Snoring and its Treatment (or How Can I Sleep without Sounding Like a Freight Train!?!)

You snore. No, you really snore – like the-neighbor-down-the-block-complains snoring; like your-wife-moved-to-the-next-county-to–get-a-good-night’s-sleep snoring. Even your dog won’t sleep in the same room with you. They are all mad because you wake up refreshed, when they lose sleep because YOU SOUND LIKE A TRUCK! What is a person to do?

You’ve tried online remedies (those throat sprays really don’t work for you, anyway). No matter how hard you try you keep rolling over onto your back. Nasal strips either fall off or rip up your skin. Treating your allergies didn’t seem to help either. You’ve even considered losing weight (but let’s be honest, that takes work!) No matter what you try, nothing seems to do the trick. And, even though you seem to sleep soundly despite the noise, those you love can’t get a decent night’s sleep without moving to another zip code.

What is Snoring?

Most often, that horrible noise you make comes from the back of your throat. As you fall asleep your muscles relax, including those in the tongue and palate. Your breathing rattles them around, and nasal congestion compounds the problem.

So, what can you do that really makes a difference? How can you get your partner back in bed? A serious cure for your serious snoring problem will likely require a trip to the doctor.

The Medical Approach to Snoring

Snoring often is a “them” problem. You sleep just fine, they can’t. But snoring can also indicate a much more serious condition – Obstructive Sleep Apnea (OSA) – which is a “them” and a “you” problem.

OSA is a common and under-diagnosed medical condition. “Apnea” means that your throat collapses so much while you are asleep that you periodically stop breathing. Not breathing is bad, as you’d probably guess. If OSA goes untreated it can lead to significant health implications – the list includes increased risk of heart attack, stroke, heart failure, blood pressure problems, and heart rhythm issues. It also disrupts your sleep, even though you may not even be aware of this. Chronic sleepiness due to OSA can be a factor in decreased productivity, bad moods that can wreck relationships, and drowsy driving, which is just as dangerous as drunk driving. Heavy snoring can lead to heavy stuff. Your doctor might recommend an overnight sleep study to help determine if OSA is a problem for you.

If you and your doctor conclude that OSA is not your issue, you can safely focus on sleeping more quietly. And, there are a lot of different tactics to treat snoring.

Medical approaches to snoring focus on nasal congestion and the floppy tissues at the back of the throat. An examination by your doc or a sleep specialist will look for the following:

  • Nasal structural blockage (septal deviation, turbinate enlargement)
  • Signs of nasal inflammation (allergic or otherwise) and congestion
  • Enlarged uvula and/or an excessively long and saggy soft palate
  • Enlarged tonsils
  • Large tongue

If the exam reveals any of these problems, or some combination of them, your doctor will help create a game plan to fix what can be fixed.

Side note: Typically, insurance will NOT pay for your snoring treatment. Perhaps the insurance industry doesn’t acknowledge “disruption of marital bliss” as a coverable condition. This means that most all of the devices and surgical procedures described below will require out of pocket expense, performed for the purpose of quieting your nighttime racket.

Non-Surgical Snoring Treatments

Medical Treatment of Nasal Congestion

Over-the-counter remedies for allergic and non-allergic nasal inflammation can make treatment very easy. Nasal steroid sprays are a frequent choice for their direct, effective action in the nose. OTC antihistamines also work very well.

Prescription medicines, like topical nasal antihistamines and oral anti-allergy drugs can be added to the mix.

Oral Appliances

The MAD (or Mandibular Advancement Device) is most often, and most successfully (versus OTC/online devices), prescribed and fitted by a dentist with experience and expertise in snoring and sleep. These devices consist of an upper and lower mouthpiece connected by a crank. The lower jaw is pulled forward relative to the upper teeth. As it moves forward so comes the tongue and soft palate – opening the back of the throat and relieving snoring (and even sleep apnea in some patients). Potential drawbacks include dry mouth, drooling, and problems with the temporomandibular joint (TMJ). Some people complain that the mouthpiece irritates their tongue. Also, while effective, your pricey MAD will need to be worn nightly.

CPAP (Continuous Positive Airway Pressure)

This is frequently the treatment of choice for OSA. There also is a non-prescription CPAP device that treats only snoring. CPAP provides constant airflow at pressure to gently push air past those collapsible tissues at the back of the throat. One drawback is that adjusting to wearing a face mask at night can be difficult. Also, nasal congestion can make it less effective. There are many people who just can’t get to sleep wearing it. And, CPAP must also be worn nightly to be useful.

Surgical Procedures for Snoring

Obviously riskier and more aggressive, but sometimes (based on their doctor’s best advice) a person has to do what a person has to do!

Surgical Treatment for Nasal Congestion

Improving the nasal airway improves the ease with which air flows in through the nose. The easier it flows in the less your throat collapses and the less noise you make; it is as simple as that. Of course with surgery comes risk (bleeding, infections, and continued nasal congestion because the procedure didn’t work.) Fortunately these are very low risk procedures. There are 3 sites where improvement can be made.

  1. Nasal Septum – the interior dividing wall separating one side of the nose from the other is called the septum. If it is crooked or deviated enough to block airflow a surgical procedure to straighten it (Septoplasty) under general anesthesia may help relieve snoring.
  2. Turbinates – these are normal structures that protrude into the nasal airway from the sidewalls. If they are enlarged there are a variety of in-office or Operating Room surgeries to reduce their size and improve airflow.
  3. Nasal Valve – the valve is the narrow section of the airway from the flare of your nostril to roughly beneath the bridge of your nose. Nasal valve collapse means that when you forcibly inhale the sides of your nose collapse inward. A weak nasal valve can be stiffened surgically, although to date there are no uniformly effective treatments for this problem. Research is ongoing to find an effective answer.

Palatal Stiffening Procedures

These approaches, most of them performed in the office without general anesthesia or sedation, attempt to quiet snoring by stiffening floppy tissues of the palate. There are few downsides to these procedures. Risks are low with the most common being that your snoring doesn’t cease.

  1. Uvulectomy – yes, just lop off the uvula! Effective but painful with a minor risk of bleeding. Occasionally the pronunciation of certain sounds is affected too.
  2. LAUP (pronounced like the basketball move “lay-up.”) is a fairly invasive procedure that uses a laser to cut the palate on either side of the uvula. When the wounds heal they shrink and the scars stiffen, with the goal that snoring stops.
  3. Palatal implants – little bits of woven polyester (cue the disco music please) are tunneled into the mid part of the palate. Believe it or not your body doesn’t like that material in there and reacts with lots of scarring. This stiffens the palate and decreases the vibration that causes snoring.
  4. Injection Snoreplasty is fairly self-explanatory. A substance like alcohol (unfortunately not a nice single malt Scotch) is injected to scar, shorten, and stiffen the palate.

Despite what magazine ads may say, none of the snoring treatments described above are always completely effective as stand-alone therapies. All tend to decrease snoring for most people to some degree, but the degree and duration of relief is variable. And you can’t predict success until you use the device or have the procedure. Often a combined approach (like improving nasal congestion and stiffening the palate) offers you the best chance to sleep with someone by your side again.

Desperate times sometimes call for desperate measures. Friends, take what steps you need to preserve your health and keep peace in your household. Whatever the outcome, you can hope your bed partner will at least appreciate the effort!

About The Author: Mark T. Brown, MD, MBA is the author of the book Smarter Sleep: Real Answers, Science-Based Solutions, Healthier Sleep. He is the founder of Great Hills ENT and Sleep Lab, in Austin, Texas.

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