Snoring Cures! Do you sound like a freight train at night? Snoring cures are the topic of this blog, following last week’s installment on Snoring Science. Be sure to read that blog for the danger signals that should cause you to immediately consult your doctor rather than attempting self-help.
The last section of today’s blog presents a strategy for successful treatment: you may wish to go directly to that section, because the details make this a pretty long blog.
As mentioned in the first installment, most snoring cures can be discovered by focusing on two places where most snores originate: the nose and the back of the throat. What we present here is a menu of the devices and techniques for snoring cures. Each individual will need one or several of these in combination, depending on his or her exact snoring condition.
When your nasal passages are narrowed or obstructed, two things can happen:
– The air you breathe rushes more rapidly through your nose, causing the tissues to vibrate and creating a snoring sound.
– If your nose is sufficiently obstructed, you will automatically open your mouth to get air, becoming the disgusting “mouth breather” of those annoying commercials. The passing air vibrates the tissues inside your mouth, and your open mouth forms a resonant chamber to amplify the resulting snoring.
If your snoring is caused by nasal obstruction, prepare for confusion. Hundreds of products are on the market: each one promises to be the perfect solution for your problem, and each has its passionate supporters and detractors. Here’s a brief description of the type of snoring cures aimed at nasal snoring:
Nasal Strips are springy flat strips that glue to the outside of your nostrils, pulling them wider to let through more air.
Caption: BreatheRight.com nasal strips
Breathe Right is heavily advertised but other brands also exist. Since the adhesive lasts for only one night (sometimes not even that long), you can easily spend $150 per year using this product.
Nose Vents, or Nasal Dilators, are appliances that clip onto the columella (columella nasi), the fleshy divider between your nostrils. They protrude into each nostril with a device to widen the nostril from within, typically with a tapered hollow tube.
Chin Straps may in a few cases be successful as snoring cures. The chin strap works for a person with just the right breathing situation: nasal air flow that is only slightly obstructed, not enough to cause a snoring sound in itself but enough to cause the sleeper to breathe through his mouth and snore from the sides and back of his throat.
Septoplasty is surgery that can correct obstructions that occur farther into the nose, out of the reach of nasal strips and dilators. If the partition that separates the left and right half of the nasal cavity is off-center (deviated septum), it not only obstructs breathing but can also aggravate sinus conditions. The surgery realigns the septum or opens a window in it to permit good air flow. If you snore more loudly when sleeping on one side than on the other, you may very well have a deviated (off-center) septum.
Of the above nose-related snoring cures, only septoplasty is expensive and permanent. All the other approaches are inexpensive enough that you can try several and see what may be effective for you. If you read the product reviews, you’ll see that what works for one person does not work for another. Among the regularly reported problems are: doesn’t stop my snoring; doesn’t fit me; had to modify it to fit properly; comes out and gets lost during the night; irritating; so uncomfortable I can’t sleep.
Tongue Snoring and Throat Snoring
The other common cause of snoring involves the tongue and the tissues surrounding the back of the mouth.
Most people breathe so quietly when they are awake that we do not pay attention to its sound. However, when we sleep our muscles relax, including those maintaining muscle tone inside the throat. Thus the normal air flow of the breath can cause loose tissues lining the mouth and throat to vibrate, creating snoring.
This vibration effect is usually made worse by a narrowing of the air passage. Loose skin may partially obstruct the airway. Even worse, if the relaxed tongue falls backwards it may partially or totally block the throat, precipitating obstructive sleep apnea (OSA), the serious condition mentioned in last week’s installment.
Nasal snoring can often be addressed on a do-it-yourself basis. However, tongue snoring and throat snoring are more difficult to control. In most cases you will want to consult a doctor to help you through the many choices of treatment. Nevertheless, many people suffering from this condition first try do-it-yourself snoring cures.
