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Snoring is one of the main symptoms of sleep apnoea (obstructed airways while sleeping).
What causes snoring?
Snoring happens when a collapse, blockage or restriction to the upper airway obstructs the flow of air through the back of the mouth or nose. The sound is created by the vibration of the soft tissues at the back of the throat.
A common cause of snoring is obesity – overweight people have extra bulk around the neck that can restrict their airways. There's also experimental evidence that abdominal fat pushes the chest up towards the upper airway, which then loses its tension, becoming floppy.
Snoring is one of the main symptoms of sleep apnoea, where airways are obstructed during sleep until the person wakes up – often gasping for air. Sleep apnoea is more common among overweight people.
Drugs such as alcohol, muscle relaxants and sleeping tablets can also cause snoring by making the tongue and muscles in the throat relax, go floppy and vibrate. Smokers are also more likely to snore than non-smokers.
Nasal congestion, late eating
Nasal congestion from a cold or allergies can cause snoring, as can eating too much at night, though this would be only temporary.
Anatomical problems that cause snoring are a bent septum (the wall that separates the nostrils), nasal polyps or an enlarged tongue, uvula (the dangly thing at the back of your mouth), tonsils or adenoids.
Because there are many different reasons for snoring, there is no one-size-fits-all solution. You should start with talking to your doctor. They can do a physical examination and make sure it's not a symptom of something more serious.
Many regular snorers, especially heavy snorers, also have sleep apnoea. Sleep apnoea can cause high blood pressure, diabetes, heart attack and stroke.
Poor sleep due to sleep apnoea can also lead to daytime drowsiness, which impairs your performance at work and increases the risk of accidents.
Your GP may refer you to a sleep physician, or perhaps an otolaryngologist or ear, nose and throat (ENT) specialist.
Certain lifestyle changes can help with snoring, and are worth trying as a first line of treatment.
If you snore because you're overweight, you could get some support to help you stick to a new eating and exercise plan. Even moderate weight loss has been shown to reduce or stop snoring.
Other lifestyle changes that may help include:
- Avoid sleeping pills, tranquillisers and muscle relaxants.
- Talk to your doctor about alternatives to medication for anxiety and sleep problems, such as cognitive behavioural therapy.
- Don't drink alcohol for at least four hours before going to bed.
- Give up smoking.
Not drinking wine for at least four hours before bedtime can help with snoring.
Back snorer? Positional therapy may help
Many snorers snore only when they sleep on their backs – the tongue and throat muscles relax, and slump backwards, causing a partial blockage of the airway. If this is you, lying on your side may reduce the problem.
Positional therapy involves techniques designed to make you sleep in a position where you don't snore, usually on your side.
Various anti-snoring pillows claim to prevent snoring by holding your head in a certain position – perhaps to encourage you to sleep on your side, or to 'correct head and spine alignment'.
Unfortunately, given that they're such a simple solution, experts doubt a pillow could hold a person in one position for the whole night, particularly if they're prone to tossing and turning.
More sophisticated positional therapy devices use vibrations to gently encourage the wearer to change positions without disrupting their sleep.
Associate professor Darren Mansfield, deputy chair of the Sleep Health Foundation, says such devices are recommended by more and more sleep physicians thanks to their efficacy, relatively low cost and high patient compliance rates compared with other treatment options.
One of the most commonly prescribed positional therapy devices is the Night Shift Sleep Positioner. This is an electronic device worn around the neck that vibrates when the wearer sleeps on their back, training them over time to sleep on their side. They cost about $480, or you can rent one if you'd like to try it out first.
An alternative DIY solution is the tennis ball technique (yep, that's its official name), which involves placing a tennis ball into a pocket sewn onto the back of your pyjama top, making it uncomfortable to sleep on your back. Perhaps unsurprisingly, this technique isn't widely used any more.
Dental sleep medicine
Dentists specialising in dental sleep medicine (also known as oral sleep medicine) supply and fit oral appliances to prevent snoring, usually in the form of a mandibular advancement splint (MAS). This device forces the lower jaw forward, increasing the air cavity at the back of the throat. They're very effective – as long as people can tolerate using them.
Experts say the newer appliances are more comfortable than the bulky mouthguards of old, and are good for people with apnoea who can't tolerate a CPAP machine (see below). The best devices are those customised to the individual – so-called 'boil and bite' models are a lot cheaper, but not as effective.
