Do Anti Snore Pillows work? (Sleep-Expert Review 2019)

Do Anti Snore Pillows work? (Sleep-Expert Review 2019)

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

Anti snore pillows: Do they work?

Anti snore pillows seem ideal: an easy and comfy way to return peace and quiet to your bedroom…

But:

Do they really stop you snoring? 

If you’re thinking of buying an anti snore pillow, then read this independent (no advertisements or affiliate links!) sleep-industry expert review.

I examine:

  • How anti snore pillows claim to work
  • What the clinical evidence tells us 
  • What the experts say
Adrian Zacher MBA

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

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

Google Scholar

Tired of the sleepiness and the snoring?

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

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

CAUTION: Snoring may be a symptom of Obstructive Sleep Apnoea / Apnea (OSA)

Without first being screened for obstructive sleep apnoea (OSA) your purchase of an anti-snore pillow could be delaying your diagnosis and effective treatment (should your snoring be a symptom of OSA.)

A treatment that will prolong your healthy life!

Get signposted to the most appropriate professional (it’s free!)

The professional will screen you for OSA and decide if you’re ‘just’ a snorer or if your snoring needs investigating.

Your GP may be able to help you. Or if you live the UK, you can also find sleep-trained dentists who can screen you and recognise Obstructive Sleep Apnoea/Apnea (OSA) symptoms. These dentists can also provide you with a custom-made anti-snoring device.

Anti snore pillows (How they claim to work)

Various anti snore pillows are available, yet they share design similarities:

They’re either ‘door-wedge’ shaped or double-curved with the hollow being where you place your head.

In this independent review, I look past the marketing ‘hype’ and examine the science (if there is any) behind their claims:

sleep on your side Encouraging you to sleep on your side
better breathing by supporting your head and neck Encouraging better breathing by supporting your head and neck
better body alignment Encouraging better body alignment (whatever that is)

 

So we have 3 claims to review:

Anti Snore Pillows (What I'm not including in this review)

There’s another type of anti snore pillow that I’m not including in this review.

They’re the expensive (circa 300 USD) ‘high tech nudge’ pillows that don’t treat your snoring – they merely disturb your sleep in some way when a snore is detected. They wake you up enough to regain muscle tone in your throat.

Some manufacturers claim that after a while you will get used to this pillow movement and regain tone in your throat without waking up.

The jury is out on this.

No. 1. Anti Snore Pillows make you sleep on your side

Why? Why is sleeping on your side an aim? And how does that help stop snoring?

Think First Aid.

Are you familiar with the ‘Recovery Position’? Perhaps you should be!

This is when the unconscious individual is moved by a first-aider off their back into a semi-prone position known as the ‘Recovery Position’ to help them breathe.

We’ll come back to how this relates to snoring and anti snore pillows, later in this post (it’s called positional therapy).

Check out the video below about the Recovery Position by the St John’s Ambulance. It’s all about ensuring you can breathe when unconscious.

Here’s an authentic and less than favourable review of an anti snore pillow in the Huffington Post

The Recovery Position (YouTube video) by the St John’s Ambulance.

No.2. Anti Snore Pillows support your neck

According to the NHS ↗, the most common cause of neck pain is when your neck has become locked in an awkward position while sleeping.

But what’s neck pain got to do with snoring?

Allow me to explain:

If your pillow inadequately supports your neck while you sleep, and your head is on your shoulder. Then the airway in your twisted neck may become restricted.

And you guessed it:

You snore.

Anti snore pillow neck ache
So, there is merit in supporting your neck while you sleep:
  • From both a neck pain perspective
  • And if your current pillow could be improved upon, it seems reasonable it could improve your breathing while you sleep

But unless your pillow is truly terrible and you routinely wake-up with neck pain from a strange sleeping position;

I would not expect it to stop you snoring.

But what do the experts say?

What do the experts say about anti snore pillows?