Here are the methods used for tongue and throat snoring cures:
Side Sleeping. Many people snore only when they are on their back, since in this position a relaxed tongue is more likely to block the throat. If you can contrive to sleep only on one or the other side, you may cure your snoring that way. Try to ensure that your nose is clear (use nasal spray or drops if necessary) and that your pillow is not so soft that you sink into it and block your nose.
How does one control their sleep position? Here are the time-honored techniques:
– Use a pillow that is designed to encourage side sleeping.
– Attach something to your back that keeps you from lying comfortably on it: classic candidates are walnuts in a pocket sewn to the back of your shirt; a couple of “wiffle” type baseballs or golf balls balls tied to the back of your shirt with sewn ribbons; or tennis balls in a tube sock pinned to your shirt back.
– Invite your bed partner to kick you when start snoring on your back, to force you to shift position. This gets pretty old for the partner, however.
Raised Upper Body. You can reduce the pull of gravity causing your tongue to fall backward by raising your upper body when sleeping. Some sources recommend elevating the head of your bed by four to six inches (10 to 15 cm). Others favor using a wedge pillow to elevate the upper body, keeping the spine straight from the waist up.
Caption: medslant.com wedge pillow
I personally find that a wedge pillow is a valuable ingredient in a snoring prevention strategy.
Weight Loss. If you lose weight, you will have less excess flesh inside your mouth and throat. That will open up the airway and also provide less loose stuff to vibrate in the air stream. Such snoring cures are quickly advised by sleep doctors for men with neck circumference 17 inches or more, and women with neck 16 inches or more.
Alcohol, Tranquilizers and Smoking. Alcohol and tranquilizers tend to relax your tongue and throat muscles, which can interfere with sleep as well as cause snoring. Alcohol can also disrupt sleep patterns, causing less restful sleep and in some cases more serious sleep disorders. You can help both your snoring and your quality of sleep if you can let three hours elapse after drinking before going to bed, and avoid taking medications that act as muscle relaxants. Smoking, in addition to its other unhealthful effects, also aggravates snoring because it irritates the airway and deposits ash in the lungs.
Surgery. Just as septoplasty is a surgical option to open up nasal breathing, there are surgical snoring treatments that can clear away obstructions in the mouth and throat. Of these, the most common is UPPP, a short abbreviation for a long name: uvulopalatopharyngoplasty. UPPP is a general term that may include removing parts of the uvula, the roof of the mouth and other excess tissue. The tongue is even a candidate for trimming in some cases. UPPP in itself rarely provides complete snoring cures or OSA correction, but in conjunction with other treatments may be helpful.
CPAP. As noted above, many snorers also have obstructive sleep apnea. If you are diagnosed with OSA, the automatic reaction of many physicians is to prescribe CPAP, which stands for continuous positive airway pressure. CPAP holds your airway open by providing you pressurized air to breathe. The amount of additional pressure is not large, typically 6 to 14 cm H2O, which equals about 1% of standard atmospheric pressure. CPAP machines are the most popular snoring cures for doctors because they are covered by almost all medical insurance, they are non-invasive, they eliminate OSA for many sufferers and, by the way, take little of the doctor’s time and thought.
CPAP is unfortunately a no-go for many people. It involves sleeping with a mask strapped to your face, connected by a tube to a pressure pump. You can’t help feeling like the Bride of Frankenstein being pumped up to wreak havoc upon the world. More to the point, some users experience sinus problems and nasal dryness; however, these can be alleviated by adding a CPAP humidifier. Another type of machine, BIPAP, is sometimes used and may be better tolerated by patients; it provides different pressure levels for inhalation and exhalation. CPAP intolerance is in fact a problem: a typical study shows poor compliance by CPAP patients; a third of them never start using the machine and of those who use it, a third abandon it within a few years.
