HOW TO STOP SNORING:

The Definitive Guide (2018)


This Guide will tell you exactly how to stop snoring. Permanently.

And if your snoring is actually a symptom of sleep apnoea – we’ve got you covered.

Never tried to stop snoring before? This Guide walks you back, step-by-step to quiet sleep and happy rested mornings; waking up together with your partner.

Bottom line: If you want to stop snoring and sleep in the same bed as your other-half (and wake up with them smiling), you’ll love this Guide.

Snorer.com
Rated 5/5 based on 7 customer reviews

Contents:

CHAPTER 1

Signposting the treatment routes

CHAPTER 2

Assessment and screening for Obstructive Sleep Apnoea (OSA)

CHAPTER 3

Sleep testing and diagnosis

CHAPTER 4

Treatment options

CHAPTER 5

Follow-up

CHAPTER 6

FAQ

CHAPTER 1:

 

Signposting the treatment routes


Signposting or guessing?

You choose

Signposting removes the guess work of over-the-counter (OTC) snoring cures, aids and gumshields.

The Oxford English dictionary defines signposting as:

A sign giving information such as direction and distance...”

Signposting in sleep medicine, is about providing free, valid information, regarding available services and options. And pointing out the right ‘road’….

Your GP or a UK sleep-trained dentist, can then rapidly screen you for sleep apnoea, and determine if you need further investigation.

Interested? If you’re a:

  • Snorer? Sign-up as a beta-tester
  • A sleep-trained dentist (in the UK) interested in screening snorers (and where appropriate offering oral appliances)? Sign-up here 

Beta-test Snorer Signposting™ (free)

* indicates required

Snorer.com Ltd will use the information you provide on this form to stay in touch with you and to provide updates and marketing. Please let us know all the ways you would like to hear from us:

You can change your mind at any time by clicking the unsubscribe link in the footer of any email you receive from us, or by contacting us at [email protected] We will treat your information with respect. For more information about our privacy practices please visit our website. By clicking below, you agree that we may process your information in accordance with these terms. We use MailChimp as our marketing platform. By clicking below to subscribe, you acknowledge that your information will be transferred to MailChimp for processing. Learn more about MailChimp's privacy practices here.

Step 1. Create a free Snorer Signposting™ account

First, go here: we’ll insert the link to the tool when its live new window and create an account. Snorer Signposting™Signposting creates a report to give to your GP (or sleep-trained dentist) to save them clinical time and speed you on your way speeds up your care, by your completion of assessment forms, in your own time. You arrive with answers – not questions.

Register with Signposting

You need signposting because snoring may be a symptom of sleep apnoeaSee call out box and different approaches apply.

And what if you have existing medical conditions?

They need to be factored in, to ensure any snoring ‘cure’ doesn’t make a problem, while trying to fix another.

Overview of Snoring and Obstructive Sleep Apnea Guide
Need an Overview of Snoring & Sleep Apnoea and the Treatments?

Step 2: Complete your profile

Next, complete your profile.

Your data is kept securely and used to send your results and help you find local sleep services.

TIP:

Don’t forget to click the link in your email to verify you’re a human being 🙂

Complete your profile

Step 3. Begin Snorer Signposting™

Then click Start and (ideally with your partner) complete the assessment forms.

Start Signposting

The questions are in series A, B and C.

Note the blue progress bar across the top of the page.

Series A is shown below:

Start Signposting

The questions are in series A, B and C.

Series A is shown below.

Note the blue progress bar across the top.

question series A

Snorer Signposting™ checks for ‘show stopping’ symptoms of sleep apnoea and other major problems. It quickly, rules in or out, mandibular repositioning splints (MRS)We highlight jargon and use call out boxes on the right to explain.

Your GP (and optionally the sleep-trained dentist if you’re in the UK) can use the information you’ve supplied to screen you for obstructive sleep apnoea (OSA) and determine if you need further investigation.

JARGON ALERT!