Clinical experts research products or theories to establish if it does or doesn’t work. You can think of it as proof or as close as possible to ‘fact’.

There is good evidence that positional therapy i.e. training the individual NOT to sleep on their back (No. 1 in this review) can help stop snoring1.

What do the experts say about anti snore pillows?

No. 3. Anti Snore Pillows stop snoring by encouraging 'Better Body Alignment'

Encouraging better ‘body alignment’ (as in sleeping with your head and body straight and your neck not bent) would on the face of it seem reasonable.

Perhaps if you were to sleep with your neck at an acute angle (as I mentioned in my review of claim No. 2) then yes the airway in your throat would be restricted and it could make you snore.

However, marketing a pillow with a supposed anti snore feature being improved ‘body alignment’, is I think reaching a little.

Anti snore pillows are they the most effective positional therapy device?

The Real Question

So if positional therapy has some validity as a way to stop snoring, the real question is:

Are anti snore pillows the most effective positional therapy device?

And to answer that I will:

  • Look a little closer at positional therapy
  • Provide a rough cost/benefit analysis
  • Review what the experts advise

Unless your pillow is truly terrible, I would not expect a new one to stop you snoring.

Adrian Zacher MBA

Snoring & Sleep Apnoea Care Navigator

Positional therapy for snoring and sleep apnoea

Turn over you're snoring!

Positional therapy for snoring is ‘as old as the hills‘. Think tennis ball in the breast pocket of a t-shirt worn back to front.

Position dependent snoring1 is the technical name for when snoring either stops or lessens in different (not on your back) sleep positions.

Fortunately things have moved on some from tennis balls and anti snore pillows.

I’m not going to review the various high tech ways to or my experience of them here.

Suffice to say positional therapy may be useful IN ADDITION to:

  • A prescription, custom-made anti-snoring device
  • Positive Airway Pressure therapy

To get either of these you’ll need to know what you’re trying to ‘fix’. As in not self-diagnose yourself.

Keep reading:

Sleeping prone or on your front with an anti snore pillow

My personal experience of an anti snore pillow

When I rolled over and tried to sleep prone (on my front) my wife reported that the part of the pillow designed to support my neck when I slept on my side, pushed against my throat.

It appeared to be collapsing my airway!

She said I was making some very strange noises…

However, I continue to use an orthopaedic neck support pillow (remarkably similar shape!) and wouldn’t used anything else. I’ve learnt not to sleep quite so flat on my face!

Are they worth the money?

Anti Snore Pillows (Cost/Benefit Analysis)

Are anti snore pillows worth the money?

From a financial perspective its hard to beat the tennis ball in the pocket of the t-shirt.

With anti snore pillows on the market from 5 GBP they may be worth a punt.

However, you need to be aware of these limitations:

  • The tennis ball or anti snore pillow might not be enough to stop the snorer sleeping on their back (they just ignore it)
  • You have no evidence of effect throughout the night (other than the lack of a partner’s elbow in the ribs!)

Anti Snore Pillow: Costs

Anti snore pillow prices online and in the shops range from as little as 5 GBP to 25 GBP.

As a first-line and relatively harmless way to stop snoring they probably make financial sense.

However (and it’s a big HOWEVER) if they don’t stop the snoring problem then you need to seek the advice of a professional.

Pretty much everything is going to cost more than a tennis ball or a stop snoring pillow, but if you’re serious about no longer snoring, then consult a professional. There are considerable drawbacks to self-diagnosis.

  • If you have mild to moderate obstructive sleep apnoea (OSA) and you’re using an oral appliance then some data to show you turned over and your sleep has improved might be worthwhile.
  • If you’re on an auto-titrating PAP then getting off your back may reduce pressure and make PAP more tolerable.

Are you trying to ‘cure the snore?‘ (Before you know what’s wrong?)

Trying to ‘cure the snore’ before you know why you snore – is like driving a car before you’ve passed your test.

Wrong

You might think you can drive – but you could be on the wrong side of the road!

