Siamak N. Nabili, MD, MPH
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
In this Article
- Snoring facts
- What is snoring?
- How common is snoring?
- What causes snoring?
- How do medications and alcohol affect snoring?
- Why is snoring a problem?
- What is the clinical importance of snoring?
- What are different levels of snoring?
- How should someone with snoring be evaluated?
- How is it determined if snoring is a medical problem?
- What are some objective tests to measure sleepiness?
- What are the treatments for snoring?
- What are some non-surgical treatments for snoring?
- What are the surgical options for snoring?
- What is the success of surgery for snoring?
- Find a local Sleep Specialist in your town
What are some non-surgical treatments for snoring?
The main categories of non-surgical treatment of snoring are:
- Behavioral changes
- Dental devices
- Nasal devices and medications
- Nasal CPAP
- Over-the-counter products
Behavioral changes are the easiest to identify, but some of the hardest to accomplish. For example, if a person gains ten pounds, his or her snoring may become a problem. It is easy to tell a person to lose the ten pounds, but it is difficult to accomplish. Behavioral changes include weight loss, changing sleeping positions, avoiding alcohol, smoking cessation, and changing medications that may be the cause of snoring.
Losing weight may improve snoring. Snoring usually is worse when lying flat on the back, as discussed previously. To help this problem, a pocket can be sewn into the back of the snorer's pajama tops. A tennis or golf ball in the pocket will "encourage" the snorer to roll over to sleep on his/her side. Special sleeping pillows to prevent sleeping on the back are also available. Alcohol or sedative medications make snoring worse, and therefore should be avoided.
As previously discussed, snoring is exacerbated by normal airflow through a narrowed area in the throat. Part of the narrowing is caused by the tongue and palate falling back during sleep. Some dental devices have been developed that hold the jaw forward. Since the tongue is attached in the front to the jaw, the tongue also is held forward when these devices are used. Some devices are designed to hold the palate up and forward.
Dental devices (similar to a mouthpiece) may also be referred to as oral appliances or mandibular advancement devices. The devices are best made by a dentist or experienced physician to ensure a correct fit without causing problems and adequate treatment of the sleep problem. These devices may improve snoring in 70% to 90% of cases. There are some drawbacks to dental devices, however. They must be worn every night in order to work, can cause or exacerbate temporomandibular joint (TMJ) problems, can cause excessive salivation, and can be moderately expensive.
The available data on some of these devices revealed both subjective and objective improvement in snoring. These devices may be appropriate and recommended for those individuals with primary snoring or mild obstructive sleep apnea who did not benefit or did not qualify for the aforementioned behavioral changes.
Nasal devices and medications
For people with narrow nasal passages, snoring can be alleviated with nasal devices or medications. Breath-rite strips open the anterior nasal valve (front part of the nose). If this is the main or only area of narrowing, snoring may improve with use of these strips, but this is frequently not the case.
If nasal mucosal (lining) swelling from allergies or irritation is causing the problem, nasal sprays may help. Nasal saline irrigation spray is a way to clean and moisturize the nasal lining since environmental irritants that stay in the nose (dust, pollen, and smoke) continue to irritate as long as they are present. The nasal lining also swells when it is cold and dry. Nasal saline helps to wash away irritants and moisturizes the mucosa without side effects.
Other nasal sprays that may be used to improve nasal breathing include nasal steroid sprays and nasal decongestants. They are very helpful for swelling due to minor allergies or irritation. Steroid sprays decrease inflammation in the nasal passages. Very little of the steroid is absorbed into the body from the nose so there are few side effects with these sprays. Nasal decongestants that shrink the blood vessels in the turbinates also can be used to improve snoring that results from nasal congestion.
These measures may also be helpful for people who only snore when they have upper respiratory infections or colds, which typically cause swelling of the airway passages.
CPAP or continuous positive airway pressure is a device that is commonly used in patients with a clinical diagnosis of obstructive sleep apnea. This device works by providing a constant, increased air pressure to prevent airway narrowing during inspiration and expiration. It entails wearing a mask that is connected by tubing to a pump that keeps the pressure of the inspired air at a higher than normal level.
This device has proven to cause subjective and objective improvement of snoring and other symptoms of obstructive sleep apnea. The air pressures are adjusted individually for each patient based on their parameters of a sleep study.
The main problem with CPAP is that it has to be worn to be effective. The machines are smaller and have enhanced features along with a wide variety of mask interfaces to improve comfort and compliance. Despite this, patient adherence to the use of CPAP often is not optimal.
Over-the-counter products for snoring
There are many other simple over the counter products available to help with snoring. Generally, they may not be scientifically studied and recommended. They may be useful in some people subjectively, but night to night variability in results has also been reported. Regardless, if snoring exists, then it needs to be fully evaluated by a physician to assure that there is no underlying potential medical condition and to choose a proven method of treatment.
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