How to stop snoring (The definitive, step-by-step Guide 2019)

How to stop snoring (The definitive, step-by-step Guide 2019)

HOW TO STOP SNORING:

The Definitive Guide

By Adrian Zacher

2019 edition


Nobody wants to snore. So when it’s time to stop, this step-by-step, evidence-based, definitive guide will tell you exactly how. And if your snoring is actually a symptom of sleep apnoea – we’ve got you covered.

Bottom line: If you will work with the same types of medical and dental professionals that you already trust to care for you, you will:

  • Quickly and permanently stop snoring
  • Have sleep apnoea diagnosed or dismissed as the cause of your snoring
  • Wake up rested and happy with your better half next to you in bed

Here’s how:

How to stop snoring: The definitive step-by-step Guide
Snorer.com
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Peer review and about the Author

default image

Emeritus Professor of Respiratory Medicine, John Stradling MD FRCP

This is a very comprehensive manual for those interested in understanding why they snore and what to do about it. Adrian Zacher has many years of experience in this field. Take time to read it carefully as there is a great deal of information to digest. Armed with this information one should be able to make informed choices as to what to do about snoring and possible sleep apnoea.

Prof. John Stradling How to stop snoring guide.

Adrian Zacher MBA

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach UK dentists to help their patients stop snoring; sleep and breathe at the same time. Many of my customers find their work so rewarding they devote their practice to it. I’m a sleep-industry insider with a quarter of a century of sleep medicine experience.

Google Scholar

Contents

Click an icon to jump to each chapter.

CHAPTER 1

Self-help ways to stop snoring & signposting to treatment options

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 1:

 

Self-help ways to stop snoring & signposting to treatment options


If you snore, have been told you stop breathing while asleep, and are sleepy during the day consult your GP or Primary Care Physician immediately. Being drowsy needs medical attention.

If you’re not drowsy, here are 6 lifestyle changes to consider, as the first attempts to stop snoring.

Then we’ll introduce Snorer.me Signposting™ – which is a new, free, CE-marked software tool to connect you with the most appropriate medical or dental professional.

Signposting the treatment routes for snoring and sleep apnoea

6 self-help ways to stop snoring

Here are 6 self-help ways to stop snoring:

Lose weight to stop snoring  Lose weight.

Stop drinking alcohol in the evening to stop snoring  Avoid evening alcohol.

Stop smoking to stop snoring  Stop smoking.

Get off your back to stop snoring  Get off your back!

Breathe through your nose to stop snoring  Keep your nose clear. Consider avoiding dairy products if they make you ‘stuffy’.

Avoid sedative medication to stop snoring  Avoid sedative medication. Consult your GP for alternatives.

Download this PDF with additional methods to stop snoring self-help ways to stop snoring

 

Here are 6 self-help ways to stop snoring. These are known as lifestyle changes:

Lose weight to stop snoring  If you’re overweight, try to lose weight. We get fat inwards as well as outwards and weight around your neck reduces the diameter of your airway. If the airway in your throat gets narrower, the air you breathe has to travel faster and this makes the walls of your airway vibrate (in other words it makes you snore).

Stop drinking alcohol in the evening to stop snoring  Avoid evening alcohol. Alcohol super relaxes your throat – which makes it floppy and prone to vibrate (and you snore). I know that drinking alcohol in the evening is exactly when you want to drink it – so you have to choose.

Stop smoking to stop snoring  Stop smoking. Smoking inflames the tissues of your throat which makes your airway narrower, so you snore.

Get off your back to stop snoring  Get off your back! Gravity pulls your tongue backwards and narrows your airway. Your mouth may also fall open and as it does so your jaw moves downwards and backwards and this also narrows your airway. And no, a chin strap is NOT the answer (here’s why).

Breathe through your nose to stop snoring  Keep your nose clear. If you can’t breathe through your nose you have to breathe through your mouth. When your mouth opens it moves downwards and backwards – narrowing the airway in your throat. Ditto point 4. Additionally, some people find that dairy products make them ‘stuffy’. Consider alternatives?

Avoid sedative medication to stop snoring  Avoid sedative medication i.e. sleeping pills and painkillers (Consult your GP for alternatives if you have a diagnosed condition that necessitates their use).

