science of us

Snoring Is an Annoyance Worth Taking More Seriously

A couple of years ago, a poster in the New York City subway showed a woman lying awake in bed next to a man passed out with his mouth wide open. “He may not always be charming,” the caption read, “but he’s always your prince.”

The ad was part of a Department of Health initiative to encourage couples to stay together in difficult times, but it might have instead brought back bad memories of nocturnal irritation. It’s hard to overstate just how frustrating it can be to toss and turn next to a soundly sleeping chain saw — and awake to see the problem get treated lightheartedly, like slapstick, or a silly joke.

Snoring is the not-so-silent scourge of cohabitation. It’s why for millions of people, getting up in the morning is such a slog; why spouses develop an irrepressible resentment for each other come nightfall; why moms and dads can’t seem to get their eight (or six, or four) hours long after their children are grown; why elbowing, punching, and screaming among otherwise civil adults at 4 a.m. is way more common than you’d think. “This is one of the top things we fight about,” says Giulia Pines, a 32-year-old New Yorker living in Berlin with her German husband. “He just simply cannot comprehend how horrible it is for me to wake up to this, because he doesn’t experience it the way I do.”

For Pines, the trouble begins before she’s even fully conscious of it. “It gets incorporated into my dream, so before I wake up, I’m actually in my dream, in terror, trying to make this jackhammer or foghornlike sound go away,” she explains. “I wake up, realize what it is, and essentially punch him in the shoulder to wake him up because I’m so angry. Then arguing ensues about why I couldn’t wake him up more gently.” That snorers don’t wake up themselves adds insult to insomnia. Can’t they hear themselves?

Pines’s experience isn’t that unusual. A 2009 CDC sleep study found that 56.5 percent of men and 39.6 percent of women said they snored at night. Another study in the Journal of Clinical Sleep Medicine notes that up to 45 percent of men and 25 percent of women snore. The discrepancy is largely physiological: Men are heavier and have thicker necks, which exert pressure on their airways. Women, for their part, are more likely to have insomnia, and when they do, they suffer the effects of sleeplessness to a greater degree.

Men also snore more loudly, but women can still pack a punch. My freshman-year roommate emitted such thunderous groans that I wound up in a psychiatrist’s office, hallucinating from the lack of sleep and begging for an Ambien prescription. I’ve judiciously avoided dating snorers since; my boyfriend sleeps like a sweet, silent angel, and I’m grateful for it every day.

Whether you’re a man or a woman, a snoring partner can ruin your nights, mess up your days, and make you want to leave, or kill, your partner. Sleep deprivation is a known strain on relationships, and is said to be the third most common reason for divorce in the U.K. If that sounds extreme, consider this: The Journal of Clinical Sleep Medicine notes that in aggravated cases, snoring volumes “exceeded the limits of nocturnal environmental noise pollution levels recommended by government agencies.”

At the root of the problem is that snoring has for decades been relegated to the realm of slapstick comedy: goofy, crass, funny. But that might be changing, because sleep is having a moment. We lack it; we track it; we obsess over it; Arianna Huffington has called for a wholesale “sleep revolution” to “sound the alarm on our worldwide sleep crisis.” (Pun … intended?)

With what we now know about the deleterious effects of sleeplessness, will snoring finally be acknowledged as the debilitating medical and psychological problem it is?

“Snoring is considered too much of a minor and even comical issue, not even up there with ‘real’ marital issues like finances and infidelity,” says Pines. “I’m here to tell you that it is.”

***

Like a lawn mower. Like a chain saw. A bulldozer. A buffalo. A suffocating goat. A wounded warthog. Many, many more varieties of unhappy livestock. The sleep deprived find comfort in these unflattering similes — which, as it turns out, do have some scientific basis.

