Snoring fixes that actually work
Snoring may inspire jokes but it’s no laughing matter if you are one of the many thousands of adults affected.
More than two-thirds of snorers are men, according to the British Snoring and Sleep Apnoea Association (BSSAA).
‘It may be because men are more likely to drink and smoke, which makes snoring more likely, but men also tend to put on more weight around their necks and a thick neck is a trigger,’ says Professor Bhik Kotecha, a consultant ear, nose and throat surgeon at London’s Royal National Throat Nose and Ear Hospital.
This is because the throat inside becomes compressed and narrower so vibrates more as the air rushes past.
According to the BSSAA, it can take snorers 18 years, on average, before they do anything about it, which means they may be putting their health at risk. We all have the potential to snore. When sleeping, our throat muscles relax, our tongue falls backwards and the throat narrows. As we breathe, our throat walls vibrate – more on the in-breath than the out.
There are different types of snoring and some people may have more than one. While there are different remedies for these, all will benefit from sufferers losing weight and taking up exercise – even a few extra kilos can make a difference, and stronger neck muscles keep airways open. So what else works?
NASAL SNORING
TELLTALE SIGN: A simple test is to close one nostril with your finger and inhale through the other with your mouth closed. If your open nostril tends to collapse, you may be a nasal snorer, suggests Marianne Davey, co-founder of the BSSAA.
CAUSE: Partial obstruction of the nose, for whatever reason, can cause snoring and whistling noises. ‘Allergic rhinitis is a common cause because of the inflammation inside the nose and excessive production of mucus,’ says Professor Kotecha. ‘The nostrils themselves can also tend to fall closed during sleep.’
Nasal polyps (non-cancerous growths) can also cause this type of snoring.
TREATMENT: Decongestants and steroid inhalers – over the counter or prescription – may reduce congestion CAUSE: and mucus.
But Dr Tom Mackay, director at the Edinburgh Royal Infirmary Department of Sleep Medicine, says adhesive nasal strips, placed over the bridge of the nose to widen the nostrils, don’t work.
Snore-free nose clips and nasal dilators are not scientifically proven either.
‘Removing nasal polyps with endoscopic sinus surgery can help by opening up the airways,’ says Prof. Kotecha.
Unlike with most sinus surgery, the skin is not cut through, and patients can go home from hospital the same day after treatment.
MOUTH SNORING
TELLTALE SIGN: Open your mouth and snore from the back of your throat. Now close your mouth and try to make the same noise. If you can make a snore noise only when your mouth is open, you’re a mouth snorer. Another sign is dry mouth.
Breathing through your mouth when asleep means the air hits the back of the throat, making the soft tissue vibrate.
‘Some people may naturally sleep with their mouths open. This is because they do not have the muscle tone to stop the jaw dropping during sleep,’ says Prof. Kotecha.
Sleep apnoea is another major cause of mouth snoring. Patients stop breathing temporarily – up to 100 times an hour – for ten seconds or longer. Those affected wake up frequently but don’t realise it and are very sleepy during the day because they’re not getting enough restorative deep sleep when blood pressure drops (this may be why the condition is linked to high blood pressure, heart attack and stroke).
The snore is caused when they begin breathing again and air is forced through the airways. Obstructive sleep apnoea (OSA), the most common type, is where the throat muscles relax, blocking the airways.
Being overweight is a risk factor, so too is a family history of it.
‘It doesn’t just happen to people who have a high BMI,’ says Prof. Kotecha. ‘Your inherited anatomy – the composition of your face, skull, particularly a receding chin, and oral cavities – can increase your risk.’
TREATMENT: Chin straps and chinup strips are low-tech options that literally keep the mouth closed during sleep.
Chin straps, often made from stretchy material, are passed under the chin and over the top of the head.
Chin-up strips are disposable adhesive strips placed on the lower jaw and the skin above the corners of the mouth.
‘These devices have been shown to help in several studies, but they can be uncomfortable,’ says Prof. Kotecha.
There are surgical options for snoring not caused by OSA. A particularly effective procedure, is laser uvulopalatoplasty, where the tonsils are removed and the uvula, the dangly thing at the back of your throat, is trimmed with a microscope-mounted laser.
The soft palate, which can fall down and block the throat during sleep, may also be trimmed during this procedure.
As the cuts heal, fibrous bands of scar tissue form, pulling the whole soft palate upwards – it usually takes about two weeks for the cuts to heal fully.
‘Ninety per cent of patients report an improvement within three to four months, although only 75% say that the situation is improved after a year,’ says Prof. Kotecha.
Another option is implants with the Pillar Procedure, carried out on a day-case basis. This is where three to five woven implants are placed in the soft palate. Over three months or so, this causes the palate to stiffen.
The procedure, which takes 20 minutes, ‘has excellent long-term results’, says Prof. Kotecha.
The gold-standard treatment for sleep apnoea is the CPAP (Continuous Positive Airway Pressure) mask, which delivers a stream of air to keep the airways open.
‘It’s a bit like sticking your head out of the car window,’ says Darrel Francis, professor of cardiology at Imperial College London. ‘It is not very comfortable and a lot of people cannot tolerate it.’
About half of those who could benefit refuse to use the CPAP system at all, and half of the remaining group give up very quickly.
‘Newer nasal pillow masks are more acceptable as they fit directly into the nostrils rather than on the face,’ says Prof. Kotecha.
There is also a range of ‘intelligent breathing’ devices, such as the AutoSet CPAP, which kick in only when required – when someone stops breathing.
‘Patients find this easier to accept,’ adds Professor Kotecha.
Some of these devices can be rented on a monthly basis. See your GP for further information.
TONGUE BASE SNORING
TELLTALE SIGN: Make a snoring noise. As you do, stick your tongue out as far as it will go and grip it between your teeth. If the noise is reduced, you may be a tongue base snorer.
CAUSE: The snoring is due to lack of tone in the tongue and surrounding tissues. The lax tongue narrows the airway – if the airway becomes partially or wholly blocked, this is obstructive sleep apnoea (see above).
TREATMENT: This kind of snoring can respond to a mandibular advancement device – a bit like a gum shield – which pushes your tongue and jaw forward. These cost from €50 off-the-shelf to several thousand euro for a custom-made version.
‘Various forms of gum shield are reasonably successful at reducing snoring noises – maybe 50% or 60%,’ says Dr Mackay.