Treatment (the ‘cure’ for the snore) follows diagnosis i.e. find out if your snoring is more than just anti-social before trying to ‘cure’ it – for this you need signposting.

What about anti-snoring devices?

If anti snore pillows aren’t helping then you might wonder what else is available. Enter anti snoring devices.

Anti-snoring devices are commonly oral appliances you wear in your mouth at night.

They work by holding your lower jaw in a more forward position. This keeps your tongue away from the back of your throat so you don’t snore.

What’s the best anti-snoring device?

Example of an anti-snoring device

Example of an anti-snoring device. Image courtesy of SomnoMed and used with permission.

What about surgery?

A long way from an anti snore pillow…

Surgery for snoring is divided into whether hard and soft tissue is involved.

Soft tissue surgery is intended to improve the effect of an anti-snoring device or PAP therapy (more about what PAP is in a moment).

Whereas hard tissue surgery (that changes the way you look) is intended to eliminate the need for any other treatment.

Learn more:

Radio-frequency ablation for snoring

Image representing a soft tissue operation: radio-frequency palatal surgery.

Image representing a hard tissue operation: bi-maxillary osteotomy (both jaws operated on).

What about CPAP?

There are pillows especially designed for PAP users. Keep reading:

CPAP stands for Continuous Positive Airway Pressure therapy. Today, it is referred to as just PAP.

PAP works by providing low pressure air (through a mask worn over your nose and sometimes both your nose and mouth) to the airway in your throat. This pneumatically holds open your airway.

While an arduous therapy, it is highly effective if snoring is actually a symptom of obstructive sleep apnoea (OSA).

Learn more:

Example of a full face PAP mask

Do’s

Don’ts

  • Don’t self-diagnose yourself as ‘just’ snoring
  • Don’t buy over-the-counter stop snoring gadgets
  • Don’t ignore drowsiness or sleepiness during your normal awake time (consult your GP)
  • Signposting to the right professional

    When self-help and pillows aren’t helping it’s time to get serious.

    Signposting is when you’re directed to the most appropriate expert to help you stop snoring.

    The expert professional (your GP, additionally if you’re in the UK a sleep-trained dentist2) will screen you for sleep apnoea and decide if you need further investigation i.e. a sleep study.

    If you don’t need a sleep study a custom-made anti-snoring device (available from the sleep-trained dentist) is the first way to stop snoring and treat mild to moderate OSA3.

    Oh and signposting is free.

    Signposting to the right professional to stop snoring

    Summary

    My final verdict is that anti snore pillows are a relatively low-cost way to try to stop snoring. But don’t get your hopes up.

    You need to be comfortable to sleep well, so find a pillow that helps you sleep comfortably on your side and supports your neck. Consider orthopaedic pillows in addition to the big headline grabbing brands.

    When snoring is a problem consult a professional. If you’re in the UK you can get signposted to the right type.

    Otherwise consult your primary care physician. They have your medical history and want you to be well (they’re not trying to sell you something!)

    A final note about high tech anti snore ‘nudge pillows’:

    I’d like to see the impact this type of anti snore pillow has on the individual’s sleep quality.

    They appear to me to be fragmenting sleep and preventing deep restorative sleep from occurring. I consider the onus upon the pillow manufacturers to substantiate their marketing claim.

    And I come back to the fact that this is a ‘treatment’ before knowing why you snore: there has been no prior assessment or screening for sleep apnoea.

    Reviews

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    If you are looking for impartial advice about snoring from an expert in the field, the highly respected Adrian Zacher should be your go to. We applaud Adrian’s work, to raise awareness about the health implications of snoring, and the importance of custom-made devices for long-term success.

    Lucie Ash Director Somnowell How to choose the best anti-snoring device September 7, 2018

    Found this useful?

    Let others know what you think.

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


    Here are some more high quality, independent sleep-expert reviews of anti-snoring devices, snoring and sleep apnoea / apnea products, cures and aids!

