Snoring occurs when the muscles of the airway relax too much during sleep and vibrate (creating noise) when air we breathe passes in and out. Most people will snore at some time, however loud or chronic snoring can disrupt sleep-quality and disturb others. Particularly when loud, it is often associated with other sleep-related breathing disorders, such as obstructive sleep apnoea (OSA).
Common causes of snoring:
- Eating too much at night
- Nasal congestion
- Deformity of the nose
- Consumption of alcohol close to bed-time, especially if the amount is large
- Being overweight or obese
- Swelling of the muscular part of the roof of the mouth
- Swollen adenoids or tonsils, especially in children
- Medications, including sleeping tablets
- Sleep position – sleeping on your back may cause your throat muscles and tongue to relax; the tongue is then more likely to fall back and compress the airway, causing snoring or making snoring louder.
An overnight sleep study can be performed to assess the nature and severity of snoring, and to check for other sleep-disorders that often accompany snoring, especially obstructive sleep apnoea (OSA).
The most appropriate treatment for snoring varies according to the severity of snoring, presence of sleep apnoea, age, body-weight, degree of daytime sleepiness, alcohol-consumption, medical history and the anatomy of the upper airway. A Sleep Physician is a doctor who specialises in treating patients with snoring and other sleep-disorders, and who is qualified to help sufferers make an informed decision about which treatment is the most appropriate.
Snoring Treatment options
TheraventTM Snoring Therapy is available Australia for patients with snoring (but no obstructive sleep apnoea). The treatment involves small adhesive devices that cover the nostrils. Similar to Provent Therapy, the unique valve system is designed to eliminate snoring by increasing the pressure inside the airway.
Theravent is an effective treatment for many patients with troublesome snoring, particularly when combined with other conservative snoring treatments (including lateral sleep and weight-reduction).
Further information can be found on the Theravent website here.
Exclusively Lateral Sleep
Exclusively lateral sleep can be an effective, non-invasive treatment of snoring and obstructive sleep apnoea. It achieves this by preventing the tongue, soft palate and uvula from falling backwards under the effect of gravity, thereby causing the pharyngeal airway to be restricted. This in turn results in an increased speed of air-flow through the narrowed airway, causing an increase in soft-tissue vibration and resultant snoring. A variety of simple measures can be implemented to encourage exclusively lateral sleep, such as the use of a bolster pillow placed lengthwise in the bed (to lean against) or pinning tennis balls (or the like) to the back of a pyjama top. As the tennis ball causes discomfort to the wearer when supine, it typically causes the wearer to turn back to a lateral position. Within a few weeks, most people learn the habit of sleeping laterally and will no longer require tennis balls or similar measures. Exclusively lateral sleep is limited however in its effectiveness, particularly in sufferers with severe obstructive sleep apnoea. In this case alternative treatments are required.
Night Shift Device
Night ShiftTM is a new lateral sleep position aid that assists patients to sleep exclusively on their side. Many patients have obstructive sleep apnoea that is significantly worse (or only present) when sleeping on their back (the supine position). The device accurately monitors sleep-position and vibrates when supine sleep is detected, helping many patients with position-related airway disorders to avoid other OSA treatments. It records positional data and snoring volumes that can be downloaded, either to provide you with information on your sleep, or to provide to your Sleep Physician to monitor the progress of your treatment.
Night Shift can also be used in conjunction with other OSA treatments, including Provent Therapy. Patients who require CPAP can use Night Shift as well to lower their nightly CPAP setting.
For ethical reasons, we do not sell Night Shift or any other treatment device, but our doctors may recommend a trial based on the results of your sleep study.
More information on the Night Shift device can be found here.
Weight loss will generally decrease the severity of snoring, although not all people who snore are overweight, but weight gain will typically make existing snoring even worse. Losing even a little weight can reduce fatty tissue in the back of the throat and decrease snoring. In some patients, weight loss may not cure snoring, but can significantly reduce its loudness (sometimes to such an extent that other treatments are not required).
Cessation of Tobacco Smoking
In addition to causing cancer and being a major health risk, tobacco smoke causes the walls of airways to retain fluid and swell (this is called oedema). This causes the airway to narrow, worsening snoring (and sleep apnoea). Smokers are 4 to 5 times more likely than non-smokers to suffer from snoring and obstructive sleep apnoea. Nicotine also contributes to insomnia and poor sleep-habits.
