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While I breathe, I hope Newsletter (Turkish)

Sleep / Column

Myth or fact?

Short takes on common beliefs about sleep and snoring, with the level of evidence.

Test yourself first

How much of what you know about sleep is right? Answer our questions, each backed by research, and find out the facts about sleep.

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This content is for general information; it does not replace a medical diagnosis or treatment advice.

Articles in the column

5 articles · 11 min read in total. You can mark what you have read at the end of each article; the marks are kept only in this browser.

  1. Does taping your mouth shut reduce snoring?How far can we trust the mouth taping trend spreading on social media? The studies are few, small and weak; and for people with a blocked nose it may carry a risk.2 min read · Introductory
  2. Does sleeping on your side reduce snoring?For many people who snore on their back, sleeping on the side may help. But not for everyone; and the real difficulty is keeping it up for years.2 min read · Introductory
  3. Is a drink good for sleep?A drink may help you fall asleep. But even a small amount can weaken the restful part of the night, and the body gets used to its effect over time.2 min read · Introductory
  4. Does warm milk with honey or linden tea help you sleep?A warm drink before bed can be a soothing habit. But there is no strong study showing that it directly makes you sleep.3 min read · Introductory
  5. Do nasal strips stop snoring?A nasal dilator strip can open the nose a little and make breathing feel easier. But we could not find a controlled study showing that it reduces snoring.2 min read · Introductory

Common beliefs

We compared common beliefs about sleep and snoring with the research. Under each one there are numbers and sources for those who want them.

People who snore are sleeping deeply and well

Mostly false.

Snoring shows that the passage in the throat narrows during sleep. As the narrowing increases, breathing gets harder and the brain wakes briefly again and again to correct it1. These awakenings are not remembered in the morning, but sleep has been broken up.

For experts

Most obstructive respiratory events end with a cortical arousal; this sleep fragmentation is one of the main mechanisms of daytime sleepiness1. Under the AASM 2012 rule, a hypopnea can also be scored with an arousal instead of a 3% desaturation; this captures events that break up sleep without desaturation2.

Only overweight men snore

False.

Weight and being male increase the risk, but they are not the only causes. Jaw structure, neck width and age also play a part1. Snoring is common in thin people and in women too.

For experts

In the Swiss HypnoLaus cohort (aged 40 to 85, n=2121), an AHI of 15 or more was found in 49.7% of men and 23.4% of women3. Craniofacial anatomy is a risk factor independent of obesity1.

Women do not snore

False.

Women snore too, and have sleep apnea (breathing that stops again and again during sleep). This becomes markedly more common after menopause4. In women the symptoms can often look different, such as tiredness or insomnia.

For experts

In the Penn State cohort, the prevalence of clinical sleep apnea was lower in women than in men; it was markedly higher in postmenopausal women not on hormone therapy than before menopause4. In general population screening, moderate and severe sleep apnea is common in women as well3.

Sleep apnea only affects older people

False.

It becomes more common with age, but it also occurs in young adults5. It is estimated to affect hundreds of millions of adults worldwide6. It can even appear in children7.

For experts

According to Wisconsin Sleep Cohort data, moderate and severe sleep apnea (AHI 15 or more) is about 10% in men aged 30 to 49 and 17% in men aged 50 to 705. A literature-based global estimate calculated that about 936 million people aged 30 to 69 have mild or worse, and 425 million moderate or severe, sleep apnea6. In childhood, prevalence has been reported at 1.2% to 5.7%7.

I can make up the deficit by sleeping at the weekend

Partly true.

Sleeping long at the weekend can reduce tiredness somewhat. But it may not fully erase the effects on the body of the deficit built up during the week8. The healthiest option is to sleep enough, and regularly, every night.

For experts

In a randomised laboratory study, weekday sleep restriction with free weekend catch-up did not prevent the fall in insulin sensitivity8. In a Swedish cohort of about 44 thousand people, sleeping 5 hours or less on both weekdays and weekends under the age of 65 was associated with higher mortality, while the mortality of those who slept little on weekdays but long at weekends did not differ from the reference group; these are observational data9.

Alcohol helps you sleep

Mostly false.

Alcohol can speed up falling asleep. But it breaks up sleep in the second half of the night and reduces dreaming sleep10. Because it also relaxes the throat muscles, it can make snoring worse11.

For experts

According to the review, alcohol shortens sleep latency and increases slow wave sleep in the first half; in the second half, sleep disruption and REM suppression are seen10. In a systematic review and meta-analysis, higher alcohol consumption was associated with an increase of about 25% in the risk of sleep apnea11.

You need less sleep as you get older

Mostly false.