Getting a MAS fitted
To have a MAS fitted, you'll need a referral from a specialist, generally a sleep or ENT physician. You'll probably need to have a sleep test to determine if a MAS is the right treatment option for you.
You may need to go to the dentist a few times in the first few months for adjustments. Other potential negatives include dry mouth, irritation, dental discomfort and pain around the joint of the jaw.
A specialist we spoke to told us the devices cost anything from $1500 to $3000 depending on their construction and design, including the visits required in the first few months. You may get about half of this back on private health insurance.
Some specialists offer a satisfaction guarantee – if you're not happy after three months, they'll refund 80% of the cost. If you go down this route, check for similar offers from your practitioner.
With only a handful of suitably qualified practitioners in major cities – and it's not something any dentist can do – it's important your sleep physician refers you to someone with the right experience.
CPAP machines are the most effective treatment for sleep apnoea, though some people find them daunting to use.
CPAP and APAP machines
The most effective treatment for sleep apnoea is the CPAP machine. By forcing air into the airways through a nasal mask, it prevents tissue in the throat from collapsing and cutting off the air – and therefore oxygen – supply. And in keeping airways open, CPAP also prevents snoring.The air pressure on a CPAP machine is set manually, usually by a sleep physician.
Automatic positive airway pressure (APAP) machines work in the same way as CPAP machines. But they measure airflow characteristics and automatically adjust the air pressure accordingly over the course of the night, making them a "smarter" CPAP machine. Mansfield says CPAP machines are usually sufficient, but as APAP machines become more affordable, they're likely to become more commonly used in Australia.
Daunting to some
The prospect of using a CPAP or APAP machine, especially if it's only for snoring rather than sleep apnoea, can be daunting – the notion of wearing a mask all night can put some people off, and people feel embarrassed about all the equipment or concerned about the effects on their bed partner. Once people have started using it, problems may include dryness (though you can get a humidifier) and air leakage (you may need a different mask).
But these machines do work. They're not cheap – on average, CPAP machines cost about $1500 and APAP machines about $1700. But you can rent one for a few weeks to see if it helps and to decide whether you could get used to it.
Talk to your doctor about whether it could be right for you.
Nasal strips and dilators are designed to open the nasal passages so the user can breathe more freely through their nose rather than their mouth. These devices can help a small number of people whose snoring is caused by certain types of nasal obstruction.
How do nasal strips and dilators work?
The valves open when you breathe in, letting the air flow in easily, but partially close when you breathe out, providing resistance that increases the pressure in the airways. This pressure helps keep tissue from collapsing and prevents snoring. If you sleep with your mouth open, however, the pressure is lost.
Clinical trials have found them effective, and experts we spoke to agreed. But they also pointed out that not many people choose to use them every night because they're somewhat intrusive. That said, they can be useful, perhaps even a substitute for a CPAP machine, when you're travelling or camping.
They're also quite cheap, although at $1.25 to $1.50 a day, you may find the cost building up over time.
Hupnos eye mask
The Hupnos is a 'smart' eye mask that combines an EPAP device with positional therapy.
The mask (which costs US$99 plus shipping) uses an AI-powered app that detects when the wearer is snoring. It uses vibration to first encourage the wearer to change positions. If the snoring continues, the mask increases the pressure in the EPAP device attached to the nostrils.
Mansfield says that although he's not familiar with the Hupnos, the combination of positional therapy and EPAP could work well.
"Both therapies can be effective on their own, so combining them is a clever idea" he says.
Snoring happens when the muscles of the upper airway relax, obstructing the flow of air through the mouth or nose. Myofunctional therapy (throat and tongue exercises) tones these muscles and has been shown to improve both sleep apnea and snoring.
Muscle toning treatments are likely to work best when the cause of snoring is unknown, rather than when there is an obvious anatomical cause (such as excess tissue due to obesity or enlarged tonsils).
The Soundly Reduce Snoring app coaches users through myofunctional therapy exercises, using a game format to make the exercises more fun. The app is currently available on iOS only and although it's free to download, a subscription to the service costs $47.99 a year.
New gadget on the horizon
There's also a new gadget set to enter the Australian market, which is claimed to tone your tongue muscles for you.
The exCiteOSA is a one-size-fits-all silicone mouthpiece that delivers electrical currents to the tongue to stimulate and improve muscle function. It's designed to be used for 20 minutes a day for six weeks, followed by maintenance treatments once or twice a week to keep up results.