Download this PDF with additional methods to stop snoring self-help ways to stop snoring

 

Does Your Partner Snore?

This free Guide is for you:

Free Guide for the partner or family member of a snorer

Remember why you’re trying to stop snoring?

To:

  • Maintain intimacy with your partner
  • Share hotel rooms
  • Stay over at friends
  • Fly long-haul without complaint
  • Wake up without a sore throat / dry mouth
  • Avoid ridicule

Two problems with self-help to stop snoring:

  • It often doesn’t work.
  • It doesn’t give you a diagnosis of sleep apnoea or no sleep apnoea (spelt ‘apnea’ in the US).

If self-help isn’t helping, you need to see the most appropriate healthcare professional to get a real diagnosis.

That is the purpose of Snorer.me Signposting™. It is a self-help tool that provides free information to direct you to the right professional to get the help you need.

Carry on guessing?

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

You can either carry on guessing if your snoring is a symptom of sleep apnoea or you can use Snorer.me Signposting™.

We think you’re here because you want definite answers. Snorer.me Signposting™ is your first step to definitively answering how to stop snoring.

The Oxford English dictionary defines signposting as:

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

In medicine, signposting is about providing free, valid information, about available services and options… and pointing out the right ‘road’….

The image above illustrates one of the questionnaires used inside Snorer.me Signposting™.

Snorer.me Signposting™ works like this:

Signposting first step  You answer 25 questions on-line.

Signposting second step  Your GP (additionally a UK sleep-trained dentist) then uses your answers to rapidly screen1 you for sleep apnoea, and determine if you need further investigation (a sleep study).

Signposting third step  If you don’t need a sleep study, then you can be prescribed a custom-made, anti-snoring device.

What happens next?

Whichever way signposting directs you, the healthcare professional will screen you for sleep apnoea (spelt ‘apnea’ in the US) next.

Chapter 2 explains how and why:

CHAPTER 2:

 

Assessment of snoring and screening for obstructive sleep apnoea


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

There’s an advantage to early detection (i.e. you “nip it in the bud“), and we’re getting ever closer to definitively knowing how to stop snoring.

Assessment and screening for sleep apnoea

Step 1. Assessing and screening for sleep apnoea symptoms

What is Obstructive Sleep Apnoea / Apnea (OSA)?

What is Obstructive Sleep Apnoea (OSA)?

Obstructive sleep apnoea (OSA) is when your breathing is disrupted while you are asleep. The airway in your throat repeatedly narrows and not enough air gets to your lungs despite continued effort. Sufferers typically snore and may be drowsy in the day, because they must wake up to breathe. 

When snoring is a problem, please consult your GP (Primary Care Physician – we use ‘GP’ throughout this Guide), additionally a sleep-trained dentist (in the UK) can help. More about these professionals later.

Your GP has your medical history to hand and they want you to be well.

However, we’re all aware that GPs are extremely time-poor. Therefore, 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:

1. Fill in the forms and return to your GP

Your GP will screen you for sleep apnoea and determine if you need further investigation.

Your GP may not know much about sleep. Help them by downloading our GP Guidelines ↗ (send the document to your GP before your appointment to give them time to read it).

1. Fill in the forms and return to your GP

Your GP will use the information on the form 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 in about snoring, but equally, they may not be. Currently, sleep medicine in the UK and elsewhere, is not part of core medical training.

We’d suggest you download our GP Guidelines ↗ and send them to your GP before your appointment (to give them time to read it).

2. Waste your money on OTC (over-the-counter) snoring cures, aids and mouthguards

Naturally, it’s tempting to go for the ‘quick fix’ and buy ‘instant’ snoring remedies. That’s why we review them.

So, learn how to compare OTC mouthguards and custom-made dental devices ↗ and find out if chinstraps for snoring ↗ are dangerous, or safe and effective, amongst other reviews.

How to find a GP in the UK?

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 find a GP 2

If you know country specific web addresses for how to access secondary care services – please let us know so we can add them here to help others. Thanks.

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

Take your pick:

Find GP services in the UK

Outside the UK?

If you’re outside the UK, finding a GP may depend on how your healthcare expenses are paid for.

In the USA, if your care is paid for by an insurance company, you should check their website to see which ones are listed.