MRS (Mandibular Repositioning Splint)
MAD (Mandibular Advancement Device)
Mouthpiece, Mouthguard, ‘Gumshield’, Oral Appliance, Device, Splint…
These are different names for the same thing: a dental device worn in your mouth, which holds your lower jaw forwards, to help you breathe better while asleep.

When you’ve completed series A, B and C, click the ‘Print results’ link to trigger a PDF download to your machine (default download folder).

Print out 2 copies (1 for you and 1 ready to give the Healthcare Professional).

Print your results

Logout when you’ve completed the assessments.

Your profile and logout
Technical & Regulatory info

Our Signposting tool is CE marked, software as a medical device (SaMD).
The manufacturer is Snorer.com Ltd.

Rationale and Scientific foundation

The Signposting tool is based upon the British Society of Dental Sleep Medicine (BSDSM) protocol as published in the British Dental Journal in 2009.

The protocol co-authors were Professor John Stradling MD FRCP and Dr Roy Dookun BDS (who at the time was President of the BSDSM).

The purposes of signposting include optimising the use of finite NHS diagnostic resource and defining when it is safe to proceed with an MAD without prior medical assessment and diagnosis.

Our Signposting tool is an evidence-based approach for adults with snoring and possible obstructive sleep apnea symptoms that accepts the reality that only snoring patients complaining of daytime sleepiness (somnolence), with a positive history of obstructive sleep apnea, are likely to be referred for specialist investigation. Snoring patients with no relevant medical history and a negative obstructive sleep apnea (OSA) history are unlikely to be screened at a specialist level.

If this is the case, then the presence or absence of daytime somnolence is the first critical screening factor for specialist referral and may be assessed by the Epworth Sleepiness Scale 1.

Signposting utilises the British Society of Dental Sleep Medicine’s Pre-Treatment Screening Protocol2 to signpost individuals to the most appropriate professional.

The possible signposting outcomes include:

1) Directing to a General Medical Practitioner, to seek onward referral for specialist investigation.
2) Directing to a sleep-trained dentist for screening for obstructive sleep apnea in accordance with the British Society of Dental Sleep Medicine’s (BSDSM) Pre-Treatment Screening Protocol (2). Where appropriate an MAD (Mandibular Advancement Device) may be offered.

Likely costs and the timeframe to be expected are given prior to attendance at a no-obligation appointment.

References:  
(1)  Stradling, J., 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. Snoring and the role of the GDP.  [accessed 1st July 2015]

(2) Epworth Sleepiness Scale. Johns,M. http://www.thoracic.org/members/assemblies/assemblies/srn/questionaires/ess.php [accessed 1st July 2015]

CHAPTER 2:

 

Assessment and screening


Assessment and screening occurs when a healthcare professional checks to see if your snoring needs further investigation – for example by conducting a sleep study.

Early detection confers an advantage (i.e. you “nip it in the bud”). We’re getting closer to definitively knowing:

How to stop snoring.

Step 1. Assessing and screening for sleep apnoea symptoms

When snoring (and/or drowsiness) is a problem consult your GP (Primary Care Physician – we use ‘GP’ throughout this Guide). They have your medical history to hand and they want you to be well.

Yet today, GPs are extremely time-poor. To make better use of their clinical time, you may be asked to complete assessment forms in your own time – and to return at another appointment.

Then it goes like this: (click the tab number to view your options)

When snoring (and/or daytime drowsiness) is a problem consult your GP (Primary Care Physician – we use ‘GP’ throughout this Guide). They have your medical history to hand and they want you to be well.

Yet today, the average GP is extremely time-poor. To make better use of their clinical time, you may be asked to complete an assessment form in your own time – and to return for another appointment.

