A Patient Asks: “How do you treat snoring?”

Snoring is a sound produced by vibration of the soft tissues of the upper airway during sleep. It usually occurs during inspiration, but can also occur during expiration. Habitual snoring is common, occurring in 44 percent of men and 28 percent of women between the ages of 30 and 60. Occasional snoring is almost universal.

If you snore, it means you have increased upper airway resistance and increased throat collapsibility. Conditions that are associated with snoring include obesity, nasal congestion, nasal polyps, structural abnormalities of the mouth, hypothyroidism, acromegaly, and enlarged tonsils. The number of people who snore is much larger than the number of people who snore and have sleep apnea. That is to say, just because you snore doesn’t mean you have sleep apnea.

If you have sleep apnea, you’ll need to treat that disorder, which will resolve your snoring problem. If you just snore and don’t have sleep apnea, there are other treatments to help you stop. Snoring isn’t associated with any other health problems besides sleep apnea, so if you don’t have sleep apnea, the only problem with your snoring will be with its effect on your bed partner (which is no small issue for many couples).

Treatment

  1. Reversible problems, such as those mentioned above (i.e., chronic nasal congestion) should be ruled out or, if present, treated.
  2. A sleep study should be performed is there’s a clinical suspicion for sleep apnea.
  3. If sleep apnea isn’t suspected or is proven to be absent, treatment should focus on decreasing the snoring.
  4. Weight loss is often effective for reducing snoring. In one (admittedly small) study, losing just 6.6 pounds decreased the frequency of snoring by almost 50%. In the same study, losing 16.7 pounds eliminated snoring entirely. Unfortunately, in the same study two patients who lost on average almost 40 pounds actually increased their snoring. Bottom line: some amount of weight loss will probably reduce your snoring somewhat.
  5. Some observational studies suggest side-sleeping will reduce snoring. Unfortunately, learning to sleep on your side if you’re used to sleeping on your back is hard. Studies suggest only 50% of people manage to switch, and this often after weeks, or even months, of trying. One trick is to wear a nightshirt with a pocket sewn into position over the spine into which is placed a tennis ball. If, while sleeping, you unconsciously try to revert to the supine position, the tennis ball will stop you, often without waking you up.
  6. Oral appliances can be made that increase the size of the upper airway, which decreases snoring, usually by advancing the jaw forward, changing the position of the soft palate, retracting the tongue, or a combination of all of them. These must be custom crafted by a dentist with expertise in sleep-related breathing problems.
  7. CPAP can be used even in the absence of sleep apnea to reduce snoring.
  8. Uvulopalatopharyngeoplasty (UPPP) is a surgery that removes tissue from the soft palate and tonsils to enlarge the back of the throat. It’s not entirely clear how effective this surgery is in reducing snoring, however.
  9. UPPP can be performed with a laser (LAUP) that only requires local anesthesia. Only the soft palate and uvula are altered. Effectiveness is comparable to UPPP.
  10. Palatal implants (the pillar procedure) involves the insertion of braided polyester filaments into the soft palate through a needle, generally performed as an outpatient procedure. The benefit of this procedure, however, doesn’t appear to be sustained.

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