This site offers information about the assessment and management of snoring and obstructive sleep apnoea syndrome.
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60% of the male population over 50 years snore but only a small proportion pluck up the courage to do anything positive to reduce it. This website describes some of the treatments available to help reduce snoring noise and the more serious condition of Obstructive Sleep Apnoea Syndrome (OSAS).
Patient Assessment
Mandibular splints
A device worn in the mouth overnight resembling a sports gum-shield can be fitted so that it pulls the lower jaw (mandible) forward a few millimetres. This may be sufficient to bring the tongue forward a little and increase the airway space at the back of the throat thus reducing snoring noise. There are several such devices available. They may cause aching discomfort in the jaw joint in some patients but most are able to tolerate the mandibular splints. The success rate in reducing snoring noise in the long term can be disappointing but they may be useful in the short to medium term in patients who prefer to avoid more invasive treatments. (see sources of more information)
Continuous Positive Airway Pressure (CPAP) is a method of administering air to the back of the throat via a plastic mask fitting tightly around the nose. The mask is connected to a small electrically powered air compressor via a flexible plastic hose. The air pressure is adjusted to a high level so that the soft tissue at the back of the throat is pushed apart and the patient is able to breathe without obstruction.
The beneficial effects can be dramatic and immediate especially in cases of severe OSA. Snoring noise is also eliminated although many patients feel that the inconvenience of wearing the apparatus is almost as bad as the original snoring noise.
Various non-surgical methods may usefully be tried in order to improve the nasal airway. These include topical nasal steroid sprays such as Beclomethasone or nasal decongestant sprays eg. Otrivine or Ephedrine. Note the decongestant sprays must be used sparingly for periods of maximum one week in order to reduce risk of damage to the nasal lining.
Plastic nasal splints are also worth trying as an experiment to temporarily open the nostrils a little wider during sleep. Success in reducing snoring by sprays or splints would suggest surgery may offer a more lasting solution.
Snoring is usually most marked during REM sleep. This is when the pharyngeal muscles are maximally relaxed. Drugs such as protryptiline are used to reduce the REM phase of sleep and consequently shorten the period of snoring. The stimulant drug Modafanil may be useful in some patients to reduce drowsiness. Although these drugs can be effective in selected cases, most people would prefer not to take medication long term which alters the natural sleep pattern in this way.
Sprays are available which are applied to the soft palate before bedtime. They act as a mild irritant to the palate and can help reduce snoring noise. Generally the effect is not long-lasting.
About the Author :-
Mr Adrian Thompson is a Consultant Ear, Nose & Throat surgeon at The Queen's Hospital, Burton on Trent, Staffordshire. In addition to general ENT work, he has a special interest in the assessment and treatment of patients with snoring and related sleep problems.
Mr A.C. Thompson FRCS,
ENT Department,
Queen's Hospital,
Burton on Trent,
Staffordshire,
UK.
DE13 0RB.
Tel. 01283- 566333 Ext. 4543
Appointments and enquires: lisa.beard_burtonh-tr.wmids.nhs.uk