    Glossary

    Anti-Snoring Device – generally considered a product worn in your mouth to stop you snoring.

    Custom-made – a bespoke device made specifically for you by a registered dental technician, working to prescription, using CE marked materials. In Europe working to the Medical Devices Directive  administered in the UK by the Medicines and Healthcare Products Regulatory Authority (MHRA)

    OSA Obstructive Sleep Apnoea – (also spelt apnea) When an individual is unable to sleep and breathe at the same time. Visually, a repetitive pattern of breathing interruptions (apnoeas) occurring while the individual sleeps, due to a physical obstruction in the airway.

    OTC – Over-the-Counter product sold over the pharmacy counter or on-line without prescription, medical or dental assessment and without a review of medical/dental history.

    Signposting – Is the medical term for directing people to the most appropriate professional to help them based upon their answers to some high-level questions.

    Sleep-trained Dentist – A dentist that has undergone special interest training in sleep. As such they are able to obtain professional indemnity insurance.

    References

    1. Benoist LB, Morong S, van Maanen JP, et al. Evaluation of position dependency in non-apneic snorers. Eur Arch Otohinolaryngol. 2013;271(1):189–94. https://link.springer.com/article/10.1007/s00405-013-2570-5  new window
    2. Stradling, J. and Dookun, R. 2009, Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol, British Dental Journal, 206, 307 – 312. Available here: http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html new window [accessed 12 April 2017]
    3. The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first line treatment for patients diagnosed with mild to moderate OSA. https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/ new window

    Created by Adrian Zacher | Page last updated 3rd June 2019

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

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

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

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

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

    So, if you’re wondering:

    Do chin straps work? Are they safe and effective?

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

    Adrian Zacher MBA

    Adrian Zacher MBA

    Author, Snoring and Sleep Apnoea Care Navigator

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

    Google Scholar

    Tired of the sleepiness and the snoring?

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

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

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

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

    This makes the snoring noise

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

    Sounds good in principle…

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

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

    So its a reasonable question to ask:

    Do chin straps make snoring better or worse?

     

    Do chin straps make snoring better or worse?

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

    If you sleep on your back

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

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

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

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

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

     

    What happens in your throat when you use a chinstrap?

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

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

    On the far left the airway is normal and open.

    Breathing occurs freely and quietly.

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

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

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

    More about them later in this post.

    How does jaw position relate to snoring?

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


    Video length = 26 seconds

    chin straps and airway volume

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

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

    A chinstrap moves your jaw the wrong way.

     

    What does the clinical research say about chin straps?

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

    Which is not the case at all

    The key things to know about chin straps are:

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

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

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

    They continued:

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

    Here’s the pertinent extract:

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

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

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

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

    A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring.

    Bhat, S, et al, 2014. Journal of Clinical Sleep Medicine

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

    Good to know:

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

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

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

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

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

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

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

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

    When snoring is a problem…

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

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

    What about Mouthpieces?

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

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

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

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

    chinstrap or dental device for snoring?

    What about Surgery?

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

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

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

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

    What about surgery for snoring?

    Summary

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

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

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

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

    OSA if left untreated may:

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

    Thanks for reading. Now share this with your long suffering friends. (If you dare!)

    Created by Adrian Zacher. Last updated 19th June 2019.

    Related reviews

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

    Glossary

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

    References

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

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

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

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

    5. Mouth closing device (chinstrap) reduces mouth leak during nasal CPAP. Bachour, Adel et al. 2004, Sleep Medicine, Volume 5, Issue 3, 261 – 267 https://www.sleep-journal.com/article/S1389-9457(03)00252-1/abstract new window [accessed 24th May 2018]

     

    Reviews

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

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

    Sylvia Explanation of subject May 26, 2018

    I HATE Instant Snoring ‘Cures’ – they Do More Harm than Good [2019]

    I HATE Instant Snoring ‘Cures’ – they Do More Harm than Good [2019]

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

    It starts off like this:

    Imagine, you have a snoring problem and like so many people, you search online for a ‘cure’, a quick fix – and in no time at all there it is:

    Your instant snoring cure!

