Brits who snore wake-up alone, despite going to bed as a couple… (new free help)

Brits who snore wake-up alone, despite going to bed as a couple… (new free help)

Snorer.com
Rated 5/5 based on 16 customer reviews

Do you wake-up alone?

You know when you have a snoring problem when you go to bed as a couple, yet wake-up alone.

Your throat is sore, perhaps you have a headache and no matter how long you spend in bed, you’re still dog-tired.

And, to make things so much better (!), your partner is grumpy and blames you for their poor sleep because you kept them awake… and they ‘had’ to sleep on the couch or in the spare room.

I’m a sleep-industry insider with a quarter of century of sleep medicine experience.

Adrian Zacher MBA

Snoring & Sleep Apnoea Care Navigator, Snorer.com

Snoring seems to have somehow created this relationship problem ‘out of thin air’. You might well feel lonely, irritated, hard-done-by even…

Help is at hand. And no this isn’t a sales push for some ‘cure all’ from the pharmacy… 

British Snoring Statistics

Statistics mean very little when the problem is 100% a reality in your home. The stats tell us that an estimated 45%1 of adults snore. Which is essentially half of us!

It’s NOT funny. Not funny at all. Put aside the relationship issues (and yes divorce rates where snoring is cited…), snoring may be a symptom of a serious health problem.

Read on…

Health Consequences from Snoring?

Seriously? 

Well, apart from the risk of being murdered by your long-suffering, sleep-deprived partner 😉
[ Joke! – well at least you hope so! ]

Yes, there really are serious health risks. Snoring may well be your body noisily telling you something isn’t quite right when you breathe during sleep.  

Heard of sleep apnoea?

Snoring is a major symptom of obstructive sleep apnoea. Along with excessive sleepiness, frequent need to pee in the night, morning headache, impotence (uh oh) and irritability.

Do NOT assume snoring is ‘just’ a noisy, night-time nuisance and then go on to ‘diagnose’ it and buy a ‘cure’ from credible sounding outfits. Dodgy British (and American) snoring cures, fixes and potions are aplenty.

They make a good living separating fools from their money. Snoring ‘cures’ has to be one of the oldest scams out there!

Instead, get signposted to find out what you need to stop snoring. You will also be screened for obstructive sleep apnoea.

Oh and it’s free:

Fake cure-all for snoring

Get signposted to stop snoring

Find out if a prescription anti-snoring device could help you stop snoring or if you should see your GP

Reference

1. Olson L G, King M T, Hensley M J, Saunders N A. (1995) A community study of snoring and sleep-disordered breathing. Prevalence. American Journal of Respiratory Critical Care Medicine, 152: 711-716.

© eeZed Ltd / snorer.me 2019. All rights reserved. Created by Adrian Zacher | Page last updated 7th May 2019 | CE markSnorer.me signposting is CE marked, clinical decision support system, software as a medical device. Manufacturer is Snorer.com, 2 Baynards Green Farm Cottage, Baynards Green, Bicester, Oxfordshire, OX27 7SG, UK.

Chin straps for Snoring: Safe, Effective or Dangerous? (Sleep-expert Review 2019)

Chin straps for Snoring: Safe, Effective or Dangerous? (Sleep-expert Review 2019)

Snorer.com
Rated 5/5 based on 16 customer reviews

So your mouth opens and you snore when you fall asleep…

If during the night, when you fall asleep your mouth opens and you start snoring, then it’s easy (but perhaps mistaken) to think a chin strap to stop it doing so, would be a simple solution.

So, if you’re wondering:

Do chin straps work? Are they safe and effective?

Then read this independent sleep-industry expert (no affiliate links!) review. 

Adrian Zacher MBA

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach UK dentists how to help their patients stop snoring; sleep and breathe at the same time.

Many of my customers find their work so rewarding they devote their practice to it. I’m a sleep-industry insider with a quarter of a century of sleep medicine experience.

Google Scholar

When it's time to stop:

Get signposted (free) to the right professional. Saving you time and helping to alleviate pressure on GP practices

Snoring and mouth-opening: The case for a chin strap

As you breathe IN (inhale) the soft tissue in your throat and sometimes nose, together with your uvula (the dangly bit hanging from the roof of your mouth) may vibrate as the air passes.

This makes the snoring noise

If your mouth is closed while you sleep (sounds positive for the chin strap -- for a moment) then assuming you can… your breathing has to occur through your nose, which is what your nose is designed for.

Sounds good in principle…

And if you Google “chin straps for snoring” you will see there are plenty to choose from. With lovely colours, different length straps and sizes etc. etc.

But almost all cup your chin and have straps that go around the back of your head.

So its a reasonable question to ask:

Do chin straps make snoring better or worse?

 

Do chin straps make snoring better or worse?

When your airway gets narrower the air you breathe must travel faster. As the air speeds up, it makes floppy tissue in your airway vibrate and this makes the snoring noise.

If you sleep on your back

The problem is not that your mouth falls open, its because as your mouth opens your jaw moves backwards, which allows your tongue to reduce the size of the airway in your throat.

A chin strap exaggerates this backwards movement of your jaw, making your airway smaller and your snoring worse.

It’s now commonplace to see news articles where couples inflict various stop snoring gadgets upon each other, including perhaps a pillow and a chin strap (sometimes called a ‘jaw strap’).

Here’s a quote from currently the second most popular UK newspaper:

Even less successful is the [name removed] jaw strap….. a good solid snore resonating from her throat.

 

What happens in your throat when you use a chinstrap?

