Dr Liew Kong Yew
Certification & Qualification Bachelor of Medicine and Bachelor of Surgery (MBChB), University of Manchester, UK, 2006
Masters of Otorhinolaryngology, Head and Neck Surgery (MSur ORL-HNS), University of Malaya, Malaysia, 2016
Fellowship in Rhinology and Advanced Endoscopic Anterior Skull Base Surgery, University of Malaya, Malaysia, 2017
Kyung Hee International Nose Professional Training Program, Korea, 2015
Certificate in Snoring and Sleep Apnoea Surgery, Singapore, 2018
Prince Court Medical Centre 39, Jalan Kia Peng, Kuala Lumpur, 50450 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur
Hi I’m Dr Liew and I’m an ENT specialist. I’ve met many patients over my years in practice who’ve asked me questions about snoring and sleep apnea and I want to share this information so that you will be more aware of your health and loved ones around you. Who knows, after reading this, you might recognise who around you have symptoms of sleep apnea and you might be able to save their health!
Snoring is something that I am certain the majority of people have some experience with, either as complaints from their partners or having been kept up at night by their partners who snore. Invariably, it is always tied to loss of sleep and tiredness for one or both parties. Snoring is such a common occurrence that almost everybody assumes it is a normal and harmless thing and nothing can be done about it. However that cannot be further from the truth.
So Dr Liew, what are the reasons that people snore?
Are there types of people or people with certain types of lifestyles who typically snore?
Okay, let’s address what snoring is. Snoring happens due to a narrowing in one or more locations within the airway when we sleep. This can be anywhere from the nose, to the back of the nose, the palate or just above the vocal cords. During sleep, the relaxation of the muscles in the airway adds to this and worsens the narrowing. As air is forced through the narrow segments, the increased airflow leads to an increased pressure and further worsens the obstruction. It is this airflow turbulence and surrounding tissue vibration that leads to snoring.
Certain groups of people are more prone to develop snoring, mainly ones with areas of airway obstruction, or people with poor sleep habits or jobs that lead to overtiredness.
Here are 4 causes of snoring:
1. Untreated nasal allergies and underlying inferior turbinate hypertrophy, septal deviation or nasal polyps.
2. Adenotonsillar hypertrophy and recurrent tonsillitis.
3. Overweight individuals (BMI of more than 23), as fat tissue is deposited in the tongue and throat tissue.
4. Patients with craniofacial abnormalities leading to small jaws and crowded mouth and throat.
Other than anatomical obstruction, poor sleeping habits and lifestyle may also lead to snoring as well
The following habits can also lead to an increased risk of snoring and sleep disruption
1. Getting insufficient sleep (less than 6 to 8 hours for adults).
2. Shift workers and those that work odd/long hours.
3. Drinking alcoholic drinks or caffeinated drinks too close to bed time.
4. Those with irregular sleeping patterns.
Dr Liew, what are the health implications of snoring? I heard that snoring is normal and some even say that it shows that you are getting great sleep.
No, that’s false. Instead, snoring is a great indicator of compromised health. If snoring persists, your health may be at risk, and the psychological wellbeing to those around you.
For the snorer themselves, snoring may be a symptom of obstructive sleep apnoea (OSA), which is a form of sleep disordered breathing where the airway blocks during sleep, depriving the body of oxygen. This will occur many times during sleep and the built up damage to the brain and heart due to this lack of oxygen can increase the risk of having a stroke or heart attack, as well as increase the risk of getting diabetes or hypertension. Also, these repeated episodes of oxygen deprivation and sleep disturbance make snorers feel chronically sleepy and prone to micro sleeps and road traffic accidents.
For partners and family members, they too may suffer from disrupted sleep due to the snoring. Studies of recorded snoring loudness to be up to 90 decibels (dB), which is about as loud as sleeping next to a lawnmower. Imagine how noisy that would be!
Okay Dr Liew, so how can we check if we are snoring?
If you have a bed partner or room mate, the quickest way is to ask them. For some, the snoring may be loud enough that it can be heard anywhere in the house. Otherwise there are now multiple apps and gadgets that can record while you sleep to help you to identify if you might be snoring.
However, the important part is to detect from the snoring if you have OSA, which is the main danger. This can only be done via a sleep study (polysomnography) organised by a sleep trained technician or medical practitioner. Without a sleep study it is not possible to diagnose or treat OSA.
Are there different types of snoring? If so, what are they and do they have different health implications?
Sometimes people are classified according to the location of the airway blockage or from the type of sound that is made. These are fairly arbitrary classifications and identification of the locations of obstruction should be performed by a sleep trained surgeon to allow effective treatment.
Medically, snoring is seen more as a spectrum, from harmless occasional light snoring to OSA and then OSA with medical complications. The only way to know one from the other is to undergo a formal sleep study.
Dr Liew, what are 3 things we can do to stop snoring?
Good sleep hygiene. Avoid overtiredness and get enough hours of sleep. Have a set bedtime routine and stick to it. Do not take alcohol or caffeine beyond lunchtime to reduce its effects on your sleep.
Lose weight. Maintaining a healthy BMI with diet control and regular exercise throughout the week is not only good for your health but it reduces any areas of airway narrowing that may result from excessive fat.
Treat your nasal allergies. It is natural to breathe through your nose and mouth breathing worsens snoring and OSA. This is particularly important for children as it can lead to problems with teeth and jaw growth.
If help is needed please consult a sleep trained doctor (usually either an ENT/ORL surgeon or respiratory physician) for further information.
Dr. Liew Kong Yew is a consultant otorhinolaryngologist (ENT), head and neck surgeon currently practising in Beacon Hospital, Petaling Jaya, Malaysia. His scope of practice includes general ENT conditions covering head and neck cancers, ear related and hearing disorders, and throat and voice disorders. His subspecialty focus is on sinus disease, snoring and sleep apnoea surgery, having received his fellowship in rhinology from University Malaya, Malaysia with further exposure to sleep surgery in Korea and Singapore.