If you’re covered by Medicare use this link to find a doctor:

https://www.medicare.gov/physiciancompare/

Step 2. Consult your GP

Return to your GP with your completed assessment forms (ideally you did these 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:

Option 1: Referral to a sleep unit

Your GP may suspect you’re suffering from sleep apnoea (find out more about sleep apnoea (OSA) in the FAQ) and refers you to a sleep unit.

Ask someone else to take you to the appointment, as you 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 England, visit the NHS e-referral website:  https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-e-referral-service/e-referral service3

Option 1: Referral to a sleep unit

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 England, visit the NHS e-referral website: e-referral service3

You will need your:

  1. booking reference (first page)
  2. year of birth

and the (automatically generated) password to login (that’s on the last page of the print-out your GP gave you).

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

If you’re in Scotland the GP will make a referral for you and the Hospital will contact you with an appointment. Similar electronic patient referral management systems are being rolled out around the world. As we learn of them we will add them here. Let us know.

NHS e-referral service

Option 2: Lifestyle change & local management

If your GP does not suspect obstructive sleep apnoea (OSA) they may suggest you try to stop snoring naturally with 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…).

Option 3: Dental appliance for snoring

If your GP does not suspect obstructive sleep apnoea: they may consider 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 or ‘mouthpiece’.

This type of dental appliance is 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.

* In exceptional circumstances some ‘benign’ snorers (i.e. not sleepy) may dependent on the availability of local expertise and budget, be offered a hospital dental laboratory manufactured oral appliance.

Options 2 and 3 require you to take action yourself.

So, now you’re wondering:

How can I stop snoring?

If you’re given Option 2 (lifestyle change) or 3 (dental appliance for snoring), the good news is that you’re unlikely to have sleep apnoea symptoms.

Hang on:

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

There’s very good evidence 4 that custom-made, adjustable dental appliances for snoring (aka mandibular repositioning splints) will help with anti-social snoring. Below are two examples (there are many more to choose from). The images below are used with permission from SomnoMed UK Ltd. and Somnowell (UK) Ltd. respectively.

Custom-made, adjustable dental devices for snoring
Custom-made, adjustable dental devices for snoring

Clinical research5 has established that custom-made dental appliances are NOT the same as over-the-counter ‘gumshields’ or other mechanisms, and neither are they valid as a trial of whether a custom-made dental appliance will work.

So, be sure to bookmark my independent review of the top 13 criteria for choice of ‘gumshield’, so you can come back to it later.

Otherwise its time for…

CHAPTER 3:

Diagnosis of obstructive 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.

Medical diagnosis of sleep apnoea

Snoring and Sleep Apnoea happen for a reason

An investigation into the cause of your ‘snoring’ is called an assessment.

Together with an overnight sleep study, the specialist respiratory medicine physician may 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?

It’s a “cause-and-effect” relationship, while the ’cause’ is unknown; until you’re diagnosed, the ‘effect’ is the all too familiar, loud snoring problem….

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?

How to know if your snoring is actually sleep apnoea?

Click the tab headings for the 3 steps.

You will be invited to attend the Hospital sleep unit for basic assessments including height and weight measurements, your medical history and a review of your GP referral letter.

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

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

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

You will be loaned some sleep apnoea test equipment, to put on over your pyjamas, before you go to sleep. The sleep physiologist will show you how to use it. The sleep-test equipment records (amongst other things) your snoring, how much oxygen there is in your blood and how much of the night you sleep on your back.

Stowood sleep study equipmentImage used with permission from Stowood Scientific Instruments Ltd ↗

In the morning when you wake up, turn it off, repackage it and return it promptly to the sleep unit. The data it has captured is then downloaded and analysed by a skilled sleep physiologist. They will ‘score’ your sleep study and create a report to accompany your medical history.

The sleep doctor will then review your scored sleep study, sleep physiologist’s report, your medical history and assessment forms. If possible, and if there is sufficient data, they will then diagnose your sleep condition and severity.

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.

Once again, its not a bad idea to take a copy of your Snorer.me Signposting™ printout with you as well.

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, mouthpiece. Known as a
    custom-made mandibular repositioning splint (MRS)
  • Surgery is usually only considered appropriate to enhance the use of PAP and MRS

If you are not diagnosed with obstructive sleep apnoea syndrome then the healthcare system of the country you live in, determines what help if any they may provide.