So your options are: (Click the tab heading for option 2)

Sign-up for Snorer Signposting™ to complete the assessment forms in your own time BEFOREHAND:

  • Save yourself time: (both your GP or a sleep-trained dentist in the UK)
  • Get signposted to the most appropriate treatment route based upon your symptoms (and not guesses)
Fill in the forms and return once again to your GP. They will use this information, to screen you for obstructive sleep apnoea (OSA) and other related conditions, and determine if you need further investigation in a sleep unit or perhaps ENT (Ear, Nose and Throat) department. Your GP may be clued up about snoring, equally, they may not be. Currently, sleep is not part of core medical training. Download our GP Guidelines ↗ and give them to the GP (to help you both).
Waste your money on OTC (Over-the-Counter) snoring cures, aids and gumshields. Learn how to compare OTC gumshields and custom-made dental devices ↗ (known as Mandibular Repositioning Splints) and find out if chinstraps for snoring are dangerous, or safe and effective.
Fill in the forms and return once again to your GP. They will use this information, to screen you for obstructive sleep apnoea (OSA) and other related conditions, and determine if you need further investigation in a sleep unit or perhaps by referring you to an ENT (Ear, Nose and Throat) department. Your GP may be clued up about snoring, but equally, they may not be. Currently, sleep medicine in the UK and elsewhere, is not part of core medical training. Download our GP Guidelines ↗ and give them to your GP (to help you both).
Waste your money on OTC (Over-the-Counter) snoring cures, aids and gumshields. Learn how to compare OTC gumshields and custom-made dental devices ↗ (known as Mandibular Repositioning Splints) and find out if chinstraps for snoring are dangerous, or safe and effective.

Jump straight to the assessment forms: Snorer Signposting™:

Snorer Signposting™ saves (both the healthcare professional and you) an appointment, by having you complete the assessment forms your GP needs, in your own time.

Oh and its free.

Why is there no name on the printout?

When you call to make an appointment, you also give the receptionist your Snorer Signposting™ Patient ID (its on your printout top-left).

Your patient ID is used instead of your name on your assessment forms, and it connects you discreetly with your data, to protect you from accidental, careless disclosure.

Your patient ID

Answer the questions, print, post and make an appointment

1  Download our GP Guidelines for snoring and sleep apnoea new window and post them together with your Snorer Signposting™ printout (yup, good old snail mail) to your GP surgery, ahead of your appointment [to give them time to read both documents before you turn up].

2  Make an appointment with your GP, in the usual way.

3  Take your Snorer Signposting™ printout with you when you attend your appointment.

Pat yourself on the back.

You’ve taken the initiative, demonstrated your commitment to no longer snoring, and saved the healthcare professional’s clinical time (and yourself) an appointment merely to collect paperwork.

If you’re in the UK and don’t have a GP you can find one here:

https://www.nhs.uk/Service-Search/GP/LocationSearch/4

Punch in your location (PRO TIP: It works better with a place name rather than postcode).

Take your pick:

Find a GP to stop snoring

Step 2. Consult your GP

Of course, you can always consult your GP with your Snorer Signposting™ report. However, if you’re in the UK, and directed to select a sleep-trained dentist, it’s likely the NHS will consider you don’t merit treatment.

Now, the outcome of your GP appointment can go 1 of 3 ways: (Click the tab number to view the options)

Step 2. Consult your GP

Return to your GP with your completed assessment forms (ideally you completed the forms with the help of your partner – they may have a different perspective…).

Now, the outcome of your GP appointment may go 1 of 3 ways: (Click the tab numbers for options 2 and 3)

Referral

After reviewing your assessment forms, consulting your medical history and perhaps a physical examination; your GP may suspect that you’re suffering from obstructive sleep apnoea (find out more about OSA in the FAQ) or something else that is making you drowsy (as well as snore) and considers further investigation necessary. They may then refer you to a sleep unit for further investigation.

If you often experience daytime drowsiness when driving, ask someone else to take you to the appointment, as you might be told by the doctor that you cannot legally drive yourself home.

Important:

Keep hold of your referral paperwork and if you’re in the UK, visit the NHS e-referral website: https://www.ebs.ncrs.nhs.uk/login

You will need your:

  1. booking reference (first page)
  2. year of birth
  3. and the (automatically generated) password to login (that’s on the last page).

