep apnea may exist, which is a serious, potentially life-threatening condition. Those with the condition have five or more episodes per hour while sleeping of totally obstructed breathing; they stop breathing for 10 or more seconds and then gasp for air to start breathing normally again. Patients do not often notice the problem but will feel sleepy during the day, especially while driving. Your bed companion, however, is sure to notice. Patients with sleep apnea are more likely to fall asleep at the wrong times, and have a higher rate of automobile crashes and work-related accidents. Those with the condition often have related cardiovascular problems as well. Symptoms to look for that indicate risk for sleep apnea are:

• Chronic, loud snoring
• Gasping or choking episodes during sleep
• Excessive daytime sleepiness (especially drowsy driving)
• Automobile or work-related accidents due to fatigue
• Personality changes or cognitive difficulties related to fatigue (From "Sleep Apnea: Is Your Patient at Risk?" Sept. 1995. National Heart, Lung, Blood Institute (NIH)).

If you or someone you love (or just sleep with) experiences these symptoms, you must get them checked out by a doctor, because the condition can be serious, and because there are treatments for apnea and for snoring that your doctor will know about. He/she may refer you to an Ear, Nose, and Throat (ENT) specialist, or a sleep center. Treatments for snoring and apnea range from behavior modifications like exercise, sleeping on your side, and avoiding alcohol before bedtime, to various oral/dental devices and even surgery to correct the underlying cause of the snoring. The most effective noninvasive therapy for apnea is continuous positive airway pressure (CPAP), which I won't explain now but your doctor can certainly do so later. There are even some 'alternative' therapies, but I would consult a doctor first before trying them. A technique known as Sutra-Neti, where one passes a catheter or similar material through the nose and out of the mouth as a means of clearing the airway, is the kind of thing you might not want to try before talking with your doctor or trusted medical advisor.

Bottom line? You can reduce your snoring by sleeping on your side by whatever means necessary or raising the head of your bed by about 4 inches if you must sleep on your back. Also, relieve any nasal congestion, try not drinking alcohol or eating a heavy meal or taking a sedative within 3 hours of bedtime, exercise, and lose weight if overweight. For those with serious snoring, see a doctor to find out what's going on, so you can be back in bed as soon as possible, just like we promised.