Such a large number of OSA patients have either quit CPAP or refuse to use it that physicians have worked hard at finding other snoring cures and OSA therapies. The good news is that, although no single treatment is a one-size-fits-all silver bullet like CPAP, a combination of several modalities is as effective as CPAP for most people. The two dental appliances about to be discussed are a valuable component of such snoring cures. The bad news is that medical insurance is reluctant to grant coverage for such devices unless CPAP is simply out of the question.
Mandibular Advancement Splint (MAS). This is a long name for a dental fixture (splint) that moves your jaw (mandible) forward (advancement). Its principle of operation is that by moving the jaw forward, the base of the tongue moves away from the back of the throat, helping to keep the throat open if the tongue slumps backward.
Many do-it-yourself MAS devices are available, ranging in price from $40 to over $250: you can Google “snoring mouthpiece” or consult a comparative product review. Most are of the “boil and bite” design – you plunge the appliance into hot water, which softens its plastic, then bite down on it to mold it to your teeth.
Originally, appliances of this type effectively welded your jaw together when inserted. Some of them still do, and are uncomfortable for most people! However, better-designed devices today allow you to open your mouth and move your jaw, permitting yawning, speaking, drinking and (if you wish) breathing through your mouth.
Some such appliances also permit you to adjust the amount of jaw offset. This is a desirable feature because you want just the right positioning of the jaw: too much offset is painful and can cause TMJ problems, yet too little an offset will not open the throat sufficiently to allow easy breathing. My dentist (Dr. Robyn Mullinger, whom I enthusiastically recommend) advises me that the amount of jaw advancement typically used is no more than 5 millimeters, that is, two-tenths of an inch.
User reviews reveal that people find it difficult to mold the do-it-yourself devices to the mouth, sometimes having to boil and bite several times to achieve the right fit. I personally prefer an appliance that is fitted and overseen by a dentist, to ensure a perfect fit and the best adjustment for one’s particular needs. However, they are expensive, and may not be covered by your insurance. I understand that such devices cost about $1500 today.
Caption: MAS using Herbst-style hinge (smlglobal.com)
Note that some people simply can’t sleep with any kind of device in their mouth. I have a friend who was prescribed a simple bite guard to prevent tooth wear due to bruxism (grinding). She would wake up in the morning to discover that some time during the night she had removed the device and thrown it across the room. Since some of these appliances are fragile, they would have a very short service life in the custody of such a sleeper.
Tongue Stabilization. Rather than moving the jaw forward, there are devices for snoring cures that work by holding the tongue in place so that it can’t fall backward. These devices are anchored to the teeth and traditionally have required fitting by a dentist; examples are
Full Breath Solution, OASYS and SnörEx. One newer product allows do-it-yourself fitting: the Zyppah, which is heavily advertised, consists of a MAS boil-and-bite appliance with an added elastic band that presses down on the tongue. There is also a dentist-fitted “professional” version.
A New Zealand sleep specialist, Dr. Chris Robertson, invented an alternative that does not require fitting to the individual. It’s a molded silicone appliance that sits in front of and just inside the lips. You squeeze a bulb to create suction that holds the end of your tongue in place.
Caption: aveoTSD anti-snoring device (getaveo.com)
This invention is protected by US patent #7,073,5069 and is sold in the US and Canada as the aveoTSD, whose initials stand for Tongue Stabilization Device. It sells for approximately $150 – over the counter in Canada, by prescription in the US. I have seen what appears to be an identical device from an online supplier based who-knows-where for only $65, and there are similar-but-not-quite-identical knockoffs as well. One Chinese version that I saw appeared to infringe on the Robertson patent and so far as I could tell, its material was not of medical quality.
Since the aveoTSD is not fitted to the individual, it’s not surprising that some users find that it slips out during the night. You need to adjust the suction strongly enough to stay in place, but not so strongly that you wake up with a sore or stretched-feeling tongue. Thus like all the other snoring cures, it is appropriate for some snorers but not others.