Mandibular Advancement Splint (MAS)
A Mandibular Advancement Splint is a small device (a type of dental splint) which is placed in the mouth during sleep, causing the lower jaw and tongue to be held more forward than usual. This in turn opens the pharyngeal airway, resulting in a lower rate of air-flow. This minimises vibration of the tissues at the back of the pharynx, thereby reducing the volume of snoring. However, there are a number of problems which can occur for users of a MAS, including a build-up of excessive amounts of saliva, discomfort of jaws and teeth, problems with the gums and other oral tissues with certain types of MAS, particularly if fitted incorrectly and in a significant percentage of patients, permanent repositioning of the teeth and an altered bite over a period of years.
Continuous Positive Airway Pressure (CPAP)
As for obstructive sleep apnoea (OSA), CPAP is currently the most effective treatment for simple snoring. CPAP involves the use of a compact air pump to deliver a continuous flow of pressurized air (via a mask) to an individual’s airway. This pressurised air acts as a pneumatic splint and prevents the airway from collapsing, which in turn causes snoring to cease. Each individual’s pressure-requirement differs, depending on a variety of factors, including weight and severity of snoring. These and other details of
CPAP therapy are discussed in the CPAP section of this website.
Nasal Steroids and Allergy Treatments
Naso-pharyngeal congestion from allergies can also contribute to a narrowing of the airways. Nasal congestion limits the amount of air a person can breathe through their nose while asleep. This can be caused by the presence of an allergen in an individual’s immediate environment, resulting in an inflammatory response and mucosal swelling, which blocks the nose. Mouth-breathing is then the only available means to ensure that sufficient oxygen is delivered to the body. Nasal steroids can be an effective way to combat the underlying allergic reaction, eg, with prescription agents such as ‘Nasonex’. Certain over-the-counter nasal steroids are also available from pharmacies.
Non-Steroidal Over-The-Counter Nasal Sprays and Other Anti-Allergy Treatments
Other over-the-counter treatments may also be beneficial in patients prone to nasal allergies or troublesome nasal congestion at night-time. The most common cause of nasal congestion is temporary swelling of nasal passages due to colds or allergic reactions to pollen, dust, mould, animals or some foods. These can cause the lining of the nasal membrane to become inflamed, and mucus to thicken and become acidic. There are a number of over-the-counter nasal sprays that can be helpful in the short term, eg, FESS® Nasal Spray, a non-medicated saline nasal spray. Nasal sprays like Afrin, Neo-Synephrine, NasalCrom (Cromyln) and anti-histamines can also be useful as decongestants. However the use of such sprays for more than 72 hours can cause a rebound, negative effect. Allergy desensitization treatments will sometimes be recommended by a Sleep Physician, Allergist or General Practitioner.
ENT Interventions and Surgery and Other Procedures on the Soft Palate
When narrowing is due to structural abnormality, ENT surgery can be very helpful as a means of opening the nasal passages, thereby improving nasal air-flow and eliminating the sufferer’s need for mouth-breathing.
Surgical procedures which have been used in the hope of reducing snoring include uvulopalatopharyngectomy (UPPP), radio frequency uvulopalatopharyngectomy (RFUPPP) and laser-assisted uvuloplasty (LUAP). These treatments tend to be painful and expensive, and they often fail to cure snoring, especially when this is loud. They have no place as a treatment for snorers who also suffer from moderate or severe OSA (and in fact, can complicate later treatment of OSA with CPAP).
Injection snoreplasty is a nonsurgical treatment for snoring whereby the soft palate is injected in front of the uvula with a hardening agent. This creates an inflammatory reaction and results in scar tissue, which in turn stiffens the soft palate and ultimately reduces the amount of palatal tissue ‘flutter’. When this is the cause of snoring, the treatment can result in reduced snoring volume. Unfortunately, a number of other pharyngeal tissues can vibrate and cause snoring and this technique cannot assist when this is the case. Also, this is presently a new treatment, with limited long-term evidence of its effectiveness.
External Nasal Strips
Nasal strips such as ‘Breathe Right’ appear to reduce snoring in some patients through opening the nasal passages, but there are no published scientific studies which definitely prove that these strips do in fact assist significantly with snoring. These strips probably have their main place in the 5-10% of individuals whose nostrils collapse during inspiration.
Nocturnal Sedatives and Alcohol
Nocturnal sedatives (such as sleeping pills) and alcohol (especially in large quantities) can cause narrowing of the pharynx as a result of relaxation of pharyngeal muscles, with a resulting increase in soft-tissue vibration and snoring. Reducing the intake of these agents commonly therefore helps to reduce snoring volume.