TIP: Compare waiting times. If you are prepared to travel for a consultation, you may find you can be seen sooner.

NHS e-Referral website

NHS e-Referral service

Lifestyle change & local management

If your GP does not suspect obstructive sleep apnoea (OSA) they may suggest lifestyle changes (e.g. lose weight if you’re overweight, stop smoking (if you do), quit the evening alcohol, get off your back when sleeping, exercise…).

Dental appliance for snoring

If your GP does not suspect obstructive sleep apnoea, and considers your snoring to be ‘benign’, they may offer lifestyle advice (as Outcome 2), and suggest you consult a sleep-trained dentist with a view to a prescription dental appliance, known as a custom-made mandibular repositioning splint (MRS).

Grab this ↗ free, evidence-based Guide about how to choose a ‘mouthpiece’ to stop snoring.

The NHS will not fix snoring

Bad news?

Only option 1 above (Referral) involves NHS treatment.

Options 2 and 3 require you to take action yourself.

So you’re wondering: How can I stop snoring?

If you’re given Option 2 or 3, the good news is that you’re unlikely to have sleep apnoea symptoms. But don’t feed the ‘circling sharks’ and buy an Over-the-Counter ‘cure’.

There is good evidence1 that custom-made, adjustable dental devices (mandibular repositioning splints) will help with anti-social snoring. Clinical research2 has established they are NOT the same as OTC ‘gumshields’ and they are not valid as a trial of whether a custom-made one will work.

How to compare the two types? Check out this new window expert review. And remember with your Signposting login new window you can find your nearest sleep-trained dentist.

It gets better:

In Chapter 4, we cover all the treatment options including dental devices, surgery and PAP.

What’s PAP?”

Bad news?

Only option 1 above (Referral) involves NHS treatment.

Options 2 and 3 require you to take action yourself.

So now you’re wondering: How can I stop snoring?

If you’re given Option 2 or 3, the good news is that you’re unlikely to have sleep apnoea symptoms.

Hang on: Don’t go and feed the ‘circling sharks’ by buying an over-the-counter ‘cure’.

There’s very good evidence1 that custom-made, adjustable dental devices for snoring (aka mandibular repositioning splints) will help with anti-social snoring.

Clinical research2 has established that custom-made devices are NOT the same as over-the-counter ‘gumshields’ or other mechanisms, and neither are they valid as trial of whether a custom dental device will work.

How to compare the two types? Check out this new window expert review of the criteria to judge over-the-counter and custom-made dental devices for snoring.

It gets better:

In Chapter 4, we cover all the treatment options including dental devices, surgery and PAP.

What’s PAP?”

CHAPTER 3:

Diagnosis of sleep apnoea


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.

Soon, you will sleep better – and more quietly.

Snoring and Sleep Apnoea happen for a reason

Its a ‘cause-and-effect‘ relationship, while the ’cause’ is unknown; until you’re diagnosed, the ‘effect’ is the all too familiar, loud snoring noise….

An investigation into the cause of ‘snoring’ is called an assessment. This typically includes an overnight sleep study and a review of your medical history.

All of which helps the specialist respiratory medicine physician come to a diagnosis.

When you have a diagnosis, the doctor will determine what is the most appropriate treatment, and this (finally and definitively) answers your question:

How to stop snoring?

The 3 steps are:

Step 1

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.

Its not a bad idea to take a copy of your Snorer Signposting™ printout with you as well (just in case its been mislaid).

Step 2

Some time later, you will be invited to the sleep unit (should a sleep study be considered appropriate).

Home Sleep Testing (HST) is, in the UK, the default way to examine your sleep quality and quantity. Home Sleep Testing is testing of your sleep at home, in your own bed. Learn more about home sleep testing new window

You will be loaned some sleep test equipment, to put on over your pyjamas, before you go to sleep. The sleep unit nurse 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.

sleep study equipment

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 technician. 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 tech’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 3

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 not a bad idea to take a copy of your Snorer Signposting™ printout with you as well (just in case its been mislaid).