  • In the UK, then routinely there is no NHS help available. Sometimes sleep units may have an informal network of dentists that can help you obtain a custom-made anti-snoring device as a private, fee-paying patient.
  • 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.

Now, it’s time for treatments for snoring and sleep apnoea:

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 (OSAS)?

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.

Now, it’s time for treatments for snoring and sleep apnoea:

First-line and second-line therapies

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

CHAPTER 4:

 

Treatments for snoring and sleep apnoea


Treatment follows diagnosis.

In this chapter we’ll introduce the various prescription ways to stop snoring and treat obstructive sleep apnoea.

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

How to stop snoring?

Treatment for snoring and sleep apnoea permanently

3 Categories of treatment for snoring & sleep apnoea

The 3 prescription ways to stop snoring and treat sleep apnoea are:

  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 exceptionally bariatric (stomach surgery to reduce your weight)

Your sleep Doctor will determine which category of therapy is most appropriate for you.

Additionally, 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 in a sleep unit.

There are essentially 3 categories of prescription treatment for snoring and obstructive sleep apnoea syndrome (OSAS) or in other words – three ways to stop snoring and treat sleep apnoea:

  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 exceptionally bariatric (stomach surgery to reduce weight)

Your sleep Doctor will determine which category of therapy is most appropriate for you.

Additionally, 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 in a sleep unit.

 Mandibular Repositioning Splints (MRS)

How do dental appliances for snoring and sleep apnoea work?

Mandibular repositioning splints work by holding your jaw forwards.

  1. They keep your tongue away from the back of your throat
  2. They tension your soft palate

You must wear the MRS (while you sleep) for it to work.

There’s much more here about dental appliances for sleep apnoea.

Dental appliances for snoring and sleep apnoea (known as Mandibular repositioning splints or MRS) keep your airway open by holding your jaw forwards (repositioning it).

This does two things:

  1. Keeps your tongue away from the back of your throat
  2. 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.

They do not cure snoring. They are a therapy that must be worn (while you sleep) for it to work.

There’s much more here about dental appliances for sleep apnoea.

How do dental appliances (mandibular repositioning splints) work?
Mandibular repositioning splints mechanically open the airway in your throat

What happens next?

The sleep-trained dentist will check to see if a dental appliance is right for you.

If appropriate they will take moulds of your mouth and send these to a dental lab for your dental appliance to be made.

When the dentist fits the appliance they will teach you how to insert and remove it.

You will need to visit the dentist again at regular intervals.

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 and push your chin forward).

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 stop snoring mouthpiece for you
  • What the sleep-trained dentist can do
  • How to compare over-the-counter with prescription anti-snoring devices

No signup is required.

No credit card.

Nothing at all in fact.

We do this to help – because we can.

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

What is PAP for sleep apnoea? And how does it work?

Positive Airway Pressure (PAP) therapy prevents your airway narrowing or collapsing while you sleep.

PAP works by pumping air into your nose (and or mouth) through a mask worn over your face.

A common misconception is that oxygen is pumped in. This is rarely the case.

Positive Airway Pressure (PAP) therapy for obstructive sleep apnoea (OSA) is a treatment that prevents your airway narrowing or collapsing while you sleep.

PAP works by pumping air into your nose (and or mouth) through a mask worn over your face.

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

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

A common misconception is that oxygen is pumped in. This is rarely the case.

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 apnoea treatment with Positive Airway Pressure therapy

  1. Have a PAP mask fitting and loan of an Automatic PAP
  2. Return to collect ‘your own’ PAP machine
  3. Return for a 3-month review and sleep test
  1. Have a PAP mask fitting and loan of an Automatic PAP
    After you receive your OSAS diagnosis, you usually have an appointment the same day, with a sleep unit nurse. At this appointment they will:

    – Provide an explanation of PAP therapy
    – Fit you with a PAP mask
    – Loan you an automatic PAP machine (an automatic PAP establishes over the following 2 weeks your specific PAP therapy pressure)
    – Supply you with support details

  2. 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.
  3. 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 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 Lizzie Hill PhD Click for full profile [new tab]

Dr Lizzie Hill PhD

Dr Lizzie Hill PhD RPSGT EST. Clinical Sleep Physiologist (RCCP M-Level registered); Education Lead, British Sleep Society & President, European Society of Sleep Technologists.