According to Dr. Martin Goldman, a snoring specialist in Berkeley, California, the loudest recorded snoring sound has hit 90 decibels — noisier than a vacuum cleaner and an alarm clock, and not all that far from the sound of a 118-decibel airplane. The Daily Mail identified one Jenny Chapman, a grandmother of four who snored at an astonishing 111 decibels. For scale: 130 decibels is the point at which a sound causes physical pain. “The first time I became aware of how predominant snoring was was when I took my daughter to the Grand Canyon with her school class,” Goldman recalls. “The fathers slept in one bunk and the girls in another. When we got back, I said to my wife, ‘I couldn’t sleep; it sounded like a cattle stampede!’ To which she answered, ‘No kidding.’”

Goldman — a reformed snorer himself — came out of retirement seven years ago to open a dedicated sleep practice. He now retrofits patients with anti-snoring mouth guards that push the patient’s jaws forward and prevent their tongues from sliding back. Goldman notes that his work is different from most medical professions in one crucial respect: Patients come in not because they’re in pain, but at the urging of the person they share a bed with. Snoring also seems to defy the laws of physics: The sound tends to wake everyone up but the person who’s producing it.

That said, in most cases, “You’re both sleeping on eggshells: The person who snores doesn’t want to disturb; they’re embarrassed and don’t want to be an issue, and the person sleeping next to them is just waiting for the next episode.” It can get to the point where it’s a job not just for a physician, but for a couples therapist: One woman I spoke to said her husband only took her complaints seriously once she threatened to move out.

Snoring takes place when a person’s airway narrows and when their tongue and soft palate slide back toward the throat, producing vibrations and turbulence. A major cause of loud snoring is obstructive sleep apnea, which is when a person’s breathing is interrupted — sometimes hundreds of times — during sleep because of a blocked airway, and a gasping, choking sound is caused by air trying to get through. It affects 4 percent of men and 2 percent of women, and is a serious medical condition that can increase the chance of developing high blood pressure, diabetes, heart attacks, and early stroke.

There’s also such a thing as “benign” snoring with no underlying cause. “It’s just the luck of the genetic draw. Some people have a narrow airway that tends to vibrate when they sleep,” Goldman says. Age can also make the tissues softer and the muscles that control them slacker; being overweight also tends to make snoring worse. Whatever the cause, it’s seldom harmless, as “fragmented sleep has real, serious health implications,” Goldman notes. And yet the problem is vastly under-diagnosed — Goldman says only 9 percent of apneic people have received a diagnosis, while the data for garden-variety snoring isn’t very good at all. He sees this in part because snoring is still a taboo.

“I think there’s a stigma attached to it — it’s embarrassing; it’s not sexy, you know, to be a snorer. People feel embarrassed,” he says.

Like every taboo, though, he’s found that once you get people started, they won’t stop. “It’s universal! I don’t think there are very many topics where you walk up to people and bring up snoring and encounter personal anecdotes. Everyone’s got a snoring story.”

***

Anyone with a snoring story has heard the same advice, usually dispensed by a well-rested friend who falls asleep at the drop of a pin and could snooze through a hurricane: Earplugs.

“No, no, no!” yells Leigh Longwitz, who is 44 and lives in Madison, Mississippi, where she and her husband, Will — a snorer — bought a bigger house, so “we’d have a place for him to go at night.” She adds, “If they’re suggesting earplugs, they’ve never dealt with it! I’ve tried every pair of earplugs I could buy, and I couldn’t tolerate them.”

Nose strips are another common suggestion. Those tend to only work for occasional congestion. White noise? You can’t wash over vibrations that physically shake you out of slumber. Benadryl? Not strong enough. Xanax? Works great, but it’s also a controlled, highly addictive substance.

As for exercise, yoga, and meditation, these are all good things that help you sleep — but not at 4 a.m., when you’ve been woken up for the sixth time and want nothing more than to throttle the oblivious lump that’s lying by your side as you watch the sun’s slow creep toward daylight. Besides, Goldman says that it’s the snorer who should be working out: Even modest weight loss can make a difference because of the decrease in weight and pressure on the airways.