The device now has TGA approval, but isn't yet available in Australia. It's set to go on sale here in October 2021 and is expected to cost about $975 for the app, controller, and mouthpiece (including shipping). The mouthpiece needs to be replaced every three months and will cost $95.
Compliance a problem
Mansfield says that although products such as the Soundly Reduce Snoring app and the exCiteOSA (which aims to improve muscle tone) certainly have the potential to relieve snoring, the main issue is getting patients to stick with them.
"While toning the muscles of the throat and tongue can certainly help with snoring, the hardest part is getting patients to follow through with the required exercises, especially six or 12 months down the line," he says.
Devices such as Somnifix help you to breathe through your nose while you sleep.
Promoting nasal breathing
People who sleep with their mouths open are more likely to snore because an open mouth narrows the airway and the walls of your throat at the back of the mouth vibrate more easily than the walls at the back of your nose.
If you snore only when you breathe through your mouth, you can try a device that promotes nasal breathing, such as the Somnifix. The Somnifix is a single-use adhesive strip with a central safety vent that allows limited mouth breathing. The strips cost about US70c each, depending on how many you buy. You can order a four-week pack for about US$20 (plus shipping), or a year's supply for about US$220 (free shipping).
Mansfield says devices to encourage nasal breathing can definitely help with snoring, and although products such as the Somnifix may be more comfortable, regular tape can also do the job (and costs a lot less).
Surgery for snoring
There are several procedures that tighten the palate by causing tissue scarring and shrinkage, making it firm and less prone to vibration.
Such procedures include some types of laser treatment (with a 'non-ablative' laser, which doesn't remove or cut tissue), radio frequency treatment and 'snoreplasty' – injections of hardening (sclerosing) agents into the palate.
Another palate-tightening treatment is the Pillar implant system, where small plastic rods are inserted in the palate, causing it to become firm and reduce vibration.
Not invasive, but still not cheap
These treatments are considered less invasive than other surgical procedures, because they can be done under local anaesthetic, don't involve cutting and stitching, don't require much (if any) recovery time, and cause little pain afterwards.
But they may still cost thousands of dollars – without providing a long-term solution, meaning you may need to go back for more. Laser treatment in particular is falling out of favour because of its lower efficacy. There's also some concern that scarring could make other treatments, such as CPAP, more difficult if needed in the future.
More invasive surgical procedures can help with snoring, but only if they're right for those particular people – such as those who aren't overweight but have a large palate, a nasal blockage, enlarged tonsils, or an enlarged tongue that's causing obstruction.
Talk to your GP if your child shows signs of snoring or gasping while asleep.
Children who snore
For kids, snoring and nighttime breathing difficulties may be linked to learning difficulties, aggressive behaviour and hyperactivity.
Parents should look out for symptoms including:
- making noises such as snoring or gasping
- restlessness in bed
- grinding their teeth
- talking in their sleep
- sleepiness or irritability in the morning.
Dr Mark Levi, a dentist and paediatric craniofacial dental sleep medicine practitioner, says that although many of these symptoms are common, you should still pay attention to them.
"These issues are becoming increasingly prevalent in children, but that doesn't mean they should be ignored," he says.
If your child is showing these symptoms, your GP can refer them to an ENT specialist, who will check for evidence of crowding in the airway. Your child can also be referred for a sleep study for a closer look at what's happening when they sleep.
Treatment options for children
Over-the-counter treatments should not be used on children, as their effectiveness and safety for children haven't been confirmed and some products may interfere with a child's development.
Treatment options include surgical removal of the adenoids and tonsils (adenotonsillectomy) or your child may need to have an oral appliance fitted to expand the upper and lower jaw, opening up the airways.
Over-the-counter treatments should not be used on children, as their effectiveness and safety for children haven't been confirmed
Dr Levi, who is trained in fitting these oral appliances, says he often refers dental patients to work too with osteopaths, chiropractors or orofacial myofunctional therapists to get the muscles of the face to work better.
Night after night of disturbed sleep because of loud snoring is extremely trying on your health and your relationship. If you're the snorer, the none-too-gentle kicks from the other side of the bed aren't too soothing either.
The good news is that there are solutions to the problem – and they're cheaper than divorce!
We look at treatments that can help you, such as lifestyle changes, dental appliances, continuous positive airway pressure (CPAP) machines and surgery.