Diagnosed with obstructive sleep apnoea syndrome (OSAS)?

If you’re diagnosed with obstructive sleep apnoea syndrome (OSAS):

  • First-line therapy is Positive Airway Pressure therapy (PAP)
  • Second-line therapy is a prescription, custom-made mandibular repositioning splint (MRS)
  • Surgery is usually only considered appropriate to enhance the use of PAP and MRS

Chapter 4 (coming up in a moment) explains more about these treatment options.

Not, diagnosed with obstructive sleep apnoea syndrome?

If you are not diagnosed with obstructive sleep apnoea syndrome of a severity that merits treatment with Positive Airway Pressure therapy (PAP) then the healthcare system of the country you live in, determines whether prescription mandibular repositioning splints (MRS) are a funded therapy:

 

  • If you’re in the UK, then you will most likely be told no NHS help is available. That said, sleep units often have an informal network of dentists that may help you as a private, fee-paying patient.
  • If you’re not in the UK, then you should discuss what options exist with your sleep doctor. In the US and in some EU countries your healthcare system may contribute to the cost of treatment.
First-line and second-line therapies

Initial and preferred therapy is known as ‘first-line’ and the backup option as ‘second-line’.

Overview of Snoring and Obstructive Sleep Apnea Guide
Need an Overview of Snoring & Sleep Apnoea and the Treatments?

CHAPTER 4:

 

Treatment of snoring and sleep apnoea


Treatment follows diagnosis.

In this chapter we’ll introduce the various prescription treatments for snoring and obstructive sleep apnoea.

The choice of treatment (made by your Doctor) is the definitive answer to your question:

How to stop snoring?

3 Categories of treatment for snoring & sleep apnoea

There are 3 categories of prescription treatment for snoring and obstructive sleep apnoea syndrome (OSAS):

  1. Dental appliances known as Mandibular Repositioning Splints (MRS)
  2. Positive Airway Pressure (PAP)
  3. Surgery (both soft and hard tissue in the nasal and respiratory airway) and bariatric (stomach surgery to reduce weight)

Your sleep Doctor will determine which category of therapy is most appropriate for you. Also, if you’re in the UK your sleep-trained dentist may offer you a prescription, custom-made MRS if you do not require further investigation.

 Mandibular Repositioning Splints (MRS)

Mandibular repositioning splints are dental appliances that splint open your airway. They hold your lower jaw (mandible) forwards while you sleep. Moving your jaw forwards also moves your tongue away from the back of your throat and tensions your soft palate.

The effect of an MRS is similar to that of the anaesthetist’s hands with an unconscious patient. The dental appliance moves the jaw forwards (and in turn the tongue) to open your airway and help you breathe.

Mandibular repositioning splints mechanically open the airway in your throat
What happens next?

The sleep-trained dentist will assess your suitability (from a dental perspective) for an oral appliance.
Factors include ability to protrude your lower jaw more than 5mm, oral hygiene, jaw-joint health, number and distribution of teeth.
If an oral appliance is 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). This information is then sent to a specialist dental laboratory for the dental technician to make your oral appliance. When it is fitted you will learn how to insert, remove and perhaps how to adjust it. You will be requested to visit the dentist again in a week to two weeks, and again at regular intervals.

How to choose a '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 one 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.

Anti-Snoring Device Guide

Meet the co-authors

Adrian Zacher. Click for full profile [new tab]

Adrian Zacher MBA

Author and founder of Snorer.com, co-founder and former CEO of the British Society of Dental Sleep Medicine

Dr Roy Dookun BDS

Dr Roy Dookun BDS

Co-founder and former President of the British Society of Dental Sleep Medicine

Dr Shouresh Charkhandeh DDS Click for full profile [new tab]

Dr Shouresh Charkhandeh DDS

Award-winning Dental Sleep Medicine Dentist

 Positive Airway Pressure (PAP) therapy

Positive Airway Pressure or PAP therapy is considered the ‘gold standard’ or reference therapy for obstructive sleep apnoea.