    Sold to you with all sorts of promises, guarantees and ‘testimonials’ – etc. etc.

    What could possibly go wrong? 

    I HATE instant snoring ‘cures’ because they do more harm than good.

    What annoys me about supposed instant ‘snoring cures’, aids, strips and goodness knows what gadgets, is that unscrupulous businesses are simply exploiting desperate snorers (and their families and partners) for profit, without giving a damn about the punter; the harm their ‘cures’ do and the delay the cause, in obtaining actual help.

    Such businesses encourage the desperate to part with their cash by asking daft questions, such as:

    ‘Work out what kind of snorer you are’

    Read self-diagnose to then sell them a supposed instant ‘snoring cure’ to ‘treat’ snoring.

    The merit (or otherwise) of the supposed ‘cure’ is one thing, but:

    The individual is unable to distinguish between anti-social, nuisance snoring and obstructive sleep apnoea

    It is a SCAM and a dangerous one at that. Funnily enough they will have just the cure you need in stock!

    That’s a surprise isn’t it…

    Here’s an analogy

    If you cannot see properly – do you guess what lenses you need and fit your own glasses?

    No of course you don’t.

    You get assessed, diagnosed and provided with the right ones.

    Key points are:

    1  Assessment
    2  Diagnosis
    3  Prescription treatment

    In that order – by a Professional.

    Snoring is no different.

    It’s not a joke: 

    In fact it could be very serious indeed.

    So, if you’re thinking about a ‘cure’ then get signposted to the most appropriate professional to help you. 

    Read on…

    Let’s break your argument down

    You’re the expert right?

    Its your snoring after all – and your mouth, teeth and gums too. What would a Dentist know about teeth and gums?

    Yes exactly:

    A lot.

    But Snoring? What do Dentists know about that?

    Instant snoring cures are most commonly things you wear in your mouth. Some Dentists (see below) choose to develop a special interest in snoring or more correctly ‘sleep-related breathing disorders’ (SRBD) and they should be your first call when you’re thinking of a snoring cure.

    Think about it 

    You’re going to wear this thing in your mouth while you are ASLEEP and depend upon it to keep your throat open, so you can breathe and sleep at the same time (and pray it doesn’t break and you end up inhaling or swallowing it…)

    Dunno about you but I like breathing… and not having bits of broken gadget in my lungs…

    That’s apart from the impact your instant snoring cure WILL have on your teeth, your gums and jaw-joints…

    Click for: Dentists with a special interest in sleep

    The lesson here is to see someone who knows what they are doing (and hasn’t just been on a manufacturer’s half-day course)

    Both snoring and sleep apnoea / apnea deserve proper assessment, diagnosis and treatment. Not muffling with a ‘quick fix’ cure or gadget.

    You might have seen some blurb for instant snoring gumshields online, at the Pharmacy, Dentist, Doctors or perhaps read about them here and there.

    They are all over the internet.

    You might have even read our Free NHS England’s Information Standard accredited Guide about
    “How to choose a ‘mouthpiece'” and perhaps thought: – 

    “Yeah that’s obviously a sales pitch as its co-written by a Dentist… and Dentists just want to make money right – so they’re going to say that Dentist fitted mouthpieces are better!”

     

    Well, you’d be wrong:

    We don’t sell anti-snoring gadgets, potions, cures, sprays or aids…..!

    Get signposted to the most appropriate professional to help you stop snoring
    (hint: it’s free)

    How to stop snoring: The definitive, step-by-step Guide

    What’s your beef with instant stop snoring ‘cures?’

    I particularly hate instant snoring cures worn in your mouth, as the balance of side-effects versus benefits, is generally not in your favour:

    All anti-snoring mouthpieces have side-effects

    This is true for both instant and professional fit/custom-made ones fitted by a dentist.

