ZZZSPLURT,ZZZNKK, ZKLHHNH, ZCHLNKK. Snoring.
Are you laughing? Of course.
Even the doctors laugh. Then they tell you it isn't funny.
In children, chronic snoring might portend facial abnormalities or growth or cardiac problems. In adults, in its worst manifestation, it could mean heart failure -- and nocturnal death.
But even the ear, nose and throat specialists -- the otolaryngologists -- hadn't been doing much more than laughing until recently.
It had been speculated, says otolaryngologist David N.F. Fairbanks of George Washington University Medical Center, that "snoring offered some survival advantages, that those ferocious sounds might have frightened off predatory animals.
"It is my own contention that snoring is given like wisdom teeth, hernia, hemorrhoids and appendixes to afflict and torment us. We can transplant hearts, split the atom and explore outer space and yet the conquest of the snore has been much more elusive."
Doctors, however, are working hard on the problem -- and making some real head-er, upper air-way. But first, the jokes.
Moderating a seminar last weekend called "Snoring: Not Funny, Not Hopeless," Fairbanks, for example, went through a list of some 300 registered inventions designed to teach snorers not to.
They range from the marble taped in the middle of the back -- something he actually suggests as a possible aid for back snorers -- to Rube Goldberg-like electrical contraptions. The range is from the "ingenious to the frankly diabolical."
One of them -- his "favorite," he says with tongue firmly in cheek--is a contraption in which a microphone picks up a snore and then triggers a sequence "of five noxious stimuli." First a light goes on in the snorer's eyes. If there is no response, it begins to flash on and off. Next is a buzzer in the ear, followed by a bell clapper that pounds the person on the biceps, concluding with an electric shock that wakes up the snorer.
"But," notes Fairbanks, "the error in this is that these sadistic methods of conditioning don't work because snoring is purely an involuntary problem and one cannot be psychologically trained to stop. He only can be trained to stay awake all night."
But his main point is this: "Snoring is not a single disease. It is one sign of an array of different diseases with quite widely varying causes, requiring quite different treatments."
Dr. Fairbanks and specialists in the various aspects of snoring -- in children, in adults in general and in those with the more serious sleep apnea--discussed the A to ZZZZZs of it for several hours at GW last weekend. Fresh from a recent meeting of the American Academy of Otolaryngologists, the specialists brought some encouraging words on new surgical remedies for the worst of it and a strong pitch for increased consideration by pediatricians of either tonsillectomies or adenoidectomies or both in children whose snoring is constant or who evidence other symptoms of blocked airways, such as chronic mouth breathing.
Fairbanks credits sleep researchers with calling attention to potential dangers of snoring. The condition called "sleep apnea," in which the victim snores and snorts, fighting to get a breath and actually does not breathe for 10 to 15 seconds at a time, up to about 35 times a night, can cause hypertension and serious cardiac problems because of lack of oxygen to the system. People who die in their sleep, experts speculate, may have suffered heart failure stemming from their sleep apnea. Sometimes the victim awakens several hundred times a night, often without realizing it.
Sleep apnea itself usually affects middle-aged men who are often obese, often hypertensive. Daytime sleepiness in child or adult suggests a blocked airway problem at night.
But even less serious snoring can be dangerous, especially if it is constant and occurs even when the sleeper is not on his or her back. And, says Fairbanks, when it is more than a "one- or two-room" snore, it can have grievous effects on families.
But there is hope even for the three-roomer. Out of the sleep research has emerged a surgical technique which is, for adults, only slightly more uncomfortable than having the tonsils and adenoids out -- and, says Fairbanks, only a logical extension of that operation for surgeons. They call it the UPPP, which stands for the strangling (which it cures) uvulo-palato-pharyngoplasty. The surgery was devised to deal with serious cases of sleep apnea where it was found that airway obstruction was caused by "floppy" uvula (that fleshy thing that hangs down from the soft palate) and bulky and floppy pharyngeal walls that get more so as a person gets older.
Although it is not a perfect solution for sleep apnea, the operation has been found to be 100 percent effective in eliminating "obnoxious snoring. And when," asks Fairbanks, "did you ever hear about an operation that cured anything 100 percent?" (The operation, he says, requires a week away from work and a two-week-long sore throat.)
Sometimes something as simple as a nose polyp or hay fever can be behind a snoring problem. And before any adult surgery is considered, Fairbanks suggests trying these remedies first:
* Adopt an athletic life style. Good muscle tone may prevent floppy pharynx.
* Drink no alcohol within two hours of retiring.
* Drink a cup of coffee before retiring so the non-snorer can get to sleep first.
* Sleep with an elevated head. Especially if the problem comes with seasonal rhinitis: hay fever.
* Go ahead and try the marble (or a jack) taped on the back.
If other complaints like chronic stuffy nose, recurrent sore throats, difficulty in swallowing accompany snoring, see a doctor. Be sure to tell him you snore.