The diagram below (used with permission from Elsevier Press1) and taken from our FREE How to choose a Mouthpiece Guide illustrates the negative consequence of this backward jaw movement, created by gravity and aggravated by a chinstrap.

Three airway examples: normal, with apnea (created through use of a chinstrap), restored.

On the far left the airway is normal and open.

Breathing occurs freely and quietly.

The middle picture shows how the jaw and tongue have moved backwards and no breathing is possible.

This is technically known as ‘mandibular retrusion’ and it is not safe. It is dangerous.

The third diagram on the right illustrates how a ‘Mouthpiece’ protrudes the jaw and helps the individual sleep and breathe at the same time.

More about them later in this post.

How does jaw position relate to snoring?

This brief video will will show you how jaw position relates to snoring. Click bottom right of the video to expand it full-screen.


Video length = 26 seconds

chin straps and airway volume

The X-ray images on the left have red highlighted areas, that indicate the size of the airway behind the tongue.

The right-hand one illustrates how airway volume increases with protrusion

A chinstrap moves your jaw the wrong way.

 

What does the clinical research say about chin straps?

Since I first published this post (2017) I have seen some vendors of chin straps misquote a case study2 (which means ONE patient) to make out that clinical research proves chin straps are a valid option for snoring and obstructive sleep apnoea (OSA).

Which is not the case at all

The key things to know about chin straps are:

  1. Clinical research has proved chin straps are not effective for snoring
  2. If you use Positive Airway Pressure therapy for sleep apnoea / apnea then a chin strap may help avoid mouth leak

Since the case study (2007) found one patient experienced an improvement with a chin strap, Bhat, et al,3 (2014) established chin straps had no place in treating sleep-disordered breathing and snoring. Indeed the original case study authors also published a paper4 (2014) trying to clear things up:

We learned that entrepreneurs were advertising high priced (to our mind) chin straps for treatment of snoring and OSAS, and that information from our case report was used to bolster claims of chin strap effectiveness.

They continued:

The lead author spent considerable time answering emails and phone calls to state unequivocally that we at Eastern Virginia Medical School Sleep Medicine did not support the use of the chin strap for the treatment of OSAS, and that more investigation was warranted.

Here’s the pertinent extract:

We thus applaud Bhat et al. for their work in investigating the potential utility of the chin strap for treatment of snoring and OSAS.

They demonstrated that the chin strap appears to be an ineffective treatment for a typical apnea population.

Which means that chin straps for snoring are not safe nor effective, and they also delay diagnosis and effective treatment.

For the sake of a balanced argument, in the next paragraph I will explain how some patients using Positive Airway Pressure (PAP) therapy for obstructive sleep apnoea (OSA) may find certain chin straps have a role.

A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring.
Bhat, S, et al, 2014. Journal of Clinical Sleep Medicine

The Efficacy of a Chinstrap in Treating Sleep Disordered Breathing and Snoring (2014)

Good to know:

Snorer.com is independent. We don’t sell anti-snoring devices, chin straps or whatever! And we don’t benefit from affiliate deals.

I use Positive Airway Pressure (PAP):  Will a chin strap help with mouth leak?

A chin strap may help if you use a nasal mask and air is escaping from your mouth5.

However, the real solution if you use PAP and have mouth leak, is a full face mask.

Grab our freeHow to Choose Positive Airway Pressure (PAP) Guide‘ to learn more.

I would add, that if you’re fixed on buying a chin strap, then find one that is designed to just close the mouth and NOT pull your lower jaw backwards

The big PAP companies sell these: look for Philips Respironics. (No I’m not on commission and no, I do not have, or want, an affiliate link! Thank you).

How to choose PAP - and whether a chinstrap helps
Don't buy a chinstrap if you want to stop snoring!

When snoring is a problem…

You can’t ‘fix’ something if you don’t know what is wrong.

Grab our completely free Overview of Snoring and Sleep Apnoea Guide and then get signposted (for free) to the most appropriate professional to help you.

What about Mouthpieces?

I mentioned ‘protrusion‘ earlier and this is what a ‘mouthpiece’ technically known as a mandibular (jaw) advancement device (MAD) does.

There are two basic groups. They work by holding your jaw more forwards and this opens your airway behind your tongue.

The first group you can buy in shops and on-line, the second group of MAD is custom-made exclusively for you by a dentist with a special interest in sleep apnoea. Be careful not to confuse custom-made with customised (customised means a ‘gumshield’ adapted or customised to you).

But this is not a definitive guide to choosing a dental device (Mandibular Advancement Device -- MAD) to stop snoring. This is.

chinstrap or dental device for snoring?

What about Surgery?

Although surgeries are rarely performed, surgical approaches have been largely confined to:

  • Reduction of the soft palate and uvula (dangly bit at the back of the mouth)
  • Removal of nasal polyps (‘lumps’ inside your nasal airway)
  • Septum straightening (correcting a crooked nose)
  • Advancing the upper and lower jaws which advances the soft palate and tongue, opening up the airway, known as an MMA (MMA = Maxilla (upper jaw) Mandible (lower jaw)

If you want to know more about safe and effective ways to stop snoring and treat obstructive sleep apnoea/apnea, then grab our free, evidence-based Information Guide:

Things to discuss when considering surgery for snoring and obstructive sleep apnoea

What about surgery for snoring?

Summary

Chin straps do not stop snoring and may well be dangerous. 

I implore you NOT to waste your money, harm yourself, your loved one or I pray your children.

Chin straps have been clinically proven to be neither safe nor effective.

And they could mask symptoms of obstructive sleep apnoea / apnea (OSA) and/or delay your eventual OSA diagnosis and effective treatment.

OSA if left untreated may:

  • Reduce your life expectancy
  • Increase your risk of stroke
  • Increase your risk of a fatal heart attack
  • Predispose you to type II diabetes, depression, impotence and driving or work place accidents to name but a few!

Thanks for reading. Now share this with your long suffering friends. (If you dare!) or let me know what you think by entering a quick comment below. I read every one.

Created by Adrian Zacher. Last updated 27th Dec 2019.

Related reviews

Here are some more independent reviews and guides about snoring and sleep apnoea / apnea, ‘cures’, assessment, diagnosis and treatments.

Glossary

Airway Volume The volume is the amount of space that a exists in your throat to breathe through.
Information Standard NHS England’s Information Standard. Organisations that join The Information Standard are showing their commitment to producing good quality health and care information.
MAD Mandibular Advancement Device Jaw advancing device, worn at night while asleep to hold forward the lower jaw to stop snoring and prevent obstructive sleep apnoea / apnea.
Mandibular Retrusion Backwards movement of your jaw
MMA Surgery to move both jaws. MMA = Maxilla (upper jaw) Mandible (lower jaw).
OSA Obstructive Sleep Apnoea When an individual is unable to sleep and breathe at the same time. Visually, a repetitive pattern of breathing interruptions (apnoeas) occurring while the individual sleeps, due to a physical obstruction in the airway. Apnoea is spelt Apnea in the US.
Palate Roof of your mouth.
Polyps Refers to nasal polyps in this Guide. These are ‘lumps’ inside your nasal airway.
Protrusion Forwards movement of your jaw.
Septum is the tissue that separates the left and right airways in the nose, dividing the two nostrils.
Sleep-trained Dentist A dentist that has undergone special interest training in sleep. As such they are able to obtain professional indemnity insurance.
Soft-palate Soft tissue behind your palate (roof of your mouth).
Uvula ‘Dangly’ bit at the back of the mouth.

References

1. Sleep-disordered Breathing, Adrian Zacher & Michael McDevitt, Carranza’s Clinical Periodontology -- E-Book: Expert Consult: Online, Elsevier Health Sciences, 2017. Accessible here: https://www.elsevier.com/books/carranzas-clinical-periodontology/newman/978-0-323-18824-1 new window [accessed 24th May 2018]

2. Vorona RD, Ware JC, Sinacori JT, Ford ML, Cross JP. Treatment of severe obstructive sleep apnea syndrome with a chin strap. J Clin Sleep Med. 2007;3:729–30.

3. The Efficacy of a Chinstrap in Treating Sleep Disordered Breathing and Snoring, Bhat, S, et al, 2014, Journal of Clinical Sleep Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106943/ new window [accessed 24th May 2018]

4. Vorona RD, Ware JC. Use of a chin strap in treating sleep-disordered breathing and snoring. J Clin Sleep Med. 2014;10(12):1361. Published 2014 Dec 15. doi:10.5664/jcsm.4304 Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237533/new window [accessed 4th Nov 2018]

5. Mouth closing device (chinstrap) reduces mouth leak during nasal CPAP. Bachour, Adel et al. 2004, Sleep Medicine, Volume 5, Issue 3, 261 -- 267 https://doi.org/10.1016/j.sleep.2003.11.004 new window [accessed 24th May 2018]

 

Reviews

Found this useful? Write a review and let us, and others know what you think.

Sylvia
Explanation of subject
May 26, 2018
    

I found this document clear, understandable with no jargon and recommend the advice given to any sufferers.

Dental Gadgets for Snoring: 9 Crazy Claims Sleep-expert Reviewed (2019)

Dental Gadgets for Snoring: 9 Crazy Claims Sleep-expert Reviewed (2019)

Snorer.com
Rated 5/5 based on 16 customer reviews

Dental devices for snoring: available without prescription

Wow! Over-the-counter (OTC) dental devices sound great! 

So, I’m going to show you everything you need to know about their claims.

Researched over 4 years, this comprehensive review, also looks at the regulatory framework governing the device manufacturers.

Do they stop snoring? Are they easy to self-fit?

What else should you know?

Let’s find out…

Adrian Zacher MBA

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach UK dentists how to help their patients stop snoring; sleep and breathe at the same time.

Many of my customers find their work so rewarding they devote their practice to it. I’m a sleep-industry insider with a quarter of a century of sleep medicine experience.

Google Scholar

Tired of the sleepiness and the snoring?

Then read our free, definitive step-by-step how to stop snoring Guide.

This comprehensive Guide walks you through self-help, signposting, screening, professional assessment and diagnosis, the three categories of prescription treatment, follow-up and rounds off with a substantial FAQ.

Claim 1 – OTC dental devices stop your snoring

After all, that’s what you buy them for…

Verdict: Do OTC dental devices stop your snoring?

Sadly, these gadgets do not always stop snoring. But don’t take my word for it, the BBC, when covering a ‘Which?’ report1 (the UK’s consumer champion) noted, that claims made for their success were an ‘exaggeration’.

Indeed, the BBC report had a callout box stating, “Many snoring products simply don’t live up to their claims”.

in other words… “they don’t work”.

Hmm… It seems lots of OTC dental devices are sold, and the Which? report is a bit old (2001), so could the Beeb and Which? have looked at the wrong devices?

Let’s continue…

Many snoring products simply don’t live up to their claims

Emma Copeland,
Health Which?

stop OTC devices don't work

Claim 2
Does what the expensive ones do

You might think:

I will try this (OTC device) and if it works, then I’ll get a custom one”?

Which on the face of it, seems reasonable…

Verdict – Are they the same as the expensive ones?
Clinical research2 has shown that OTC dental devices bear little resemblance to custom-made ones.

But it’s harmless right?

No.

If you fail with an OTC dental device for snoring, you may also think a custom-made anti-snoring device won’t work, which is known as a ‘false negative’.

This ‘false negative’ delays people getting valid help. Which for the snorer with undiagnosed sleep apnoea, who has tried and failed with an OTC dental device for snoring, is a potentially life-and-death issue.

They may kill themselves (and others) should they fall asleep in unsuitable circumstances

When it's time to stop:

Get signposted (free) to the right professional. Saving you time and helping to alleviate pressure on GP practices

OTC beaten up

Claim 3 – OTC dental devices for snoring are cheap

Over-the-Counter, dental devices for snoring range in cost from approx. £50 – £200 GBP. But remember you’re bypassing medical assessment and diagnosis, and then bypassing the dentist.

DIY appears to save money, but….

 

What are the risks of bypassing Dentists?

Verdict - Are OTC dental devices for snoring actually 'cheap'?
Moving past the medical risks of self-diagnosis for a moment…. which we’ll come to in Claim 5.

Dentists are experts in mouths, teeth and jaw-joints. Bypass them and self-fit your OTC dental devices for snoring and you’re asking for trouble.

Always a pleasure, having failed at DIY, to then ask an expert to clear up after you…

What does the sleep-trained dentist do?
From a dental perspective, if you use an OTC dental device for your snoring you’re ‘going it alone’. The sleep-trained dentist would monitor your teeth for what is known as ‘uncontrolled orthodontic tooth movement’. Which means your teeth tilting in various undesired ways. This could result in a change to how the teeth in your upper and lower jaws bite together (creating what is known as a malocclusion).

That same sleep-trained dentist would also monitor your gums (periodontal condition) and jaw-joints. They wouldn’t prescribe a custom-made, dental device until they were sure it wasn’t going to harm you.

And, if they felt it necessary they would take X-rays to ensure your roots could withstand the lateral loads the device creates – and they carry professional indemnity insurance should anything go wrong…

While perspective is needed when considering tooth movement and breathing, a dentist and a custom-made, prescribed anti-snoring device can limit and control things.

OTC dental devices for snoring ultimately cost you more money and cause you pain
MONEY – perhaps much more than you would spend on a prescription alternative to correct jaw pain, dental and periodontal issues (assuming you don’t lose your teeth or any existing crown & bridge work aka ‘caps’).

PAIN both short-term and perhaps permanent, chronic pain:

SHORT-TERM PAIN if you’re lucky, short-term pain from overloading individual teeth (typically the upper front incisors). This is short-term if you stop wearing the device, resume snoring, ‘put it down to experience’

PERMANENT (CHRONIC) JAW PAIN from an imposed incorrect ‘bite’ (when you close your teeth together). Jaw pain is known as temporo-mandibular joint dysfunction (TMD). It may be caused by devices that don’t close together evenly (known as a ‘premature posterior contact’) or devices that force your jaw to move beyond its limits.

Risky Business
Having tried to wear the OTC device a few nights and found yourself dribbling profusely when it’s in your mouth, experiencing tooth ache and jaw-ache in the morning…. you might now think to return it for a refund.

Nope. You’re unlikely to be successful with any claim on the promoted ‘Money-back guarantee’, because the device is now ‘used’. Gotcha!

Permanent pain and occlusal change

So, OTC anti-snoring devices have other costs, even if financially they at first appear ‘cheap’. They may cause you permanent, chronic pain and occlusal change (which means how your teeth ‘bite’ together).

In 2014, an eminent British dental expert, Dr R.J. Wassell, published in the British Dental Journal4 about ‘Over-the-Counter’ devices (he focused on devices for people who grind their teeth – ‘bruxists’). This is relevant, because he notes OTC devices sold online (and he includes those for snoring and sleep apnoea) are purchased by individuals as a possible alternative to manage their condition, without the need for a dental or medical consultation.

He notes safety information on many internet sites was “notable for its paucity” or was totally lacking.  He points out that manufacturers are not obliged to provide safety information online, but it must be provided with the product and observes that the MAUDE adverse events database5, maintained by the FDA, “showed a number of potentially serious adverse events associated with these splints including choking hazards, tissue damage and occlusal changes”.

Dr Wassell advised the GDC about the OTC device market in 2014. What are we to conclude from their apparent inaction, some 4 years on?

Claim 4 – Easy to self-fit

If you go around professional assessment, ‘treat’ yourself with an OTC gadget and amazingly no longer snore (which is unlikely) you might assume you’re fine.

Are you?

Verdict - Are you OK and are they easy to self-fit?
You should be screened for sleep apnoea before using any dental device for snoring (see Claim 5) and we looked at why going the DIY route (cutting out the dentist) is a bit dumb in Claim 3. However, for the sake of argument, let’s explore this ‘Easy to Self-Fit’ claim.

IF you read the instructions, you’ll learn you must heat up each part and – while its hot – ‘squidge’ (for want of a better word) the device onto your teeth.

Repeat this for the other jaw.

OK, not so bad you might think. But it gets worse…

For some devices, you must do both jaws AT THE SAME TIME and ensure both parts correctly line up. Or it won’t work and you can’t get your money back. Oh don’t forget to make sure it clicks comfortably into place or…

It won’t work.

If the pieces don’t line up – it won’t work – you will have to heat it up again, reform the material and try again. Assuming of course, that the material can withstand another heat cycle…

Try now to claim on the ‘Money-Back Guarantee’. Hah! Good luck with that!

But of course, this is exactly what the OTC dental device for snoring manufacturer wants. They’ve had your money after all – and there’s no comeback on them, if you give up. Regardless of whether it doesn’t work or causes you problems.

All the above assumes you fit the device – i.e. the shape of your mouth and the alignment of your jaws suit the device. Which is totally backwards, it would be like the shops only selling underpants in one or two sizes…

Ouch.

Anti-snoring devices, exist at the point where medicine and dentistry meet

Both are essential

pants

Claim 5 – Quick Fix – No need to wait

Anti-snoring devices, exist at the point where medicine and dentistry meet.

I’ve highlighted the importance of the dental role.

But is a medical assessment essential?

Verdict - Is it a 'quick fix'?
Medical assessment (screening for sleep apnoea at a minimum) for your breathing is a no-brainer. Subsequent dental assessment (should anti-snoring devices be the proposed option), is necessary because the anti-snoring device used to help you breathe, is in your mouth.

Cutting out either professional is, shall we say, ‘foolish’? Bypassing assessment and/or prescription (going the DIY route), is risky because the snorer may have undiagnosed, and therefore untreated, sleep apnoea/apnea.

Claim 6 – Adjustable in protrusion

(How much they push your chin forwards)

Some, but not all, OTC anti-snoring devices are adjustable in protrusion. In either relatively large steps or for more money, with a screw-thread at the front of the mouth, like a ‘volume control knob’!

volume control knob
Verdict - Are OTC dental devices adjustable in protrusion?

The increment technology (approx. 2mm steps) is inherently flawed, because assuming everything else is good…, the difference between an effective position and a painful, impossible to tolerate one, may be much less e.g. 0.5mm.

Outcome: It won’t work

Problems with the volume control
As for the ‘volume control knob’ type, you fit the device in one position and as you adjust it (most likely forwards, because you’re still snoring and think more advancement is required), the ‘biting’ relationship changes. Which changes the alignment of the upper and lower parts of the device, most likely making it hard or even impossible to close your mouth and put your teeth together evenly.

Now, you’re in trouble, whichever way you go:

  • If you persist with the device (because you feel emotionally blackmailed by your partner) and ignore the pain, you risk creating permanent dental and jaw-joint issues. See Claim 3 above.
  • If you stop wearing the device, you’re in ‘hot water’ with your partner, because you’ve ‘quit’ trying to stop snoring…

Oh, and forget the ‘Money-Back Guarantee’ – you’ve used the device. Did you read the small-print? No, thought not.

stop snoring

Claim 7 –
Fits most people’s teeth and jaws

I covered ‘Easy – Self-Fit’ (Claim 4) above, and arguably, yes, the overall shape of OTC dental devices for snoring approximates people’s teeth and jaws BUT,

and here’s the thing:

Verdict - Do OTC dental devices for snoring fit most people’s teeth and jaws?
 

  1. 1OTC dental devices for snoring are inherently bulky (to make them ‘one-size-fits-all’ so they cannot be discrete and comfortable). Which means you may attractively dribble while it’s in your mouth. If it isn’t comfy you won’t wear it, and of course if you don’t wear it – it won’t work.
  2. 2You might struggle connecting the two parts, once in place in your mouth (upper and lower jaw). If you struggle with it – you’re unlikely to wear it – if you don’t wear it – it won’t work.
  3. 3It might not stay in place on your teeth. Your dentist will call this ‘poor retention’. If it doesn’t fit properly then (you guessed it) – it won’t work.

Above, are three more reasons why it’s pointless, struggling in the bathroom mirror with boiling water, squidging bits of hot plastic into your mouth.

Incidentally, custom-made, prescription devices would be remade or professionally adjusted if they exhibited these problems.

You guessed it…  

It won’t work

Where everything gets lost with which Regulator is responsible

I also contacted the Charities Commission because one business, seemed ‘confused’ about its commercial status, variously claiming to be a ‘not-for-profit’ organisation or a Charity.

The result of all the above?

The status quo: Encouraging snorers to DIY their diagnosis, ‘treatment’ and follow-up. Which is wrong on so many levels. 

Regrettably, unlike snorers, the above regulatory organisations are (so far) silent…

As for claiming ‘FDA Cleared’ [FDA means Food and Drug Administration and they control the US market for medical devices]…. my advice is to read what it is cleared for.

OTC devices have been FDA cleared for snoring – not for sleep apnoea/apnea. This means the manufacturers can market them.

But, I must repeat, in the US (just like the rest of the world), there is:

NO WAY to differentiate between snoring and sleep apnoea/apnea symptoms without an overnight sleep study.

Seriously though, after reading this, do you think DIY is sensible? There’s more about the US system in Claim 9 below.

silent
Do You Recall This Materials Scandal?
Relying on a manufacturer’s assertion the product or materials used are safe (which is what you do with an EU Class 1 device, US Class 2 device) leaves you potentially at risk, should the manufacturer not be entirely honest. I’m not saying they’re all dishonest but…

Do you remember this?

French firm, Poly Implant Prothese (PIP) manufactured breast implants using industrial grade silicone not medical device grade7,8. And this was for an implanted medical device (EU Class 3) that should have been tightly regulated. Not something seen as ‘low-risk’ e.g. an OTC anti-snoring device….

Having a professional at least look at the product before you rely upon it to help you breathe while you’re defenceless (asleep) might be considered a good idea!

Surely consulting an expert is no-brainer…?

CE mark

Claim 9 –
OTC dental devices for snoring are: Low-Risk

A bunch of boring but essential rules exist for US and European medical devices. In medical device language, they control how devices are ‘placed on the market’.

Verdict - Are OTC dental devices for snoring 'Low-Risk'?
In the process of researching this, I found some US pre-market notifications (FDA 510k’s) for OTC dental devices for snoring and observed that the FDA review boards for some were ‘dental’ (were any medical professionals involved?).

In Europe, the medical device ‘Class’ is defined by the manufacturer, when they register with the ‘Competent Authority’. If they choose, they may opt for ‘Low-Risk’ (Class I) without any checks on this decision – no external assessment. They may then put the CE mark on their packaging.

OSA trivialised
This trivialises undiagnosed sleep apnoea / apnea

Sadly, EU regulators appear impotent, despite my notification (and notifications by others and also some reputable professional organisations). They fail to protect the Public (yes, I did say that). They continue to allow unscrupulous businesses to sell dental devices for snoring directly to the Public, because the manufacturers have declared the product a ‘low-risk’ Class 1 device.

In May 2017, I happened to visit a leading brand, High Street pharmacy. Amongst the snore-relief products (which irritates me enough) I found an OTC dental devices for snoring that claimed to treat SLEEP APNOEA / APNEA… [lost for words].

——————–

In the US, the FDA does assess whether medical devices are safe and categorised correctly, before they’re sold. The FDA took legal action against one manufacturer9 – yet the device is still available. The FDA did make the manufacturer stop claiming their product treats sleep apnoea/apnea. Consequently, the manufacturer calls it a ‘Snore Relief Device’…

A quote below from an OTC anti-snoring device website Disclaimer (brand name removed), where they proclaim the device is for sale in Europe without a doctor’s prescription and the materials are safe [accessed 22 Oct 2016]:

OTC dental device for snoring Disclaimer - what does this tell you?
Seriously, when you see disclaimers and legal notices like the below on a page – what does it tell you?!

OTC disclaimer

“The XXXXX mouthpiece is designed to cure snoring but the United States, FDA will not allow us to make the claim that our mouthpiece is a cure for sleep apnea, which is a medical condition. Should you suffer from this complaint then you should consult your doctor. While we do not claim to cure sleep apnea, many people have found relief from it as an additional benefit of eliminating snoring with the XXXXX mouthpiece.

Though the FDA won’t allow us to sell the XXXXXX anti-snoring mouthpiece without a doctor or dentist prescription, it is approved for sale in Europe under the European Union Seal of Approval without a doctor’s prescription.

We have deliberately decided to not pursue FDA approval for our product because of the associated costs that we would have to pass on to you, our customer. It has always been our intent to provide a low-cost snoring relief solution. Rest assured, 100% of our product is sourced and made in the USA with non-toxic, latex and BPA-free materials.

It just so happens that the XXXXXX mouthpiece also works very well as a “sports” mouthpiece. That is why we have decided to only sell the very same “anti-snoring” mouthpiece in the United States as a XXXXXX brand “sports mouthpiece”.

Scandalous
Stating: “Should you suffer from this complaint [sleep apnoea/apnea] then you should consult your doctor”, is scandalous. It is impossible to differentiate between snoring and sleep apnoea (unless you’re a sleep-trained expert!) If it was easy, we wouldn’t need Doctors or sleep units….

Arguing the toss, by saying manufacturers comply with the rules, just means the rules are wrong, inadequate or in reality unpoliced. Regardless of which side of ‘the pond’ you are, unscrupulous manufacturers are swerving the existing rules and lack of action by the regulators to sell (in my view) incorrectly categorised products (that should be prescription items), directly to the naïve Public. Buyer beware!

To add insult to injury…. In the UK, dental devices for snoring (both OTC and custom-made) are classified by HMRC as ‘luxury items’10.  Which means they’re standard rated (currently 20% VAT).

What an indictment!

It just goes to show, how poorly sleep-related breathing disorders, of which snoring is one, are understood.

In this way, they’re:

  1. 1Avoiding the cost (and the commercial risk of failure) of a ‘Notified Body’ assessment
  2. 2Gaining access to the whole EU market without external verification of that decision
The correct way to approach a snoring or drowsiness problem:
  1. Professional screening for sleep apnoea using a recognised protocol
  2. Diagnosis if sleep apnoea is suspected
  3. Prescription of the appropriate therapy/treatment

If the proposed treatment is an anti-snoring device, you then have a dental examination prior to being prescribed an appropriate custom-made one.

Although not yet widely adopted, the UK refines this process further by permitting sleep-trained dentists to screen for sleep apnoea6, and in defined circumstances, provide a custom anti-snoring device, without a prior medical diagnosis. Sleep-trained dentist are ideally placed to help simple or ‘benign’ snorers.

This pragmatic solution short-circuits the costly, time-consuming and pointless referral to hospital, of anti-social snorers without sleepiness symptoms or other comorbidities (other related health problems).

The expensive-to-the-system (ask yourself who’s profiting?) alternative, which at the time of writing is current practice in the US and Europe is:

  • For every snorer to be assessed by their GP (Primary Care Practitioner) and then if sleep apnoea/apnea is suspected, referred for further investigation to a sleep centre. This ‘paper assessment’ is time-consuming and requires knowledge that your GP/PCP may not possess.
  • Only for the individual (who after consuming secondary care resources) doesn’t merit treatment with Positive Airway Pressure (PAP) therapy, to then be lost to the system, when they’re ‘advised’ to obtain an anti-snoring device (no formal referral being made due to a silo mentality – see my post about Guidelines for the medical profession).

And they’ve cost the system how many thousands of pounds/euros/dollars? Perhaps in some US States things aren’t so bleak, so perhaps I’m being cynical. But this IS the overall picture.

We’ve been over the medical and dental consequences of buying OTC anti-snoring device, but to summarise:

  • Is BREATHING important to you? Assuming staying alive is important, why would you trust this device to keep your airway open, when you’re ASLEEP?
  • How much would you pay for a pair of glasses (spectacles)?
  • Quite a lot, I imagine because you consider it essential to see. Why then do you think your teeth, gums and jaw-joint are any less important?
  • Do you like to eat without chronic long-term pain in your jaw joint(s)? and to retain your smile?

Illustration of how OTC dental devices for snoring delay Diagnosis and Treatment

Encouraging self-diagnosis and self-treatment to profit from sales of an OTC dental devices for snoring, is irresponsible, harmful to the individual’s health, costly and perhaps dangerous to society.

The step-by-step illustration below is meant to illustrate what typically happens. While fictitious and dramatised, it is based on typical disease progression.11 

 

  1. 1“Johnny Snorer” self-diagnoses his snoring and buys an OTC dental device for snoring online. Miraculously his snoring is silenced, but his undiagnosed sleep apnoea remains untreatedhe remains drowsy during the day, yet doesn’t snore at night.
  2. 2“Johnny” has a near-miss on the motorway because he ‘nodded off’ for a moment. This time, he’s fortunate not to have an accident. He brushes it off and later forgets all about it.
  3. 3“Johnny” is prescribed high blood pressure medication. He falls asleep on the settee immediately after dinner – every night. He never sees the end of the movie. His wife leaves the bedroom after he goes to sleep because his snoring is so bad.
  4. 4He wakes up with a headache every morning, feels hungry all the time, and struggles with his weight. His wife cannot broach the subject of his snoring, because it just ends up in blazing row.
  5. 5“Johnny” has lost interest in sex. His relationship is in crisis, he’s irritable and not much fun to be around. His weight gain is seemingly out of control.
  6. 6“Johnny” is diagnosed with type II diabetes. His GP sends him for dietary advice.
  7. 7His family thinks he “Drives like he’s Drunk” and are very worried about him.
  8. 8His work performance is woeful, and when he has an accident at work through inattention, his employer issues a formal warning and refers him to Occupational Health. His GP refers him for a sleep study.
  9. 9His obstructive sleep apnoea syndrome is diagnosed, some years after he began using an OTC dental device for his snoring.
  10. 10 He begins PAP therapy and rediscovers his love of life. His erectile dysfunction resolves itself and he begins to take exercise. He feels “ten years younger”. He fights to hold on to his job, his home and his family.
  11. 11 Sadly, irreversible damage has been done, to his heart, blood vessels and metabolism. He’s lucky not to have had a stroke.

Conclusion

Time and Money

Everyone likes to save money, but OTC dental devices for snoring are a false-economy, and in my view incorrectly categorised medical devices, that delay sleep apnoea diagnosis and effective treatment.

The personal and socio-economic cost of quite possibly years of mismanaged, undiagnosed sleep apnoea, through the inappropriate sale and use of OTC dental devices for snoring, far exceeds the cost of consulting trained professionals.

Effective, life-transformational, sleep apnoea therapy is NHS funded (it’s ‘free’ in the UK) because it makes economic sense for the NHS to pay for it12.  Businesses that sell OTC dental devices for snoring have flourished in a vacuum because, until now, there has been no viable alternative. Snorers searched online and were easy ‘prey’.

PostScript

I am reliably informed, (name withheld) that should a medical professional, suggest to a snoring patient that they use an Over-the-counter dental device for snoring (self-fit), their professional indemnity insurer would consider them having acted outside their area of professional expertise.

They would then be personally liable for the dental consequences.

Clearly, the correct thing to do, is to refer to appropriate expertise: a sleep-trained dentist. I blogged about the need for Guidelines for the Medical Profession when it comes to oral appliance therapy, in 2012!

Here are two useful resources, if you’re struggling with a snoring problem:

Found this useful?

Let others know what you think.

1 - 5 out of 5, where 5/5 is the best and 1/5 is the worst


References

References

  1. Snoring cures success ‘exaggerated’ http://news.bbc.co.uk/2/hi/health/1701735.stm [accessed 16th Oct 2016]
  2. Vanderveken OM, Devolder A,  Marklund M, et al, 2008. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med; 178: 197–202. Available here:  http://www.atsjournals.org/doi/abs/10.1164/rccm.200701-114OC#.V9ukcFT_rio[accessed 12 April 2017]
  3. Horstmann, S. et al, 2000, Sleep related accidents in sleep apnea patients. Sleep 1;23(3):383-9.https://www.ncbi.nlm.nih.gov/pubmed/10811382
  4. Wassell, R. J. et al 2014. Over-the-counter (OTC) bruxism splints available on the Internet. British Dental Journal 216. E24. Available here: http://www.nature.com/bdj/journal/v216/n11/full/sj.bdj.2014.452.html [accessed 9th April 2017]
  5. FDA maintained MAUDE database of adverse events: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Search.cfm
  6. Stradling, J. and Dookun, R. 2009, Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol, British Dental Journal, 206, 307 – 312. Available here: http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html [accessed 12 April 2017]
  7. Breast implant register for UK in the wake of the PIP scandal. https://www.theguardian.com/world/2013/dec/29/breast-implant-register-established-pip-scandal [accessed 17th October 2016]
  8. Wikipedia link https://en.wikipedia.org/wiki/Poly_Implant_Proth%C3%A8se#Scandal [accessed 9th April 2017]
  9. The legal fight between the FDA and an OTC anti-snoring device manufacturer: https://www.meddeviceonline.com/doc/legal-brief-anti-snoring-mouthpiece-manufactu-0001 [accessed 8th August 2017]
  10. HMRC VAT Notice 701/57: health professionals and pharmaceutical products https://www.gov.uk/government/publications/vat-notice-70157-health-professionals-and-pharmaceutical-products/vat-notice-70157-health-professionals-and-pharmaceutical-products [accessed 27 Oct 2016]
  11. Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proceedings of the American Thoracic Society. 2008;5(2):136-143. doi:10.1513/pats.200709-155MG.
  12. Weatherly, H. et al. 2009. An economic analysis of continuous positive airway pressure for the treatment of obstructive sleep apnea-hypopnea syndrome, International Journal of Technology Assessment in Health Care. Available here: https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/an-economic-analysis-of-continuous-positive-airway-pressure-for-the-treatment-of-obstructive-sleep-apneahypopnea-syndrome/2124FA6645420641F224C1A1C75113F1# [accessed 9th April 2017]
  13. ARTP standards of care v.4 http://www.artp.org.uk/en/sleep/sleep-standards/sleep-documents.cfm/sleep-standards-iods [accessed 15th June 2017]

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Created by Adrian Zacher | Page last updated 22nd March 2019

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Is a Caffeine Tax a better idea than the Sugar Tax?

Is a Caffeine Tax a better idea than the Sugar Tax?

Are high caffeine drinks the symptom or cause, of our short sleeping, overtired population?

While sipping a new thing to me, a Caramel Machiato (bit too sweet for me), and enjoying the ‘Cafe Culture’, I looked around me and a thought occurred to me.

“Is perhaps the next way for Governments desperate to prop up failing economies a caffeine tax?”

Would a new indirect tax be such a surprise?

We have tax on alcohol, tax on cigarettes, tax on fuel and soon a tax on sugar.

Why not start taxing caffeine?

My thoughts continued like this:

We have a ban on advertising alcohol and cigarettes that is justified by health economic arguments. I suggest a health economic argument could be made for the impact of caffeine on sleep, which we know if fragmented impacts leptin and ghrelin*, which in layman’s terms means we getting fatter.

The International Diabetes Federation suggest that there may be a relationship between obstructive sleep apnoea and type 2 diabetes** and we have obesity and cardiovascular epidemics. This all adds up to a considerable cost to the State…

Could we then perhaps conclude that full fat milk, high caffeine coffees and also perhaps sugar loaded, high caffeine ‘energy drinks’ contribute to Society’s obesity problems and are not so much a symptom of our short sleeping society but actually the cause?

I don’t consider it too improbable, that in time, we may see a tax per mg of caffeine in coffee and ‘energy drinks’….

Remember, you read it here first! 🙂

Related posts

http://www.ncbi.nlm.nih.gov/pubmed/17212793 new-window

** IDF statement: http://www.idf.org/sleep-apnoea-and-type-2-diabetes new-window

Created by Adrian Zacher new-window| Page last updated 9 May 2016

Why I’ll sacrifice my sleep for the football

Why I’ll sacrifice my sleep for the football

Accepted. Sleep House has not seen too much sleep over the past few weeks – what with hot weather and the World Cup.

I’m not a massive football fan, but I’m massively patriotic, so I’m writing this, sitting here in red, white and blue…

And there is part of me that doesn’t want to write this blog – after all, I’m one of the loudest supporters cheering at the England team as they progress through the World Cup. I’m not poo-pooing their performance – goodness no. However, whether they lose or win, I know it will impact my sleep.

When we win 😉 I’ll have a few cheeky drinkies and as we know, alcohol might make you fall asleep faster, but that sleep is really poor quality – hence you wake up feeling unrested, and with the munchies. If we lose, there will be some commiseratory drinkies and the same will apply. So, is it just me that will drink too much? Maybe the current CO2 shortage impacting beer supply is a good thing to coincide with this worldwide tournament! Even if beer isn’t your thing, any alcohol will do the same.

But even if I gave up the alcohol, my anxiety levels are pretty high… peaking for the 90 minutes (plus stoppages) of the match… and that hormone change has an impact, particularly important for those evening matches!

So, what can we do about this?

  1. Reduce the alcohol, have lower alcohol versions – this is a good idea anyway so we don’t dehydrate with the higher temperatures. Intersperse alcohol with long soft drinks.
  2. Try to compensate – on the nights off from football, have no alcohol, and try to get more rest – you probably can’t control your wake time (employers like us turning up), so control your bedtime. Try to control your bedroom temperature. It sounds counter-intuitive, but only open the windows early morning and the evening to get cooler air in the house, and for most of the day keep the curtains/blinds drawn and windows closed to keep the heat out and that cooler air in.

Some people will say “naaaaa” and stay with the multiple drinks and not worry about the headache. If you decide to live with the tiredness tomorrow, the munchies and the slightly tighter waistband from ‘wasted’ calories (should that be ‘waisted’?) then consider adopting point two above! Also remember that if you consume alcohol, you’re more likely to snore – so expect a few extra bruises on the ribs from the other half! [Find out how to reduce snoring here]

I’m going to try 1 and 2 and accept that my sleep is not going to be as good as it could be for a while. I’ll also book in time for early nights and to recover in-between.

Come on England… I’ll gladly sacrifice my sleep on this occasion to support our World Cup campaign!
(And hope for the magic sponge to cool me down during this heatwave!)

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