 Surgery for snoring and obstructive sleep apnoea

Surgery for snoring aims to improve the airway in your throat
  1. Soft tissue surgery for snoring and sleep apnoea enhances the use of dental splints and Positive Airway Pressure therapy (PAP). 
  2. Hard tissue surgery will change the way you look. Hard tissue surgery aims to eliminate the need for other therapies (i.e. dental splints and PAP).
  3. Bariatric surgery may exceptionally be considered when your health and quality of life are impacted by obesity. 
  1. Soft tissue surgery for snoring and sleep apnoea is appropriate to enhance the use of dental splints and Positive Airway Pressure therapy (PAP). This includes surgery on the inside of your nose, soft palate and base of your tongue to remove physical obstructions and improve tissue tone.
  2. Hard tissue surgery will change the way you look. It moves the bones of your face. Hard tissue surgery aims to eliminate the need for other therapies (i.e. dental splints and PAP).
  3. Bariatric surgery may exceptionally be considered when your health and quality of life are impacted by obesity. Qualifying criteria varies – consult your doctor.
Uvulopalatopharyngoplasty (UPPP) surgery for snoring
Soft tissue surgery (UPPP)

Uvulopalatopharyngoplasty

Bi-maxillary osteotomy permanent treatment for sleep apnoea
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 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

Professor Bhik Kotecha Click for full profile [new tab]

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

Professor 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.

Check out Chapter 5 (Follow-up) to appreciate what it should look like, and Chapter 6 our extensive (FAQs) section.

CHAPTER 5:

Follow-up of snoring and sleep apnoea patients


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 of snoring and sleep apnoea treatment

Follow-up

If you’re struggling with therapy don’t give up. It’s quite common for people to need help:

  • Using an oral appliance? Go back to the dentist.
  • On PAP? Go back directly to the sleep unit.

Regrettably, snorers who are prescribed a dental appliance are NOT routinely followed-up to assess whether:

  1. It continues to provide satisfactory control of their snoring
  2. Or, if their snoring has developed into sleep apnoea

Follow-up by the dentist MUST include:

  • Assessment of perceived sleepiness or drowsiness
  • Ideally an annual home sleep apnoea test (HSAT) to determine if the appliance remains effective.

PAP therapy today, commonly incorporates monitoring technology, to track how much it’s used.

Annual follow-up is required to identify if sleepiness symptoms have returned.

Surgery for snoring. It’s vital that follow-up home sleep apnoea testing (HSAT) is performed for those who have undergone surgery for snoring.

Changes in weight, lifestyle (particularly evening alcohol consumption) may give rise to sleep apnoea symptoms that need investigating.

 

If you’re struggling with therapy do not give up. Help is available and it’s quite common for people to need help and time adjusting to routine use of an oral appliance or PAP device.

If you’re using an oral appliance go back to the dentist.

If you’re on PAP go back directly to the sleep unit.

The importance of follow-up for snoring and sleep apnoea therapy users cannot be overstated.

However, snorers who are prescribed a mandibular repositioning splint are commonly NOT followed-up to assess whether:

  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 of ‘snorers’ 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 apnoea test (HSAT) performed to determine if the mandibular repositioning splint is effective.

Dental changes should be communicated to you by your dentist and your risk/benefit analysis reviewed.

PAP therapy 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 apnoea testing (HSAT) is performed for those who have undergone surgery for snoring.

The ‘fire alarm’ of snoring has been removed. What if the far more serious fire of sleep apnoea develops?

Changes in weight, lifestyle (particularly evening alcohol consumption) may give rise to sleep apnoea symptoms that need investigating.

Driving or similar vigilance critical roles

When sleep apnoea treatment is effective and it’s used, driving may resume.

However, it’s the individual’s responsibility to ensure they remain fit to drive.

Vocational drivers and those in vigilance critical roles (i.e. pilots or train drivers) will be actively monitored to ensure the safety of others.

Should sleepiness / drowsiness symptoms return driving/flying must immediately cease. Contact your sleep unit. They will be keen to assist you.