    It is simply a risk/benefit analysis.

    This means you may well suffer some irreversible harm – or – if you get lucky just waste your money

    Let’s clear this up now:

    Anti-snoring mouthpieces may also be described as splints, gumshields, mandibular repositioning devices, oral devices and appliances. Or combinations of these terms. You may see: MRD, MAS, MAD…

    But this is not a post comparing the merits of Over-the-Counter versus Custom-Made Mandibular Advancement Devices.
    This is.

    You should be screened for sleep apnoea before using ANY ‘cure’

    Assuming you are not keen on being exploited by the unscrupulous ‘quick fix’ gang selling ‘cures’ and snake oil, or are into hurting yourself… and you want to stop snoring – you should be screened for obstructive sleep apnoea symptoms first.

    Snoring may be warning sign of Obstructive Sleep Apnoea/Apnea (OSA).

    You need knowledge and criteria for choice (which is what Snorer.com is all about):

    How you can tell if the sleep-trained dentist knows their stuff?

    Some simple questions to ask:

    • Are they a member of a professional dental sleep organisation?
    • Ask them what training they have in sleep
    • Are they insured to provide anti-snoring mouthpieces?
    • Do they offer a range of custom-made anti-snoring mouthpieces?
    • Ask to see example mouthpieces (they should have at least 2 or 3 different designs)
    • Do they work with a local hospital sleep/ENT department?

    The responsible sleep-trained Dentist doesn’t just ‘fit’ you with an anti-snoring mouthpiece and wave goodbye.

    They are going to make sure that your snoring isn’t a sign of obstructive sleep apnoea (OSA)

    And if they are concerned refer you for specialist investigation. The Dentist will assess you including examination of your teeth, gums and jaw joint, to ensure that they are healthy and are able to withstand the loads the anti-snoring mouthpiece will place upon them.

    And to establish the situation now before you start using the mouthpiece (so change may be monitored) they will take x-rays of your teeth (or if fairly recent x-rays exist – request sight of them from your regular dentist).

    They will establish that your nasal airway is satisfactory, they will assess the size of your tongue, soft palate and oral tissues. The list goes on and on. They will also keep what is known as ‘master casts’ (records of the position of your teeth). Oh and their training is recognised by their professional indemnity insurer.

    They do this to ensure they don’t make a problem while trying to ‘cure’ your snoring

    The ideal anti-snoring mouthpiece doesn’t exist

    The ideal anti-snoring mouthpiece yet exist – but fear not. Getting close to perfect for you is something that the expert sleep-trained Dentist can help you with (it depends upon many things eg: how many teeth you have and where, whether you grind your teeth [bruxism] and how much you can protrude [push your jaw forwards] amongst other things).

    The feature set below should help you have a more informed conversation:

    1. Cheap (or very durable and can be modified if you lose a tooth)
    2. Has good retention
    3. Is adjustable
    4. Isn’t bulky
    5. Comfort (as in you can use it)
    6. Has minimal side effects
    7. Is easy to keep clean

    Point 1

    Cheap – Click here to learn more

    Point 2

    Retention – Click here to learn more

    Point 3

    Adjustable – Click here to learn more

    Point 4

    Bulky – Click here to learn more

    Point 5

    Comfort – Click here to learn more

    Point 6

    Side Effects – Click here to learn more

    Summary

    Today, you have to be alert for scams online, in the Post, on the telephone, pretty much everywhere. (I even received a scam phone call while typing this).

    Please use your head.

    If it looks too good to be true – then don’t fall for it. Snoring may well be nothing more than a nuisance, but it could be obstructive sleep apnoea.

    Self ‘diagnosing’ and ‘treating’ yourself with gimmicks and instant ‘cures’ is NOT a cost saving, it may well do you harm and mask a real problem that needs investigating and treating properly, regardless of whether it’s ‘just’ snoring or sleep apnoea.

    Oh, and NO I am not a dentist.