A mask is worn over your nose (and/or mouth) and air is pumped in under pressure.

As you breathe IN more air is supplied to prevent your airway narrowing or collapsing.

For those who can tolerate PAP (an arduous therapy) it’s absolutely transformative.

PAP therapy pneumatically splints open your airway while you sleep
Positive Airway Pressure (PAP) therapy pneumatically splints open your airway while you sleep

The left-hand image illustrates airway narrowing on breathing in. The right-hand image illustrates how PAP prevents this.

What happens next?

Sleep apnea treatment with Positive Airway Pressure therapy

Have a PAP mask fitting 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 the sleep unit nurse 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

Collect your own PAP machine 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 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).

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.

Snoring & Obstructive Sleep Apnoea Overview

Meet the co-authors

Adrian Zacher. Click for full profile [new tab]

Adrian Zacher MBA

Author and founder of Snorer.com,
co-founder and former CEO of the British Society of Dental Sleep Medicine

Dr Lizzie Hill PhD Click for full profile [new tab]

Dr Lizzie Hill PhD

Registered Polysomnographic Technologist

 Surgery for snoring and obstructive sleep apnoea

Surgery (both soft and hard tissue)

Soft tissue surgery is considered appropriate to enhance the use of mandibular repositioning splints and PAP.

Hard tissue surgery (surgery on the bones of your face) is intended to eliminate the need for MRS and PAP.

Soft tissue surgery, includes surgery on the inside of your nose, soft palate (uvulopalatopharyngoplasty) and base of your tongue.

Hard tissue surgery will change the way you look. It moves the bones of your face.

Exceptionally, bariatric surgery may be considered when your health and quality of life are impacted by obesity. Qualifying criteria vary – consult your doctor.

Uvulopalatopharyngoplasty (UPPP)
Soft tissue surgery (UPPP)
Bi-maxillary osteotomy
Hard tissue (bone)

Bi-maxillary osteotomy.

What happens next?

Accuracy of the diagnosis is essential for surgery to provide a satisfactory result. Sleep nasendoscopy is sometimes performed to confirm the surgical site.

Read our Surgical Guide ↗ for a jargon-decoded explanation of all 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
  • When surgery is considered appropriate
  • Includes ‘non-gory’ image explanations
  • Details of support groups

No signup is required.
No credit card.
Nothing at all in fact.
We do this to help – because we can.

Snoring & Obstructive Sleep Apnoea Overview

Meet the co-authors

Adrian Zacher. Click for full profile [new tab]

Adrian Zacher MBA

Author and founder of Snorer.com, co-founder and former CEO of the British Society of Dental Sleep Medicine

Professor Bhik Kotecha Click for full profile [new tab]

Professor Bhik Kotecha MB, MPhil, FRCS (Ed, Eng, Orl), DLO

Professor Bhik Kotecha is the Clinical Lead for the Sleep Disorders Unit at the Royal National Throat, Nose & Ear Hospital, London.

Professor Iain Ormiston FRCS Click for full profile [new tab]

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.

CHAPTER 5:

Follow-up


Follow-up for both snorers and those with OSA is essential.

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

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:

  1. Their mandibular repositioning splint continues to provide satisfactory control of their snoring
  2. Or, if their snoring has developed into sleep apnoea

What should follow-up look like?

MRS therapy follow-up 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 test 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 follow-up 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 follow-up Surgery for snoring. It is vital that follow-up home sleep testing 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.

Regrettably, follow-up and symptomatic treatment of ‘snoring’ without any, or perhaps inadequate assessment of sleep apnoea symptoms, is today encouraged or through regulatory inaction, effectively condoned.

