Snoring & Sleep apnoea

What causes snoring?

Snoring is the result of the soft palate vibrating when breathing is strained due to obstructed airways. This typically occurs when the muscles that keep the airways open become too relaxed while sleeping.

However, obstruction of the airways can also be caused by soft tissue deformities in the head and neck. Tissues that can be affected include:

  • nasal passages

  • adenoids

  • tonsils

  • soft palate

  • uvula

  • base of the tongue

Possible sites that can cause snoring

It is very common for young children to snore. This is not necessarily anything to worry about. 

In some children, the snoring and airway obstruction can be much more pronounced to a  point that it affects their sleep pattern.  There are different terms used  to describe this; including sleep disordered breathing where there is fragmentation of the sleep pattern  and a more severe form when there are actual pauses in the breathing - sleep apnoea.

What is sleep apnoea?

Sleep apnoea occurs when airway obstruction becomes significant enough to obstruct a child's breathing. This results in a fall in blood oxygen levels, which tells the brain to wake up resulting in a disturbed sleep pattern.

If the symptoms are persistent, then this may seriously affect a child's sleep quality. 

Some signs of sleep disordered breathing and sleep apnoea include the following:

  • being restless at night - trying to find a comfortable position.

  • may sleep with their neck extended

  • sweaty or hot when sleeping

  • drooling

  • often grumpy and slow in the morning 

  • tired during the day - not having as much energy as other children and becoming easily irritated and fractious

  • younger children may have long naps in the afternoon sleeping for hours until being woken

Some of these problems may simply be due to nasal obstruction due to allergies.  However, more often than not, the underlying problem is usually the effect of enlarged tonsils or adenoids.  The condition occurs more commonly in 2 to 3 year olds.

How can I identify sleep apnoea in my child?

If one listens carefully to their breathing pattern, one may find that their child will snore and this will increase in intensity until a point where there may be a pause in their breathing.  This may then be followed by the child making a big grunt and perhaps arousing and turning over to find a more comfortable position. In more severe cases the chest seems to suck in  (sternal recession) or there may be a dip in front of the neck (tracheal tug) when they breathe in.

These are indications that there is obstruction over the airway and they are working hard to breathe. 

Taking short video clips of your child's sleeping pattern, is very helpful for an ENT surgeon to assess the impact of noisy breathing on your child's sleep patten and whether there is indeed a degree of sleep apnoea. 

Is treatment necessary?

Treatment is important to improve the quality of sleep of the child, which will then have secondary effects on their energy levels during the day and their ability to concentrate and focus. 

Sometimes treatment may be as simple as improving the child's nasal airway.  Nasal steroid sprays may be of benefit, but are probably best not to use on a long-term basis. 

If your child has allergies, try to minimise allergen exposure  from the bedroom, such as removing soft toys from the bedroom (most common source of dust mite) or changing their bedding to a non feather variety.

Finally, if the tonsils and adenoids are significantly enlarged, then surgery may be necessary. Not all children need to have both their tonsils and adenoids removed especially  if the adenoids are particularly enlarged and  the tonsils do not appear to be obstructing.  Sometimes an examination with a tiny fiberoptic camera in the nose is used to clarify the size of the adenoids and to see if the tonsils are blocking the airway.

Serious complications from sleep apnoea

Very rarely, particularly in small children or those who have craniofacial syndromes, the obstructive apnoea may have secondary effects on their heart and in very rare cases heart failure can be seen.