The recommended amount of sleep in later life changes very little compared with younger adults12. What changes is not the need, but sleep becoming lighter and more broken13. So sleeping less does not mean needing less.

For experts

An expert panel recommended 7 to 9 hours for ages 26 to 64 and 7 to 8 hours for 65 and over12. In a meta-analysis, sleep efficiency and slow wave sleep fall and wake after sleep onset rises with age13; reviews interpret this as a fall in the capacity to generate sleep, not in the need for it14.

Surgery is the only cure for snoring

False.

There are non-surgical options for snoring and sleep apnea. Mouthpieces worn at night and mask devices that deliver mildly pressurised air are some of them1516. A doctor decides which is suitable.

For experts

The AASM and AADSM 2015 guideline recommends an oral appliance in primary snoring when treatment is wanted15; the AASM 2019 guideline recommends PAP therapy in obstructive sleep apnea16. A systematic review found the evidence on the long-term effect of surgical procedures in non-apneic snoring to be limited17.

Snoring in children does not matter

Mostly false.

Occasional snoring is harmless in most children. But a child who snores three or more nights a week should be seen by a doctor7. Breathing problems during sleep have been associated with attention and behaviour difficulties in children18.

For experts

The American Academy of Pediatrics 2012 guideline recommends that all children be asked about snoring, and that a child who snores regularly and has symptoms (snoring on 3 or more nights a week is on the symptom list) be referred for polysomnography or to a specialist7. In the UK ALSPAC birth cohort (more than 11 thousand children), symptoms of sleep-disordered breathing were associated with behaviour problems at ages 4 and 718.

Everyone who snores has sleep apnea

False.

Many people who snore do not have sleep apnea. But if the snoring comes with pauses in breathing or excessive daytime sleepiness, you should see a doctor. The way to tell them apart is a sleep test19.

For experts

The AASM 2017 guideline recommends that questionnaires and clinical prediction tools not be used to diagnose sleep apnea without polysomnography or a home sleep apnea test19. Non-apneic (primary) snoring is a separate clinical picture with a different treatment approach17.

Sources

  1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-747. doi:10.1016/S0140-6736(13)60734-5
  2. Berry RB, Budhiraja R, Gottlieb DJ et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med. 2012;8(5):597-619. doi:10.5664/jcsm.2172
  3. Heinzer R, Vat S, Marques-Vidal P et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318. doi:10.1016/S2213-2600(15)00043-0
  4. Bixler EO, Vgontzas AN, Lin HM et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3):608-613. doi:10.1164/ajrccm.163.3.9911064
  5. Peppard PE, Young T, Barnet JH et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014. doi:10.1093/aje/kws342
  6. Benjafield AV, Ayas NT, Eastwood PR et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-698. doi:10.1016/S2213-2600(19)30198-5
  7. Marcus CL, Brooks LJ, Draper KA et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576-584. doi:10.1542/peds.2012-1671
  8. Depner CM, Melanson EL, Eckel RH et al. Ad libitum weekend recovery sleep fails to prevent metabolic dysregulation during a repeating pattern of insufficient sleep and weekend recovery sleep. Curr Biol. 2019;29(6):957-967.e4. doi:10.1016/j.cub.2019.01.069
  9. Åkerstedt T, Ghilotti F, Grotta A et al. Sleep duration and mortality: does weekend sleep matter? J Sleep Res. 2019;28(1):e12712. doi:10.1111/jsr.12712
  10. Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37(4):539-549. doi:10.1111/acer.12006
  11. Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis. Sleep Med. 2018;42:38-46. doi:10.1016/j.sleep.2017.12.005
  12. Hirshkowitz M, Whiton K, Albert SM et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43. doi:10.1016/j.sleh.2014.12.010
  13. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals. Sleep. 2004;27(7):1255-1273. doi:10.1093/sleep/27.7.1255
  14. Mander BA, Winer JR, Walker MP. Sleep and human aging. Neuron. 2017;94(1):19-36. doi:10.1016/j.neuron.2017.02.004
  15. Ramar K, Dort LC, Katz SG et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773-827. doi:10.5664/jcsm.4858
  16. Patil SP, Ayappa IA, Caples SM et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-343. doi:10.5664/jcsm.7640
  17. Main C, Liu Z, Welch K et al. Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment costs. Health Technol Assess. 2009;13(3). doi:10.3310/hta13030
  18. Bonuck K, Freeman K, Chervin RD, Xu L. Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. Pediatrics. 2012;129(4):e857-e865. doi:10.1542/peds.2011-1402
  19. Kapur VK, Auckley DH, Chowdhuri S et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504. doi:10.5664/jcsm.6506