The cure for snoring is elusive; Goldman says there are about 70 FDA-approved devices to help. Custom mouth guards can help open airways and adjust the snorer’s jaw into a position that’s less noisy. A number of people I spoke to said they work — but they can cost thousands of dollars, and snorers have also been known to refuse them, forget them, or spit them out in the middle of the night and resume snoring almost immediately.

Sleep-apnea patients can be hooked into continuous positive airway pressure (CPAP) machines: large, cumbersome masks to ease and regularize their breathing. Those help the snorer — but unfortunately for their partners, the machines make as much noise as the snoring itself. (One long-suffering partner said it sounds “like Darth Vader.”) Surgery on the soft palate to remove excess tissue used to be a common prescription, but is only effective half the time, and the effects don’t always last. It’s easy, in other words, to lose hope and become cynical.

Leigh and Will Longwitz said they tried all the solutions on the market. After they determined that the cause wasn’t apnea, “the doctor prescribed a face strap to keep his jaw closed. That didn’t work,” Leigh recalls. They tried a couple of different mouthpieces to no avail, and at a certain point, “the physician said there was nothing she could do about it.” It’s a testament to the strength of their marriage that after all this, they still liked each other and wanted to sleep in the same bed.

Will wasn’t a good candidate for a breathing machine because he sleeps on his side and stomach; they were sleeping in separate rooms and asking for surgical referrals when Leigh saw an ad for a device called Smart Nora and ordered it online for $259.

Smart Nora is a piece of hardware that raised $800,000 in 30 days on Kickstarter. It consists of a sensor that detects snoring noises in the room, and a small pillow insert that inflates when the sensor picks up sounds. The insert moves the snorer’s head ever so slightly to stimulate the throat muscles, reducing the sound and vibrations emitted by tightening them.

Some high-end mattresses have a similar, though not portable, feature: In an ad that Sleep Number took out on Hulu, the company asked women, “Is there an elk in your bed?” and advised afflicted parties to “tilt your tormentor!” The difference is that Nora tilts you automatically, before you even wake up. It’s also portable.

Behrouz Hariri, a designer by training, is the CEO of Nora. He came up with the idea with his father, Ali — who’s a mechanical engineer, a tinkerer, and a longtime snorer. (“You can’t work here if you don’t snore,” he jokes.) The father-son team was compelled by the unique challenge of solving a problem where the sufferer isn’t the person with the condition; in focus groups, he found that many couples didn’t trust snoring remedies because so many had failed them in the past. “It’s not the most trustworthy category of products,” Hariri notes.

It took about a year to build a prototype; then, the company started testing it by taking out ads on Facebook. “The people who reached out were all women,” says Grace Wu, Hariri’s head of communications, “and there were only a couple asking for themselves. They mainly had partners who were snoring.”

The company connected me with several users — couples who participated in a study, and also couples who’d bought the device after seeing an ad or hearing about it through friends. None of them were long-term users — the product only became available a few months ago — but the results made them downright evangelical.

“The first night it came, it was amazing,” recalls Leigh Longwitz, who paid for the device and now won’t even travel without it. “[Will] slept like a baby. But I actually woke up just about every hour expecting that he was going to wake me up snoring.” At one point, she got worried. How could he be so quiet? Was he dead?

“It was like post-traumatic waking. I couldn’t believe it was true. But the second night, we both slept all night, and have ever since.”

Goldman says that devices like Smart Nora that move the position of your head or pillow “could have some positive temporary effects,” but that they can’t work for everyone: “So many patients, no matter what pillows they use, are still snoring — think of people on airlines sleeping bolt upright but still snoring.” In these scenarios, he says, it’s the snorer himself who could feel the ill-effects of being woken up, albeit briefly, multiple times a night. “They might stop snoring momentarily, but their sleep is still being fragmented,” says Goldman.

That’s not ideal — far from it — but it does lend the situation some justice. If someone has to live with the effects of snoring, why should it be the innocent bystander and not the guilty party?

Snoring Is an Annoyance Worth Taking More Seriously