Consequently, the snorer and partner are exploited for profit:

  • Some custom dental appliance manufacturers (with a short-term view) may neglect to mention to dentists who prescribe mandibular repositioning splint therapy, that without sleep training, the dentist is practising outside the bounds of both their expertise and professional indemnity insurance. Shameless plug for on-demand sleep training for dentists new window
  • Over-the-counter (OTC) mandibular repositioning splints are commonly sold on-line and in the pharmacy as Class 1 (low-risk) devices. This is (in my assessment) irresponsible and typically delays effective treatment of sleep apnoea and its co-morbidities. Check out this exhaustive post new window about the silly claims the manufacturers make.
  • Finally, medical professionals may wish to reconsider condoning or suggesting a snoring patient use an over-the-counter gadget not least because they might find themselves personally liable for the harm such oral appliances can cause to the teeth and jaw joints, because oral appliance therapy is the practice of dentistry.

Snoring and sleep apnoea both change as we get older (and typically gain weight).

Our lifestyle may also change, so in summary:

What works tonight, may not work tomorrow night.

CHAPTER 6:

 

FAQ


We conclude with a snoring and sleep apnoea Frequently Asked Questions (FAQ) section. There’s more here than ‘How to stop snoring?’

Ask your question below or email us [email protected] if we don’t personally know the answer – we’ll find someone who does!

Please note we cannot give medical advice.

Snoring and sleep apnea FAQ
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
Snoring: a technical explanation
Assume a fixed volume of air travels into your lungs while you sleep (typically this is around is 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 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. ↗
How do you treat sleep apnoea naturally?
Sleep apnoea naturally occurs predominantly to men over the age of 50, when they smoke, put a little weight on and drink alcohol in the evening. Not smoking, losing excess weight and avoiding evening alcohol will dramatically improve your breathing while asleep. This is not a ‘treatment’ for sleep apnoea but more of a way to limit your risk through lifestyle changes. However, you must remember that some people are predisposed to have sleep apnoea, come what may.
How to 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…? 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 you need expert signposting and professional screening and assessment.
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! Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.
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, these 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, your GP is the first person to contact 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.

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).
Why do anything about snoring?
You mean apart from not being anti-social?! Snoring may be a symptom of Obstructive Sleep Apnea (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 apnea (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 ‘apneaic 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…
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 apnea 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 apnea, 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 apnea 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. Q. Is treatment really necessary? A. 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 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 if a mandibular repositioning splint is suggested?
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 a mandibular repositioning splint may not a good idea. You must have sufficient good teeth in both jaws to hold the MRS in place.
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 apnea (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 pharmacy bought stop snoring ‘cure’), and their underlying condition may continue to deteriorate, while their snoring noise is perhaps a little muffled, (but this is not a definitive guide to anti-snoring devices. This is.) It would be a bit like turning off the fire alarm (the snoring) and ignoring the fire.
Is sleep apnoea classed as a disability?
The Sleep Apnoea Trust Association state: http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/sleep-apnoea-frequently-asked-questions/#obstructive-sleep-apnoea-osa-disability-equality-act-2010 [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 expectancy3, 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.
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 ‘apneaic 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…
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 device* 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 apnea). The latest treatment today, will be superseded tomorrow. As of June 2018, I have seen a novel CPAP launch that permits the use of ‘low-flow’ positive air pressure (high air pressure being a major cause of treatment non-use). Check them out Fresca Medical.
What works best to stop snoring?
Wow. What a question! There are so 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 dentist 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

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?

The silence 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 snoring and 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 professional. You would be helping them immensely.

Now, over to you

You’ve read about how to stop snoring. Now, it’s time to act.

  • What are you going to do?
  • Does snoring mean you sleep separately?
  • Did this Definitive Guide help?

Comment or write a review and let us know.

Thanks, Adrian & Emma.

Comment or write a review about how you will stop snoring
default image

Mike McEwan

An excellent overview and specific advice. Very useful.

Mike McEwan How to stop snoring Guide October 6, 2018

Add your review

What are you reviewing? Please enter its name

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


References

Click to view the References
  1. 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]
  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]

Signposting is a CE mark marked, Clinical Decision Support System, Software as a Medical Device. The Manufacturer is Snorer.com Ltd.

Created by Adrian Zacher and Emma Easton. All rights reserved. Last updated 6th October 2018.