Snoring Cures: A Strategy for Success
We can pull together the information in last week’s blog and this week’s to provide a step-by-step approach for success in finding snoring cures. I will present these as if you are the snorer, although that may not be the case in your family. Note that if you don’t have a sleeping partner to inform you, there are smartphone apps that can monitor your snoring and provide you feedback.
Here are the steps to follow:
– Rule Out OSA. First, check the Mayo Clinic screen in last week’s blog, which can help identify the 20% of snorers who suffer from Obstructive Sleep Apnea and need to consult a physician.
– Nose or Throat? Next, try to determine whether your nose, or tongue and throat, is the biggest source of the snoring problem. If Side Sleeping and Raised Upper Body, as discussed above, reduce the loudness and frequency of snoring, the main culprits are probably the tongue and throat. In fact, if these approaches completely cure your snoring, you have completed your quest! If these have no effect on your snoring, suspect the nose of being the principal cause.
– Nose Snorers: Chin Strap. If you only snore when your mouth is open, a chin strap may provide the solution. You can rig up a test with a long piece of Velcro tape material; if that stops the snoring and seems tolerable when sleeping, then invest in a commercial chin strap that will be more comfortable.
– Nose Snorers: Opening the Nose. If the chin strap doesn’t work, the next thing to try is opening the nose. Read the reviews for nasal strips and nose vents and choose an approach to try. Just bear in mind that if you wind up adopting nasal strips, they will cost you considerably more money over the long haul. Give your chosen approach a few nights to adjust to it. If you can sleep with the device, see whether it works and if not, try another one instead. If nothing works or if you can’t tolerate the annoyance, rule this out as an approach.
– Nose Snorers: When All Else Fails. If these inexpensive devices don’t cure your snoring, you need professional expertise. Your family doctor may help, or may recommend that you see an otolaryngologist (ENT, or ear-nose-throat doctor). The doctor will study your nose and try to discover what is obstructing your breathing in that area. The resulting diagnosis may lead you to consider septoplasty surgery, or to try more vigorously to find a nasal dilator that will do the trick for you.
– Throat Snorers: Weight, Alcohol and Tranqs. If you diagnose yourself as a throat snorer but side sleeping and head elevation do not cure your snoring, you should next consider whether any of these factors apply. If you are overweight, snoring is only one of many reasons it would be good to cut back. Alcohol and tranquilizers mainly affect sleep when taken within three hours of bedtime, although moderation is a good idea at any time.
– Throat Snorers: The Decision To Seek Help. If the above approaches do not cure your throat snoring, you should seriously considering getting medical help. Your family doctor may refer you to a specialist or to a sleep disorder center (“sleep lab”); the latter are often affiliated with hospitals. If you are reluctant to call in the big guns yet, there are a number of mandibular advancement and tongue stabilization devices on the market that you can try. However, they are more expensive than the nasal snoring aids, and you may need expert assistance to find a combination that is fully effective for you. Another benefit of consulting a sleep professional is you may be able to try CPAP (and/or BIPAP), which is the closest thing to a total snoring cure that exists.
– Multiple Solutions May Be Needed. If you find a sleeping style or device that reduces but does not eliminate snoring, use it; then find something to add that improves the cure.
– A Tip and a Caution. Some reviewers report that they need to alternate between using two different anti-snoring devices; each device is effective, but becomes uncomfortable when used every night. Moreover, since sleep problems tend to increase with age, snoring cures that stop you from snoring this year may be ineffective a year or two from now. Snoring cures are a journey, not a destination.
I believe that this sequence is the most practical way to find snoring cures for each individual situation. I invite feedback from readers who can improve on anything in this article.
Snoring cures are readily available for everyone to try. I welcome your comments if you have tried any of the approaches described here, whether or not you found them to be successful.
– Headline drawing adapted from Closed Eyed Man by GDJ and Steam Locomotive 3 by IggyOblomov, both on openclipart.org
– CPAP machine drawing courtesy of user PruebasBMA on Wikipedia.org
– Other images are Iframed from the website indicated in the accompanying caption