The Sleep Apnoea Trust provide detailed guidance about driving here. ↗

When obstructive sleep apnoea syndrome treatment is effective (i.e. no more drowsiness when you should be awake) and most importantly the treatment is adequately used, driving may resume.

However, it is the individual’s responsibility to ensure they remain fit to drive.

It should be noted that if you are a vocational driver or perform some other vigilance critical role (i.e. a pilot or such like) then you will be actively monitored to ensure the safety of those around you.

Should sleepiness / drowsiness symptoms return you must immediately cease driving/flying and contact your sleep unit. They will be keen to assist you. 

The Sleep Apnoea Trust provide detailed guidance about driving here. ↗

Summing up follow-up and condition change

Beware: The snorer and partner are commonly exploited for profit:

  • Some custom dental appliance manufacturers may neglect to mention to dentists that without sleep training, they (the dentist) are not insured.
  • Over-the-counter (OTC) anti-snoring devices according to Which? are commonly sold with exaggerated claims.  They may also delay effective treatment of sleep apnoea. Check out this review new window of the silly claims gadget manufacturers make.

Finally, medical professionals may wish to reconsider suggesting a snoring patient use an OTC anti-snoring device as oral appliance therapy is the practice of dentistry and they would be personally liable for unfortunate dental consequences.

Snoring and sleep apnoea both change as we get older and/or our lifestyle changes: what works tonight, may not work tomorrow night.

Regrettably, nil 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.
  • 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 review 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 may find themselves personally liable for the harm such oral appliances can and do cause to teeth and jaw joints, but 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:

 

FAQs about how to stop snoring


We conclude with a snoring and sleep apnoea Frequently Asked Questions (FAQ) section.

Have a question that isn’t answered? Ask it below by commenting, if we don’t personally know the answer, we’ll find someone who does!

Please note we cannot give medical advice.

Snoring and sleep apnea FAQ

Snoring: a technical explanation

Assume a fixed volume of air travels into your lungs while you sleep (typically this is around 500 ml). If your airway narrows, the air must travel faster for the same volume, to enter your lungs in one breath. As the air speeds up, floppy airway walls move in-and-out and make the snoring noise.

Snoring FAQs ⤴

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 FAQs ⤴

I would like to undergo surgery to stop my snoring…

Question continued:

I would like to undergo surgery to stop my snoring, I have been to my doctor regarding this and they referred me to a specialist, who gave me a machine to test for sleep apnoea.

The results came back fine (I don’t have sleep apnoea). Yet my snoring is so bad that it keeps my partner awake, and they already sleep with ear plugs. Not sure what else to do. Have tried sleep spray, strips, mouthguard etc.

Response:

We cannot give medical advice. However we can offer personal opinion on the UK situation: Consult your GP.

You will find that surgery for snoring without sleep apnoea (the machine the specialist sent you home with to test your sleep overnight) is NOT provided by the NHS. Which means that if you’re a suitable patient you would have to pay for surgery. Of course I do not know if you’re in the UK reading this!

We have 2 things to help you make a more informed decision:

  1. Things to discuss when considering surgery for snoring and sleep apnoea Guide
  2. How to stop snoring: The definitive, step-by-step Guide (2019)

Have you tried a custom-made oral appliance for snoring? These are fundamentally different to over-the-counter devices and (if you get the right one) will help most people. You can find more about them here

Finally, I suggest you contact the Hope2Sleep.co.uk ↗ forum on Facebook. ↗ It may help to discuss things there.

Snoring FAQs ⤴

How would I go about getting surgery and how much would it cost?

First you must be screened for obstructive sleep apnoea. Consult your GP (additionally if you’re in the UK a sleep-trained dentist) and heed their advice.

Three important things to note:

  1. Surgery is an option when all other options have failed.
  2. Surgery is usually only considered to improve the effect of PAP or an oral appliance.
  3. If your weight changes it will impact upon the success (or otherwise) of surgery.

If your GP considers it appropriate, you would be referred to the nearest ENT department or you can choose somewhere else if you wish. (the NHS Constitution gives you this choice).

At the ENT department they would assess you, examine your nose and throat and perhaps do a nasendoscopy or a sleep nasendoscopy in an attempt to identify where the snoring is coming from. Various surgical options exist but the difficulty is in identifying precisely where the problem is. It may be many areas.

