How to Stop Snoring
How to stop snoring, depends on why you snore.
Follow this comprehensive Step-by-Step Guide (updated for 2023) and you’ll stop snoring and both sleep better.
Created with passion after ~ 30 years experience of this industry.
By Adrian Zacher MBA. Medically reviewed by Emeritus Professor John Stradling MD FRCP.
Estimated reading time: 40 minutes
Contents:
ORCiD
#1. CHAPTER ONE:
7 self-help ways to Stop Snoring
and our different and free
Online Snoring Test
Self-help to stop snoring appears immediately actionable…
However, some ways to stop snoring (eg. losing weight) will take some time and considerable willpower.
Our very different Online Snoring Test checks you for sleep apnoea symptoms.
And doesn’t encourage you to self-diagnose, to sell you a gadget.
Keep going. You’re on the right path.
Here’s a quick vid (3:24 mins) about the top 7 self-help ways to stop snoring – below it you’ll find more detail about each method:
Below are 7 deceptively simple, self-help ways to stop snoring. They’re a good idea for just about everyone, but I need to set your expectations: they will take time and considerable willpower.
Begin with these lifestyle changes, and if (when?) these don’t help consult a sleep-trained pharmacist.
But first:
Snoring and being sleepy when you should be alert (despite sufficient rest) needs immediate medical attention.
You may prefer terms like:
-
feeling tired,
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unrefreshed awakening,
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lack of energy,
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feeling fatigued,
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napping,
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morning headaches,
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irritability,
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or difficulty concentrating,
These are essentially different ways to describe the main symptom of sleep apnoea, a symptom that medics prefer to call1:
- Excessive Daytime Sleepiness
Irrespective, of how you describe it, your quality of life is reduced and it doesn’t have to be this way!
Consult your GP. (Primary Care Physician).
Learn more about driving and sleepiness.
Losing excess weight, will with time, support from your partner, and lots of willpower (typically 3 – 6 months to lose sufficient weight) help you stop snoring.
This is because we get fat inwards as well as outwards, and weight around your neck reduces the diameter of your airway. A narrower airway makes the air you breathe travel faster, which in turn makes the walls of your airway vibrate: makes you snore.
Consult a weight management pharmacist for valid help with this.
Alcohol makes you snore because it super-relaxes your throat – which makes it floppy and prone to vibrate.
I absolutely appreciate that drinking alcohol in the evening is when you want to drink it – so you have to choose: snoring or alcohol.
Smoking inflames the tissues of your throat, which makes your airway narrower, the air you breathe travel faster and as a consequence you snore.
Sleeping on your back makes you snore, because gravity pulls your tongue backwards, which narrows your airway.
Your mouth may also fall open and as it does so, your jaw moves downwards and backwards, which narrows your airway even more.
And no, a chin strap is NOT the answer for problem snoring.
Nasal airflow restriction may make you snore because you open your mouth to breathe.
When your mouth opens, it also moves downwards and backwards – narrowing the airway in your throat. Ditto point 4 about mouth opening and airway narrowing.
Additionally, some people find that dairy products make them ‘stuffy’. Consider alternatives?
Allergens from pets, dust and mould can also impact upon the ability to breathe through your nose.
Sedatives e.g. sleeping pills, some types of antihistamines, and painkillers may make you snore as they super-relax your throat. (Consult your GP for alternatives if you have a diagnosed condition that necessitates their use).
Some evidence exists that a reduction in snoring may be achieved if you persist with throat exercises, such as singing and playing wind instruments.
Electrical tongue and throat stimulating devices, are currently in their infancy and data supporting them as a stop snoring method is limited.
3 Major Problems with Self-Help Methods to Stop Snoring:
They often don’t work
They require self-discipline and time (be honest)
You don’t know if your snoring is a symptom of obstructive sleep apnea / apnoea
Be realistic: You want to know how to stop snoring ASAP.
So consult a sleep-trained pharmacist and get independent, expert help from a healthcare professional.
Someone not selling the supposed miracle ‘cure’.
Scroll down for our Online Snoring Test to see if you show symptoms of sleep apnoea (OSA). Your data isn’t stored.
- Anti-snore pillows – Do they work?
- Snore relief sprays – Are they any good?
- Positional therapy for snoring – Read the expert’s personal experience
- Chinstraps for snoring – Safe and effective or dangerous?
Online Snoring Test
Our free online snoring test is rather different:
You won’t find a BUY NOW button at the end!
Click or tap the male/female icons and radio buttons below to see if you show symptoms of obstructive sleep apnoea (OSA).
What does my Online Snoring Test result mean?
If you scored 7 or more, you show symptoms of Obstructive Sleep Apnoea (OSA), a life-threatening disorder that causes you to stop breathing repeatedly – often several hundred times per night – during your sleep.
Consult your GP immediately.
Need the overview without all the detail?
Watch our Snoring and Sleep Apnoea overview:
Our definitive How to Stop Snoring video covers:
- Snoring assessment
- Screening for obstructive sleep apnoea
- Signposting to the appropriate stop snoring professional
- Home Sleep Apnoea Testing (HSAT)
- Oral appliance therapy for snoring
- Positive Airway Pressure (PAP) therapy for Obstructive Sleep Apnoea (OSA)
- and the role of soft-tissue, hard tissue and bariatric surgery for snoring and OSA.
What happens next?
That's up to you...
Either pretend snoring is not your problem or keep reading.
I hope (for your sake, and that of your partner and family) you scroll down to Chapter two.
You'll learn:
How snoring and sleep apnoea relate (and what sleep apnoea is)
How to get professionally checked (screened) inexpensively for sleep apnoea symptoms
How to find out which way to stop snoring is right for you (based upon your symptoms and medical history)
Why it’s a terrible mistake to buy an anti-snoring device – without consulting a healthcare professional first
- Snoring may not be ‘just’ noise – it could be a symptom of obstructive sleep apnoea (which if severe and left untreated could reduce your life expectancy by ~ 20 years!)
- You may permanently damage your jaw joints, and risk losing your teeth and crowns
- You’re highly likely to waste your money (false economy)
To be clear, you're wasting your time and money buying Over-the-Counter supposed ways to stop snoring.
The harsh reality is that they don't work.
They're available because you are:
Desperate
Uninformed
Trying to save money
No one I know, has money to waste.
#2. CHAPTER TWO:
Screening for Obstructive Sleep Apnoea (OSA) and Signposting to appropriate care
Screening occurs when a healthcare professional checks if your snoring needs further investigation – for example by conducting a sleep study.
Signposting is about directing you to the most appropriate care pathway, directing you to the solution for your snoring or sleep apnoea.
In this way, the sleep-trained pharmacist accelerates you to the right stop snoring method, thus saving you and the NHS time and money.
There are just 2 steps:
Screening 'Snorers' for Obstructive Sleep Apnoea symptoms
It is not helping you or saving you money.
Instead consult a sleep-trained pharmacist or your GP (Primary Care Physician – we use ‘GP’ throughout this Guide) and get screened for sleep apnoea and set on the right path to stop your snoring.
Some dentists can also help. More about these dental professionals later.
But first:
What is Obstructive Sleep Apnea / Apnoea?
Obstructive Sleep Apnoea (OSA) is a life-threatening disorder that causes you to stop breathing repeatedly – often several hundred times per night – during your sleep.
The airway in your throat repeatedly narrows and not enough air gets to your lungs despite continued efforts to breathe.
Sufferers commonly snore.
- OSA fragments your sleep making your heart work harder to pump the oxygen in your blood to your brain
- OSA is more common than you may think: affecting 1 in 10 adults
- OSA is easily diagnosed and treated, restoring alertness and extending individuals healthy lives by as much as 20 years
Obstructive Sleep Apnoea Syndrome (OSAS) is when sleep is so disturbed that excessive daytime sleepiness/drowsiness occurs because the individual craves rest.
Regrettably, due to the nature of OSAS, the individual is not always aware that they have the condition. Untreated sleep apnoea sufferers may experience an irresistible urge to sleep in unsuitable circumstances.
Sleep-trained pharmacists work with your GP and have no vested interest in you having X or Y therapy.
Snorer Pharmacy® makes:
stop snoring expertise accessible and affordable
Snorer Pharmacy® is our new pharmacist-led service where you:
“Pharmacies are often the first port of call for snorers, or their desperate domestic partners.”
Alan Nathan, Pharmaceutical Journal.
Snoring may be a symptom of Obstructive sleep Apnoea (OSA).
Screening is a way to find out.
Screening tests check to see if you have a condition before you have major symptoms. The idea is that a problem is picked up before it develops, or it is in the very early stages. In this way, sleep apnoea can be treated before causing any long-term health problems.
Both your pharmacist and GP, have access to your medical history (Electronic Health Record) and they want you to be well.
Neither have a vested interest in you having X or Y therapy.
Pharmacists are highly qualified, accessible healthcare professionals, increasingly playing a role helping snorers, because as we’re all aware, GPs are few in number and extremely time-poor.
The sleep-trained pharmacist will:
There are many evidence-based methods to stop snoring and overcome sleep apnoea. The sleep-trained pharmacist, will be able to connect you to the most appropriate type of professional for you.
This is called Signposting and it is a key role for the community pharmacist:
'Signposting' is jargon for directing you the right way. Pointing you in the right direction, for the care that suits you best; taking into account your snoring and sleep apnoea symptoms and medical history.
The sleep-trained pharmacist will walk you (ideally with your partner together) through as series of questions. The video snippet below is what Snorer Pharmacy® Signposting looks like (it is speeded up):
If you’re in the UK and don’t have a GP you can find one here:
https://www.nhs.uk/service-search/find-a-GP 
4
Punch in your location (PRO TIP: It works better with a place name rather than postcode). Take your pick.
If you’re outside the UK, finding a GP may depend on how your healthcare expenses are paid for.
In the USA, if your care is paid for by an insurance company, you should check their website to see which ones are listed.
If you’re covered by Medicare use this link to find a GP:
Below is a double-speed, screen recording of our proprietary Snorer Pharmacy® signposting software. The sleep-trained community pharmacist may use this to:
- Capture relevant sleep data about your condition (to save clinical time for whoever you see next)
- Signpost you to the most appropriate healthcare professional, based upon your responses
To make the most of your consultation, here's a list of questions to help you get the conversation going:
- Why do I snore?
- Is my snoring a sign of sleep apnoea?
- How can I find out - are there any snoring tests?
- What happens during a home sleep apnoea test?
- What treatments for snoring do you recommend?
- What are the side-effects of snoring treatment?
- What can I do to help myself immediately - to reduce my snoring?
- I have other health conditions. Will you take these into account?
- Is there an actionable patient report to take home with me?
- What websites do you recommend visiting?
Don't hesitate to ask questions and voice your concerns. We recommend you have your consultation together with your partner because you are asleep when the snoring problem occurs.
If you know country specific web addresses for how to access secondary care services – please let us know so we can add them here to help others. Thanks.
The sleep-trained pharmacist will direct (signpost) you:
- If you're a non-sleepy snorer with no relevant medical history they can connect you with sleep-trained dentists (and you can give the dentist your Snorer Pharmacy® report to save a LOT of time)
- Or if appropriate, update your Electronic Health Record with their assessment and bring it to your GP's attention, so you get the help you need (once again your Snorer Pharmacy® report saves you and your GP clinical time)
Some sleep-trained pharmacists can also help with:
- Home Sleep Apnoea Testing (a simple sleep study) this may help convince your GP
- Weight management (to help you with the typical underlying reason why you snore/have OSA)
- Smoking cessation
- Alcohol reduction/cessation
- High blood pressure checks (known as 'spot interventions')
- A medicines review (perhaps a prescription medicine is having an unforeseen sedative effect worsening your snoring/OSA)
- Offer advice re positional therapy to stop snoring
Jump ahead if you've been signposted by the pharmacist to consult a sleep-trained dentist.
Now assume you've been Signposted to consult your GP about your sleep apnoea symptoms:
2. Waste your money on OTC (over-the-counter) snoring cures, aids and mouthguards
Naturally, it’s tempting to go for the ‘quick fix’ and buy ‘instant’ snoring remedies.
That’s why we provide independent reviews.
So, you can learn how to compare OTC mouthguards and custom-made dental devices and find out if chinstraps for snoring are dangerous, or safe and effective amongst other reviews.
Consult your GP about your snoring with sleep apnoea symptoms
Return to your GP with your completed sleep apnoea assessment forms (ideally you did these with the help of your partner – they may have a different perspective…).
If the sleep-trained pharmacist referred you - you'd jump to here. And your GP would also have the answers to most questions (added to your Electronic Health Record by the pharmacist).
Now, the outcome of your GP appointment may go 1 of 3 ways:
Your GP may suspect your snoring is a symptom of sleep apnoea (find out more about sleep apnoea (OSA) in the FAQ) and refers you to a sleep unit.
Ask someone else to take you to the appointment, as you may be told by the doctor that you cannot legally drive yourself home.
Important:
Keep hold of your referral paperwork and if you’re in England, visit the NHS e-referral website: https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-e-referral-service/ [new tab]
If your GP does not suspect obstructive sleep apnoea (OSA) they may suggest you try to stop snoring naturally with these lifestyle changes:
- Lose weight if you’re overweight
- Stop smoking (if you do)
- Quit the evening alcohol
- Get off your back when sleeping
- Increase your exercise…
If your GP does not suspect your snoring is a symptom of obstructive sleep apnoea:
They may consider your snoring to be ‘benign’, they may offer lifestyle advice (as Outcome 2 above), and suggest you consult a sleep-trained dentist with a view to a prescription dental appliance or ‘mouthguard / mouthpiece’.
This type of dental appliance is known as a custom-made mandibular repositioning splint (MRS). These are NOT the same as the dental gadgets you can buy online.
Bookmark our, evidence-based Guide about how to choose a ‘mouthguard’ to stop snoring.
The NHS will not fix snoring*
Bad news?
Only option 1 above (Referral) involves NHS treatment.
* In exceptional circumstances some ‘benign’ snorers (i.e. not sleepy) may dependent on the availability of local expertise and budget, be offered a hospital dental laboratory manufactured oral appliance.
Options 2 and 3 require you to take action and pay for it yourself.
So, now you’re wondering:
How can I stop snoring: What is MY snoring solution?
If you’re given Option 2 (lifestyle change) or 3 (dental appliance for snoring), the good news is that you’re unlikely to have sleep apnoea symptoms. (tick!)
Hang on:
Don’t go and feed the ‘circling sharks’ by buying an over-the-counter snoring ‘cure’.
There’s good evidence5 that custom-made, adjustable dental appliances for snoring (a.k.a. mandibular repositioning splints) will help with anti-social snoring.
Below are two examples of prescription, custom-made, dental appliances (there are many more to choose from).
The images below are used with permission from SomnoMed UK Ltd. and Somnowell (UK) Ltd. respectively to illustrate the type of product. (We do not sell these).
Clinical research6 has established that custom-made dental appliances are NOT the same as over-the-counter ‘gumshields’.
And ‘gumshields’ are not valid as a trial of whether a custom-made dental appliance will work. Don't believe the BS marketing.
So, be sure to bookmark my independent review of the top 13 criteria for choice of ‘gumshield’, so you can come back to it later.
Otherwise its time for…
#3. CHAPTER THREE:
Diagnosis of Obstructive Sleep Apnoea (OSA)
Assume you’ve been offered an appointment at the sleep unit for further investigation.
When you’re diagnosed, you know if your ‘snoring’ is actually sleep apnoea and how bad it is.
This helps the Doctor determine the most appropriate way to help you sleep and breathe at the same time.
Soon, you will sleep better – and more quietly.
How to know if your snoring is actually sleep apnoea?
Step 01
You will be invited to attend the Hospital sleep unit for basic assessments including height and weight measurements, your medical history and a review of your GP referral letter.
It’s a good idea to take a copy of your Snorer Pharmacy® report with you (just in case its been mislaid).
Step 02
Some time later, you will be invited to the sleep unit again (should a sleep study be considered appropriate).
Home Sleep Apnoea Testing (HSAT) is, in the UK and USA, the default way to examine your sleep quality and quantity. Home Sleep Apnoea Testing is testing of your sleep at home, in your own bed. Learn more about home sleep apnoea testing
You will be loaned some sleep apnoea test equipment, to put on over your pyjamas, before you go to sleep. The sleep physiologist will show you how to use it. The sleep-test equipment records (amongst other things) your snoring, how much oxygen there is in your blood and how much of the night you sleep on your back.
In the morning when you wake up, turn it off, repackage it and return it promptly to the sleep unit. The data it has captured is then downloaded and analysed by a skilled sleep physiologist. They will ‘score’ your sleep study and create a report to accompany your medical history.
The sleep doctor will then review your scored sleep study, sleep physiologist’s report, your medical history and assessment forms. If possible, and if there is sufficient data, they will then diagnose your sleep condition and severity.
Step 03
You will be sent a letter inviting you to attend the sleep unit offices to review your diagnosis with the Sleep Doctor. They will discuss the ramifications of their diagnosis, and their proposed course of action.
They may also offer lifestyle advice.
My advice is to listen. These medical professionals are experts and they’re motivated to provide you with the best care, factoring in your health, occupation and lifestyle.
Its a good idea to take a copy of your Snorer Pharmacy® report with you.
Diagnosed with Obstructive Sleep Apnoea Syndrome (OSAS)?
First-line and second-line therapies
Initial and preferred therapy is known as ‘first-line’ and the backup option as ‘second-line’.
Need a free Overview of Snoring & Sleep Apnoea and the Treatments?
Click to grab a free, award-winning guide by Adrian Zacher and Professor A Williams MD FRCS
#4. CHAPTER FOUR:
Ways to Stop Snoring and treat Sleep Apnoea
Treatment follows diagnosis.
In this chapter, we’ll introduce the various prescription ways to stop snoring, and treat obstructive sleep apnoea / apnea.
The choice of treatment (the method prescribed by your Doctor) is the definitive answer to your question:
“What are the ways to stop snoring?“
3 ways to stop snoring and treat sleep apnoea
There are 3 prescription ways to stop snoring and treat obstructive sleep apnoea syndrome (OSAS). The most appropriate method for you, depends upon your diagnosis.
The 3 prescription methods are:
Dental appliances known as Mandibular Repositioning Splints (MRS)
Positive Airway Pressure (PAP)
Surgery (both soft and hard tissue in the nasal and respiratory airway) and exceptionally bariatric (stomach surgery to reduce weight)
Your sleep doctor will discuss with you, and then prescribe the method most appropriate to help you, together with providing lifestyle advice.
First-line therapy for anti-social snoring:
Custom-made, prescription, Mandibular Repositioning Splints (MRS)
How do 'Mouthguards' for snoring and sleep apnoea work?
Dental appliances for snoring and sleep apnoea (known as Mandibular repositioning splints or MRS) keep your airway open by holding your jaw forwards (repositioning it).
'Mouthguards' do two things:
- Keep your tongue away from the back of your throat
- Tension your soft palate
The effect of an MRS is similar to that of the anaesthetist’s hands with an unconscious patient. The 'Mouthguard' moves your jaw forwards (and in turn your tongue) to open your airway and help you breathe.
They do not cure snoring. They are a therapy that must be worn (while you sleep) for it to work.
There’s much more here about dental appliances for sleep apnoea.
What happens next?
The sleep-trained dentist will assess your suitability (from a dental perspective) for a dental appliance.
Factors include ability to protrude your lower jaw more than 5mm, oral hygiene, jaw-joint health, number and distribution of teeth.
If the dentist considers a dental appliance can be prescribed they will take impressions of both your jaws (moulds of your mouth) and a bite registration in a forward posture (how your jaws meet when you close your mouth and push your chin forwards).
This information is then sent to a specialist dental laboratory for the dental technician to make your dental appliance. When it is fitted you will learn how to insert, remove and perhaps adjust it. You will be requested to visit the dentist again in a week or two, and at regular intervals.
How to choose a 'Mouthguard / Mouthpiece' (MRS) Anti-Snoring Device?
Co-author: Adrian Zacher MBA
Co-author: Dr Roy Dookun BDS, MFGDP (UK), MGDSRCS (ENG), FFGDP (UK), DIP DENT SED
Peer Reviewer: Dr Shouresh Charkhandeh DDS
In this NHS England’s Information Standard Accredited Guide, you’ll learn in jargon-free language:
- What a ‘Mandibular Repositioning Splint’ is
- How to choose the best stop snoring mouthguard/mouthpiece for you
- What the sleep-trained dentist can do
- How to compare over-the-counter with prescription anti-snoring devices
No signup is required.
No credit card.
Nothing at all in fact.
We do this to help – because we can.
Meet the co-authors:
Adrian Zacher MBA
Author and founder of Snorer.com, CEO of the British Society of Pharmacy Sleep Services (registered Charity), CIO of the EADSM, co-founder and former CEO of the BSDSM
First-line therapy for Obstructive Sleep Apnoea (OSA):
Positive Airway Pressure (PAP) therapy
What happens next?
Sleep apnoea treatment with Positive Airway Pressure therapy
- Have a PAP mask fitting and loan of an Automatic PAP
After you receive your OSAS diagnosis, you usually have an appointment the same day, with a sleep unit nurse. At this appointment they will:– Provide an explanation of PAP therapy
– Fit you with a PAP mask
– Loan you an automatic PAP machine (an automatic PAP establishes over the following 2 weeks your specific PAP therapy pressure)
– Supply you with support details - Return to collect ‘your own’ PAP machine
Approximately 2 weeks later, you return to the Hospital sleep unit and the data from your APAP machine is used to setup your treatment device. This is routinely a fixed or continuous pressure PAP machine. - Return for a 3-month review and sleep test
You will be sent a letter inviting you for a 3-month review and another sleep study using your PAP therapy. The idea is to determine both subjectively (how to do you feel?) and objectively (what does the sleep study data say?) if you are adequately treated and restored to normal function. You will meet with the sleep unit practitioner/nurse to review your latest sleep study data and see how you’re getting on with PAP therapy. This is the time to seek help with niggles with mask fit (if you haven’t already). Read the Driving and Sleep Apnoea section.
How to choose PAP therapy?
Co-author: Adrian Zacher MBA
Co-author: Dr Lizzie Hill PhD
In this 3-part NHS England’s Information Standard Accredited Guide, you’ll learn in jargon-decoded language:
- How PAP therapy works
- What to consider when selecting a ‘mask’
- What ‘titration’, ‘ramping’ and ‘humidification’ mean… and more
- Includes details of support groups and PAP user feedback
No signup is required. No credit card.
Nothing at all in fact.
We do this to help – because we can.
Meet the co-authors:
Adrian Zacher MBA
Author and founder of Snorer.com, CEO of the British Society of Pharmacy Sleep Services (registered Charity), CIO of the EADSM, co-founder and former CEO of the BSDSM
Dr Lizzie Hill PhD
Dr Lizzie Hill PhD RPSGT EST. Clinical Sleep Physiologist (RCCP M-Level registered); President, European Society of Sleep Technologists. Tutor MSc. Sleep Medicine course University of Oxford
Surgery for snoring and Obstructive Sleep Apnoea (OSA)
Soft tissue surgery (UPPP)
Uvulopalatopharyngoplasty
Hard tissue (bone)
Bi-maxillary osteotomy.
What happens next?
An accurate diagnosis is essential for stop snoring surgery to be effective.
Sleep nasendoscopy is sometimes performed to confirm the surgical site. Which means a camera is inserted up your nose while you are asleep to identify where your snoring is coming from, to know precisely where to operate.
Read our free Surgical Guide ↗ for a jargon-decoded explanation of the options.
Things to discuss, when considering surgery for snoring and sleep apnoea
Co-author: Adrian Zacher MBA
Co-author: Professor Bhik Kotecha FRCS
Co-author: Professor Iain Ormiston FRCS
In this NHS England’s Information Standard Accredited Guide, you’ll learn in jargon-free language:
- About soft tissue, hard tissue and bariatric surgery for snoring and sleep apnoea
- When stop snoring surgery is considered appropriate
- Includes ‘non-gory’ sleep apnoea / apnea surgery image explanations
- Details of sleep apnoea / apnea support groups
No signup is required.
No credit card.
Nothing at all in fact.
We do this to help – because we can.
Meet the co-authors:
Adrian Zacher MBA
Author and founder of Snorer.com, CEO of the British Society of Pharmacy Sleep Services (registered Charity), CIO of the EADSM, co-founder and former CEO of the BSDSM
Professor Bhik Kotecha MB, MPhil, FRCS (Ed, Eng, Orl), DLO
Professor Kotecha, London (Harley Street) and Nuffield Health Brentwood in Essex.
Professor Iain Ormiston BDS, LRCP, MRCS, FDSRCS, FCSHK, FHKAM, FRCS
Professor Ormiston is doubly qualified in medicine and dentistry holding dental and medical/surgical fellowships, FDSRCS, FRCS. He is also a Fellow of the Hong Kong Academy of Medicine.
Check out chapter five (Follow-up) to appreciate what it should look like, and chapter six for our extensive snoring FAQs section.
#5. CHAPTER FIVE:
Follow-up of snoring and sleep apnoea patients
Follow-up is essentially continued care.
Follow-up for both snorers and those with OSA is absolutely necessary because:
- Snoring may become sleep apnoea
- and sleep apnoea may worsen or an initially successful therapy fail to control drowsiness in the long-term.
But what does follow-up look like?
What does it entail?
Follow-up
If you’re struggling with therapy do not give up. Help is available and it’s quite common for people to need help and time adjusting to routine use of an oral appliance or PAP device.
If you’re using an oral appliance go back to the dentist.
If you’re on PAP go back directly to the sleep unit.
The importance of follow-up for snoring and sleep apnoea therapy users cannot be overstated.
However, snorers who are prescribed a mandibular repositioning splint are commonly NOT followed-up to assess whether:
- Their mandibular repositioning splint continues to provide satisfactory control of their snoring
- Or, if their snoring has developed into sleep apnoea
What should follow-up of ‘snorers’ look like for the different treatment methods?
Mandibular Repositioning Splints (MRS) are typically prescribed for ‘benign’ snorers or those with less severe sleep apnoea.
Follow-up by the dentist MUST include assessment of perceived sleepiness or drowsiness and ideally an annual home sleep apnoea test (HSAT) performed to determine if the mandibular repositioning splint is effective.
Dental changes should be communicated to you by your dentist and your risk/benefit analysis reviewed.
PAP therapy today, commonly incorporates sophisticated monitoring technology, to follow how much it is used and how effective it is.
Less commonly remote ‘titration’ or adjustment of therapy pressure to optimise treatment may occur. This has an unfortunate tendency to get tied up in data access and use permissions.
Annual follow-up is required to identify if daytime drowsiness symptoms have returned – if so they need investigating.
Surgery for snoring. It is vital that follow-up home sleep apnoea testing (HSAT) is performed for those who have undergone surgery for snoring.
The ‘fire alarm’ of snoring has been removed. What if the far more serious fire of sleep apnoea develops?
Changes in weight, lifestyle (particularly evening alcohol consumption) may give rise to sleep apnoea symptoms that need investigating.
Driving or similar vigilance critical roles
Summing up follow-up and sleep breathing condition change
Now, over to you:
You’ve read the definitive how to stop snoring guide.
Now, it’s time to act:
- Will you consult a sleep-trained pharmacist?
- Will you just have another argument?
- Kid yourself snoring doesn’t matter?
Or maybe you have a question about your snoring?
Let me know by leaving a quick comment below right now.
Thanks, Adrian.
#6. CHAPTER SIX:
FAQs about how to stop snoring permanently
Perhaps you have questions? So check out this snoring and sleep apnoea Frequently Asked Questions (FAQ) section.
Have a question that isn’t answered? Ask it below by commenting, if we don’t personally know the answer, we’ll find someone who does!
Please note we cannot give medical advice.
Click the link to go to the Question & Answer
These are real collated questions and answers from snorers and their long-suffering partners. We’ve listed them here (with back to the top of this section links) to help:
- Snoring: a technical explanation?
- What does surgery offer for sleep apnoea?
- I would like to undergo surgery for snoring..
- How would I go about getting surgery for snoring?
- What is obstructive sleep apnoea?
- Tips and Tricks to stop snoring?
- Is snoring an act that absolutely cannot be controlled?
- Snoring risk factors?
- If we are more tired, do we snore while sleeping?
- Why do anything about snoring?
- Why don’t we wake up from our own snoring?
- When does snoring indicate a more serious problem?
- How can I tell if I snored last night?
- Why do some people snore so loudly?
- Why does alcohol make you snore more loudly?
- My doctor doesn’t seem to listen or take me seriously?
- Should I visit a doctor about my snoring?
- What will the sleep or ENT consultant do?
- What will the dentist do?
- Why not buy a mandibular repositioning splint on-line or at the local pharmacy)?
- Is sleep apnoea classed as a disability?
- Do men snore more than women?
- Do dental mouthguards work for sleep apnoea?
- What is the latest treatment for sleep apnoea?
- What works best to stop snoring?
- Can snoring in children be indicative of a medical problem?
- Are there societal or evolutionary ‘benefits’ from snoring?
Snoring: a technical explanation
Assume a fixed volume of air travels into your lungs while you sleep (typically this is around 500 ml). If your airway narrows, the air must travel faster for the same volume, to enter your lungs in one breath. As the air speeds up, floppy airway walls move in-and-out and make the snoring noise.
What does surgery offer for sleep apnoea?
Surgery may appear a ‘quick-fix’ solution. However, diagnosis and accurate identification of precisely WHERE the problem is, dictates the success or outcome of surgery, which in itself is challenging.
Surgery for sleep-related breathing disorders, is split by whether bone needs to be operated on. If not then ‘soft-tissue’ surgery, is intended to improve the effective use of other therapies (see above). In contrast, surgery on the bones of the face, is intended to eliminate the need for other therapies.
This is major surgery and it will change the way you look.
A final option is to bypass the collapsing area of the throat. This is known as a tracheotomy and it’s not normally considered, until everything else has failed. Grab the Surgery for snoring Guide.
I would like to undergo surgery to stop my snoring…
Question continued:
I would like to undergo surgery to stop my snoring, I have been to my doctor regarding this and they referred me to a specialist, who gave me a machine to test for sleep apnoea.
The results came back fine (I don’t have sleep apnoea). Yet my snoring is so bad that it keeps my partner awake, and they already sleep with ear plugs. Not sure what else to do. Have tried sleep spray, strips, mouthguard etc.
Response:
We cannot give medical advice. However we can offer personal opinion on the UK situation:
Consult your GP.
You will find that surgery for snoring without sleep apnoea (the machine the specialist sent you home with to test your sleep overnight) is NOT provided by the NHS. Which means that if you’re a suitable patient you would have to pay for surgery. Of course I do not know if you’re in the UK reading this!
We have 2 things to help you make a more informed decision:
- Things to discuss when considering surgery for snoring and sleep apnoea Guide
- How to stop snoring: The definitive, step-by-step Guide
Have you tried a custom-made oral appliance for snoring? These are fundamentally different to over-the-counter devices and (if you get the right one) will help most people.
Finally, I suggest you contact the Hope2Sleep.co.uk ↗ forum on Facebook. It may help to discuss things there.
How would I go about getting surgery for snoring – and how much would it cost?
First you must be screened for obstructive sleep apnoea. Consult your GP (additionally if you’re in the UK a sleep-trained dentist) and heed their advice.
Three important things to note:
- Surgery is an option when all other options have failed.
- Surgery is usually only considered to improve the effect of PAP or an oral appliance.
- If your weight changes it will impact upon the success (or otherwise) of surgery.
If your GP considers it appropriate, you would be referred to the nearest ENT department or you can choose somewhere else if you wish. (the NHS Constitution gives you this choice).
At the ENT department they would assess you, examine your nose and throat and perhaps do a nasendoscopy or a sleep nasendoscopy in an attempt to identify where the snoring is coming from. Various surgical options exist but the difficulty is in identifying precisely where the problem is. It may be many areas.
Surgery is a private option. You could discuss the cost of this with the GP and then the ENT department.
What is obstructive sleep apnoea?
Sleep apnoea can be thought of as the serious side of snoring. The problem is, without professional assessment its impossible to say if snoring is (or is not), a symptom of sleep apnoea.
Sleep apnoea may be observed as periods of silence between snores. The snorer’s chest and stomach continue to move up and down, but no air enters their lungs, until they wake up and breathe. As you can imagine, sleep apnoea eliminates deep, restorative sleep. If left undiagnosed and untreated, the sufferer will experience multiple short and long-term health consequences.
Ultimately, untreated sufferers will die sooner than would otherwise be expected. Sleep apnoea affects the individual in what is called apnoeaic episodes. These typically last 10 seconds and can be as long as 2 minutes at a time – they occur occasionally with most people who snore and this can be considered relatively normal.
However, most observers only notice the ‘tip of the iceberg’ and the condition may be far more serious. The severely affected individual will experience daytime symptoms that may be described as ‘a cross between jetlag and a hangover‘. The partner will notice the noise and occasional moments of silence – this is when the individual is not breathing!
Get a better understanding of snoring and sleep apnoea, by grabbing our free Overview Guide.
Stop snoring: ‘Tips and Tricks’?
For some snorers a quick and easy solution to stop snoring, is to change sleep position get off your back). This may immediately reduce or stop the annoying noise: “TURN OVER!” might be something you’ve heard before…?
You may also have seen promotions for anti snore pillows? They aim to encourage you not to sleep on your back. Which is known as positional therapy.
Sadly, changing sleep position alone, doesn’t cure snoring for everyone. This is because there are many reasons, with as many solutions, for why someone may snore each night.
That’s why we recommend you consult a sleep-trained pharmacist, to be screened for symptoms of obstructive sleep apnoea and to be signposted to the most appropriate care. Thus saving you and your GP time (and money).
Is snoring an act which absolutely cannot be controlled?
Yes. It is an unintentional and uncontrollable phenomenon. While the individual can lower certain risk-factors (see above), they can’t choose ‘not’ to snore. It would be like asking someone, not to breathe!
Snoring risk factors
There are a number of risk-factors, some may be quickly and easily fixed… Others may not.
Lifestyle changes include:
- maintaining your ideal weight,
- not smoking,
- reducing alcohol consumption (and not drinking that glass or two of wine/beer in the evening – which is exactly when you WANT to drink it – I know!)
These are useful things to work on. However, lifestyle changes take time and are not always effective even then.
For example, if your lower jaw is ‘set back’ in relation to your upper jaw, this may make your airway narrower and predispose you to snore.
You may also snore if you have enlarged tonsils and adenoids – physical obstructions in your nose or throat – that limit the size of your airway.
If you’re concerned about this, contact a sleep-trained pharmacist or your GP to seek a referral for an ENT assessment.
As we get older, it’s a fact of life that our body tissue becomes less elastic (we’re back to tone again) as we age.
This ‘floppiness’, together with excess weight, is a contributory factor to why we snore.
If we are more tired, do we snore while sleeping?
If we’re exceptionally tired, we may lose body tone more rapidly and more deeply, when we go to sleep, so yes if we’re prone to snore, this would mean we snored more loudly or frequently.
Why do anything about snoring?
You mean apart from not being anti-social?!
Snoring may be a symptom of Obstructive Sleep Apnoea (OSA). OSA makes your heart race as the oxygen in your blood drops. This places strain on your heart and because after every stoppage of breathing, you start to wake up, you do not get a good nights sleep.
This affects the way you feel and your behaviour the following day.
UARS is a milder version of this and can be thought of as in between snoring (mild interference in airflow) and obstructive sleep apnoea (when the airway is closed or obstructed).
Why don’t we wake-up from our own snoring?
A classic warning sign of obstructive sleep apnoea is waking up and: …hearing the end of your own snore…
Typically, this would be as a result of what is known as an ‘apnoeaic episode’ or period of not breathing.
Typically, the sufferer doesn’t remember this. They take a breath and go back to sleep.
Its sounds like this:
Snoring…. Stop breathing… silence…. Partially awaken. [Gasp / cough / scratch / roll over.] Snoring… Stop breathing….silence… Partially awaken. [Gasp / cough / scratch / roll over.]
Repeat. All night.
However, most snorers do not wake themselves up, they just irritate those who are trying to sleep within earshot… and they repeat this all night while the partner typically leaves the room.
When does snoring indicate a more serious problem?
If you snore loudly with occasional pauses in breathing, and you frequently wake up during the night, you may be suffering from sleep apnoea.
Ask your partner, or a member of your family to listen for signs of this disorder.
Sleep apnoea is periods when you stop breathing while you’re sleeping. These interruptions in your breathing, which can last 10 seconds or longer, occur when the muscles in your soft palate, uvula, tongue and tonsils relax during sleep.
This is the same process involved with normal snoring, but with sleep apnoea, the airway narrows so much that it closes. Your breathing stops, cutting off the flow of oxygen into your body and reducing the elimination of carbon dioxide (CO2) from the blood.
Your brain detects this rise in CO2 and briefly wakes you up, re-opening your airways and re-starting your breathing. This process can be repeated many times during the night.
Proper sleep can become impossible, resulting in severe fatigue and a decreased quality of life. Sleep apnoea in adults can increase the risk of serious health problems such as heart failure, because it deprives the sufferer of adequate levels of oxygen, making the heart work harder than normal.
How can I tell if I snored last night?
Well, you could ask your long-suffering partner!
But what if you don’t have a partner? (Or if they’re not in the same bed?).
Well, if you wake up with a sore throat or perhaps a dry mouth, this probably means that yup, you were snoring.
To get slightly more scientific about it, you could buy a voice-activated dictaphone or if you have a smartphone, there are apps that may detect snoring.
A word of caution: Light from your phone at bedtime could interfere with falling and staying asleep.
Why do some people snore so loudly?
Some people are born with certain traits and characteristics that pre-dispose them to be snorers, such as a heavy set lower jaw, a large neck circumference and a high body mass index (BMI).
Why does alcohol make you snore more loudly?
Alcohol further relaxes the soft tissue in the throat and worsens any snoring noise created.
My doctor doesn’t seem to listen or take me seriously?
Some people and some doctors, do not take anti-social snoring very seriously.
Question. Is treatment really necessary?
Answer. Both ends of the spectrum deserve treatment. Benign snoring can be far from benign. The social consequences can be extremely distressing, snoring may be a symptom of obstructive sleep apnoea and as such investigation for this possibility is reason enough to take what the patient reports seriously.
The misery of snoring to both the partner and the snorer is not worthy of the joke approach. We can help you inform your Doctor of the serious social consequences, and the economic and longer-term health benefits of the available treatment options.
Should I visit a doctor about my snoring?
Your Doctor (General Medical Practitioner or Primary Care Physician) has access to your medical history. As such they will be able to make an informed decision about how appropriate the available treatment options are for you. They will want to know and discuss how your life (and that of your partner) is affected.
What will the sleep or ENT consultant do?
Upon referral from a doctor, the hospital consultant will examine you and discuss all the treatment options with you.
There are many options available and not all are suitable for everyone. You may need to spend a night at the hospital and be examined while sleeping.
What will the dentist do?
Upon referral from a Hospital Consultant the Dentist will examine the condition of your mouth and your oral hygiene. You must have good oral hygiene and be prepared to work hard to maintain it.
If you have periodontal problems or extensive crown and bridge work Sleep appliances may not a good idea. You must have sufficient good teeth in both jaws to hold the appliance in place.
Exceptionally in the UK, a sleep-trained dentist may screen your for sleep apnoea (and if they don’t recognise the need for further investigation into your sleep problem) offer you a mandibular repositioning splint without you having to be medically diagnosed beforehand.
Why not buy a mandibular repositioning splint on-line or at the local pharmacy)?
It’s essential that the presence or absence of obstructive sleep apnoea (OSA) is established before using any treatment or ‘cure’ for snoring.
Why?
Because some people with undiagnosed OSA (remember snoring may be a symptom of OSA), do not adequately respond to oral appliance therapy (the typical online purchased stop snoring ‘cure’), and their underlying condition may continue to deteriorate, while their snoring noise is perhaps a little muffled, (so read our definitive guide to anti-snoring devices.)
It would be a bit like turning off the fire alarm (the snoring) and ignoring the fire.
Instead, consult a sleep-trained pharmacist.
Is sleep apnoea classed as a disability?
The Sleep Apnoea Trust Association 7 stated: [opens in a new tab]
Untreated, obstructive sleep apnoea can be very disabling. But it is not a disability as the condition can be treated by a simple painless non-surgical approach available entirely free of charge on the NHS. For most patients, the treatment, using a CPAP machine, is wonderfully effective and dramatic. Many users experience a return to energy levels that they have not enjoyed for many years.
The main symptoms such as constant and excessive sleepiness, memory impairment, mood swings, irritability and
under performance at work are quickly eliminated. 2 Longer term benefits are still being intensively researched, but the 20% reduction in life expectancy 3, if not diagnosed and treated, is rapidly mitigated
The best treatment for OSA on the NHS is continuous positive airway pressure (CPAP). This involves wearing a mask over the nose (or nose and mouth) during sleep, connected to a quiet pump beside the bed. It supplies slightly pressurised air to keep the throat open. The mask allows the breathing to return to normal during sleep and usually ends the snoring! Many partners enjoy sleep that they have not experienced for even longer, as they are not disturbed by their partner’s snoring any more.
When successfully treated, any concerns about driving while sleepy disappear, and no driving restrictions are imposed by the DVLA.
Do men snore more than women?
Yes. Snoring affects more men than women. However, a large neck circumference, fat deposits on the neck and a heavy set lower jaw predispose both sexes to snore.
As we get older our soft tissue loses some of its elasticity and this allows it to vibrate when the air (your breathing) passes – creating the snoring noise. After the menopause, women may snore just as much as men of a similar age.
Do dental mouthguards work for sleep apnoea?
Yes, in selected cases. Over-the-Counter (OTC) gumshields for snoring are NOT the same thing as custom-made, adjustable prescription Mandibular Repositioning Splints (MRS).
There are a few important points to remember:
- You should be screened for sleep apnoea BEFORE using any ‘mouthguard’
- Clinical research has established that OTC gumshields are not valid as a trial or therapeutic device5
Adrian has examined how to choose the best anti-snoring device ↗ and also looked at the claims made by OTC dental devices ↗ for snoring manufacturers.
Grab our free Guide about how to choose a mouthpiece to stop snoring.
What is the latest treatment for sleep apnoea?
The sleep apnoea treatment market is expanding rapidly (as are our waistlines – obesity being a compounding variable for sleep apnoea). The latest treatment today, will be superseded tomorrow.
As of May 2021, I have seen a focus on improving tongue and throat tissue tone. Various approaches, including:
- Tongue and throat exercises where you make various noises
- An electric tongue pulsing device used while awake
- A horseshoe shaped adhesive electric pulsing device attached below your jawline
The market for snoring 'cures' is vast and growing so entrepreneurs will endeavour to tap into it. My advice is to look for the clinical evidence of effect - and more than a case study (one patient).
What works best to stop snoring?
There are many variables to consider and everyone is different.
That’s why a ‘One-Size-Fits-All’ approach will never work.
See your GP or a sleep-trained pharmacist and put this question to them IN CONTEXT. They will have access to your medical (and dental history) and be able to guide YOU individually to answer: “What works best to stop snoring?”
Can snoring in children be indicative of a medical problem?
Children should not routinely snore each night: If they do, then consult your GP and seek an ENT assessment.
The ENT specialist will examine your child’s tonsils and adenoids, at the back of their throat. These can become swollen and make it hard for your child to breathe. Surgery permanently cures this.
If your child snores occasionally, perhaps because they have a cold or hayfever symptoms, then this should pass and it’s nothing to worry about.
Your GP is only human, and they may not know much about snoring and sleep apnoea. Print and take with you the: GP Guidelines for Snoring and Sleep Apnoea.
Are there societal or evolutionary ‘benefits’ from snoring?
An internet myth about snoring proposes we snore to warn off prowling predators: “I am sleeping here”, Cue caveman:
“Grrr!“
Or perhaps its a warning noise:
“Do not disturb!“?
However, it’s more likely our early, grunting ancestors, didn’t snore at all! We started to snore, as we developed the ability to speak, perhaps due to a design compromise in our throat:
Our throat must be: Flexible enough to pass food to our stomach when we swallow (the wave-like action of peristalsis).
Yet rigid enough not to collapse as we breathe. These are contradictory requirements. If we contrast man with apes, their throat is more rigid (as they do not compromise their need to breathe, to be able to talk).
Do you know someone who snores?
Share this with them.
But first, put the noise to one side for a moment, have you observed periods of silence in between their snores?
Are they sleepy when they should be awake?
The silence between snores is when they’re NOT BREATHING.
Their chest and stomach rises and falls, as they make increasing efforts to breathe, yet no air enters their lungs.
They’re suffocating.
Yes really!
Eventually, they come up from deeper sleep enough to cough, take a breath… and resume snoring.
Repeat.
All night, every night.
They wouldn’t tolerate someone strangling them while awake – yet at night the snorer with untreated sleep apnoea – does it to themselves.
Learn how you might help them by reading our Partner’s Guide ↗
Other types of sleep and breathing issues
This page has focused on how to stop snoring and treat obstructive sleep apnoea (OSA), but you should know that there are other types of sleep and breathing issues (less common) where the ‘drive’ to breathe momentarily pauses.
A review of medical history, sleep study and an expert medical diagnosis is essential before starting any treatment because some people are made worse with regular PAP therapy.
If you are concerned about your own or someone else’s sleep or daytime alertness, I urge you to consult a sleep-trained pharmacist or your GP.
You would be helping them immensely.
References
- Russell Rosenberg, Paula K. Schweitzer, Joerg Steier & Jean-Louis Pepin (2021) Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management, Postgraduate Medicine, 133:7, 772-783, DOI: 10.1080/00325481.2021.1948305
- Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol. Stradling J. and Dookun R. BDJ Mar 2009 Available here: https://www.nature.com/articles/sj.bdj.2009.214 [accessed 25 Feb 2019]
- Find GP services: https://www.nhs.uk/service-search/find-a-GP ↗ [accessed 25th July 2020]
- NHS e-referral website. Available here: https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-e-referral-service/ ↗ [accessed 29th March 2019] Updated to reflect new NHS URLs coming in July 2019
- Basyuni S, Barabas M, Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. Journal of Thoracic Disease. 2018;10(Suppl 1):S48-S56. doi:10.21037/jtd.2017.12.18. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803051/ ↗ [accessed 2nd Oct 2018]
- 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]
- Is sleep apnoea a disability? Available here: https://sleep-apnoea-trust.org/patient-information/patient-info-q-as/ ↗ [accessed 25 Feb 2019]
Medical reviewer and About the Author
Medically reviewed by:
Meet the Author:
Adrian Zacher teaches healthcare professionals how to help their patients stop snoring; sleep and breathe at the same time.
Adrian hopes to help return peace to your bedroom, without you being exploited by the countless charlatans merely interested in selling their pseudo-scientific ‘snore cures’.
ORCiD
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