    Keep doing your homework by reading our impartial (we don’t sell them) comparison and review posts in the Related section below:

    Created by Adrian Zacher. Page last updated 23rd March 2019

    Related

    Here are some more high quality Guides and reviews of snoring ‘cures’, aids and gadgets:

    Found this useful?

    Let me know:

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

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

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

    Dental devices for snoring: available without prescription

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

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

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

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

    What else should you know?

    Let’s find out…

    Adrian Zacher MBA

    Adrian Zacher MBA

    Author, Snoring and Sleep Apnoea Care Navigator

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

    Google Scholar

    Tired of the sleepiness and the snoring?

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

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

    Claim 1 – OTC dental devices stop your snoring

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

    Verdict: Do OTC dental devices stop your snoring?

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

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

    in other words… “they don’t work”.

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

    Let’s continue…

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

    Emma Copeland,
    Health Which?

    stop OTC devices don't work

    Claim 2
    Does what the expensive ones do

    You might think:

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

    Which on the face of it, seems reasonable…

    Verdict – Are they the same as the expensive ones?

    Clinical research2 has shown that OTC dental devices bear little resemblance to custom-made ones.

    But it’s harmless right?

    No.

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

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

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

    OTC beaten up

    Claim 3 – OTC dental devices for snoring are cheap

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

    DIY appears to save money, but….

     

    What are the risks of bypassing Dentists?

    Verdict - Are OTC dental devices for snoring actually 'cheap'?

    Moving past the medical risks of self-diagnosis for a moment…. which we’ll come to in Claim 5.

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

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

    What does the sleep-trained dentist do?

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

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

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

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

    OTC dental devices for snoring ultimately cost you more money and cause you pain

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

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

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

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

    Risky Business

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

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

    Permanent pain and occlusal change

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

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

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

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

    Claim 4 – Easy to self-fit

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

    Are you?

    Verdict - Are you OK and are they easy to self-fit?

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

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

    Repeat this for the other jaw.

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

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

    It won’t work.

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

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

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

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

    Ouch.

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

    Both are essential

    pants

    Claim 5 – Quick Fix – No need to wait

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

    I’ve highlighted the importance of the dental role.

    But is a medical assessment essential?

    Verdict - Is it a 'quick fix'?

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

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

    Claim 6 – Adjustable in protrusion

    (How much they push your chin forwards)

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

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

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

    Outcome: It won’t work

    Problems with the volume control

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

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

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

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

    stop snoring

    Claim 7 –
    Fits most people’s teeth and jaws

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

    and here’s the thing:

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

     

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

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

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

    You guessed it…  

    It won’t work

    Where everything gets lost with which Regulator is responsible

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

    The result of all the above?

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

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

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

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

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

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

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

    silent
    Do You Recall This Materials Scandal?

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

    Do you remember this?

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

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

    Surely consulting an expert is no-brainer…?

    CE mark

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

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

    Verdict - Are OTC dental devices for snoring 'Low-Risk'?

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

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

    OSA trivialised

    This trivialises undiagnosed sleep apnoea / apnea

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

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

    ——————–

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

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

    OTC dental device for snoring Disclaimer - what does this tell you?

    Seriously, when you see disclaimers and legal notices like the below on a page – what does it tell you?!

    OTC disclaimer

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

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

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

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

    Scandalous

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

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

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

    What an indictment!

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

    In this way, they’re:

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

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

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

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

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

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

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

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

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

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

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

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

     

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

    Conclusion

    Time and Money

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

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

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

    PostScript

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

    They would then be personally liable for the dental consequences.

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

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

    Found this useful?

    Let others know what you think.

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


    References

    References

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

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

    CE mark Snorer.me signposting is CE marked, clinical decision support software, software as a medical device. 

    manufacturer Manufacturer is Snorer.com Ltd. 2 Baynards Green Farm Cottage, Baynards Green, Bicester, OX27 7SG, UK.

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