Surgery is a private option. You could discuss the cost of this with the GP and then the ENT department.

Snoring FAQs ⤴

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.

Snoring FAQs ⤴

Stop snoring: ‘Tips and Tricks’?

For some snorers a quick and easy solution to stop snoring, is to change sleep position get off your back). This may immediately reduce or stop the annoying noise: “TURN OVER!” might be something you’ve heard before…?

You may also have seen promotions for anti snore pillows? They aim to encourage you not to sleep on your back. Which is known as positional therapy. 

Sadly, changing sleep position alone, doesn’t cure snoring for everyone. This is because there are many reasons, with as many solutions, for why someone may snore each night. That’s why you need signposting and professional screening and assessment.

Snoring FAQs ⤴

Is snoring an act which absolutely cannot be controlled?

Yes. It is an unintentional and uncontrollable phenomenon. While the individual can lower certain risk-factors (see above), they can’t choose ‘not’ to snore. It would be like asking someone, not to breathe!

Snoring FAQs ⤴

Snoring risk factors

There are a number of risk-factors, some may be quickly and easily fixed… Others may not.

Lifestyle changes include:

  • maintaining your ideal weight,
  • not smoking,
  • reducing alcohol consumption (and not drinking that glass or two of wine/beer in the evening – which is exactly when you WANT to drink it – I know!)

These are useful things to work on. However, lifestyle changes take time and are not always effective even then.

For example, if your lower jaw is ‘set back’ in relation to your upper jaw, this may make your airway narrower and predispose you to snore. You may also snore if you have enlarged tonsils and adenoids – physical obstructions in your nose or throat – that limit the size of your airway. If you’re concerned about this, 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.

Snoring FAQs ⤴

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.

Snoring FAQs ⤴

Why do anything about snoring?

You mean apart from not being anti-social?!

Snoring may be a symptom of Obstructive Sleep Apnoea (OSA). OSA makes your heart race as the oxygen in your blood drops. This places strain on your heart and because after every stoppage of breathing, you start to wake up, you do not get a good nights sleep. This affects the way you feel and your behaviour the following day.

UARS is a milder version of this and can be thought of as in between snoring (mild interference in airflow) and obstructive sleep apnoea (when the airway is closed or obstructed).

Snoring FAQs ⤴

Why don’t we wake-up from our own snoring?

A classic warning sign of obstructive sleep apnoea is waking up and: …hearing the end of your own snore…

Typically, this would be as a result of what is known as an ‘apnoeaic episode’ or period of not breathing.

Typically, the sufferer doesn’t remember this. They take a breath and go back to sleep.

Its sounds like this:

Snoring…. Stop breathing… silence…. Partially awaken. [Gasp / cough / scratch / roll over.] Snoring… Stop breathing….silence Partially awaken.  [Gasp / cough / scratch / roll over.]

Repeat. All night.

However, most snorers do not wake themselves up, they just irritate those who are trying to sleep within earshot…

Snoring FAQs ⤴

When does snoring indicate a more serious problem?

If you snore loudly with occasional pauses in breathing, and you frequently wake up during the night, you may be suffering from sleep apnoea.

Ask your partner, or a member of your family to listen for signs of this disorder.

Sleep apnoea is periods when you stop breathing while you’re sleeping. These interruptions in your breathing, which can last 10 seconds or longer, occur when the muscles in your soft palate, uvula, tongue and tonsils relax during sleep.

This is the same process involved with normal snoring, but with sleep apnoea, the airway narrows so much that it closes. Your breathing stops, cutting off the flow of oxygen into your body and reducing the elimination of carbon dioxide (CO2) from the blood.

Your brain detects this rise in CO2 and briefly wakes you up, re-opening your airways and re-starting your breathing. This process can be repeated many times during the night.

Proper sleep can become impossible, resulting in severe fatigue and a decreased quality of life. Sleep apnoea in adults can increase the risk of serious health problems such as heart failure, because it deprives the sufferer of adequate levels of oxygen, making the heart work harder than normal.

Snoring FAQs ⤴

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.

Snoring FAQs ⤴

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).

Snoring FAQs ⤴

Why does alcohol make you snore more loudly?

Alcohol further relaxes the soft tissue in the throat and worsens any snoring noise created.

Snoring FAQs ