Snoring can disrupt not only your own sleep but the sanity of those around you! Forty percent of adults snore.
Most are just ‘simple snorers’ but some people have breaks in their breathing (>10 seconds) so have ‘obstructive sleep apnoea’ (OSA). OSA can cause long term health problems due to the extra strain on the heart and lungs.
SOME INSURANCE COMPANIES DO NOT COVER SNORING OR INVESTIGATIONS FOR OBSTRUCTIVE SLEEP APNOEA SO PLEASE CHECK FIRST.
When you are seen in clinic you will be asked to fill out a questionnaire known as the Epworth sleepiness score . If you score 10 or more on this questionnaire you are likely to have some degree of sleep apnoea contributing to your problem.
If this is the case you would have a sleep study to determine wether you have sleep apnoea or not.
This consists of wearing a monitor checking the level of oxygen in your blood (and sometimes breathing rate, heart rate, change in heart rate, respiratory effort). This is arranged and interpreted by a Consultant respiratory physician. If you do have bad sleep apnoea the treatment is CPAP (see below).
If the result shows no obstructive sleep apnoea (or very little) the key stage is determine which part of you is causing the snoring noise. This is the key part at ensuring a successful outcome. There is no benefit from addressing the wrong part!
You will know if your nose is blocked forcing you to mouth breath. If this is the case improving your nasal airway will reduce your snoring in approximately 50% of cases. Problems may include: deviated septum, rhinitis, nasal polyps or alar collapse.
This is performed to determine where the snoring originates once your nasal airway has been optimised (if necessary). This involves being sedated in an anaesthetic room. A fine nasendoscope is passed into your nose when you are snoring so the area(s) vibrating and generating the noise can be seen. Depending on the findings various treatments or combinations of treatments can be offered.
This is when the back of the roof of the mouth vibrates. Laser assisted uvulopalatoplasty (LAUP) is the first choice procedure. The uvula and soft palate are trimmed with a laser. As it heals it is both a little shorter and stiffer so vibrates less.
This has an 80% success rate AS LONG AS IT IS PERFORMED IN CORRECTLY SELECTED PATIENTS. It is painful for about 2 weeks afterwards. After 5 years approximately 50% are still satisfied.
For those who have had palatal surgery before further resection of the palate can lead to food and drink going back up thier nose on swallowing so a different technique is employes called radiofrequency ablation or CELON (see below).
Tonsils often shrink as we get older but remaining bulky tonsillar tissue is often a contributory factor to snoring. These can be removed- tonsillectomy.
A relatively common cause of snoring is the tongue dropping back when asleep.
This can be managed in several ways. It is often positional so if it only occurs whilst sleeping on your back then sewing a tennis ball onto the back of your pyjama top may be enough to encourage you to sleep on your side, stop snoring and keep your partner happy.
The tongue is attached to your lower jaw so lifting your jaw forward with a MANDIBULAR ADVANCEMENT SPLINT may benefit. Assessment of the likely efficacy of this can be done during the sleep nasendoscopy.
If you don’t like the idea of this or find these mandibular advancement splints uncomfortable the tissue bulk in the tongue base can be reduced with radiofrequency. This involves a probe being inserted into the base of the tongue in 8 sites.
It is carried out under a general anaesthetic. About 50% report success after 1 treatment but by repeating it again after 6 – 8 weeks this rises to 80%. It works by heating the tissue to approximately 60-80 degrees centigrade which heals with scar formation. This contracts the base of the tongue. Discomfort is usually minor.
Again, the key to success is correct identification of which part of your upper airway is causing the problem.
These treatments can all be performed under the same sedation – anaesthetic as the sleep nasendoscopy reducing the number of visits.
One of the main predictors of a good outcome from snoring is your weight. If your body mass index (BMI) is greater than 30 there is much less chance of success so you should try to achieve that first. often that is enough to stop your snoring. Your BMI can be calculated here.
CPAP is the ‘gold standard’ treatment for obstructive sleep apnoea (OSA). It involves wearing a nasal mask at night whilst sleeping. Through this flows continuous low pressure air. This keeps the airways open at night and prevents snoring. More importantly it prevents and treats the sleep deprivation that goes along with severe obstructive sleep apnoea. For this reason the patient’s general well being is significantly improved, as is the patients overall health and quality of life. Therefore the patients are often compliant with what may seem an uncomfortable therapy. In fact most patients are very tolerant of the nasal mask, and delighted to feel as well as they do on this treatment. CPAP is provided by a respiratory physician.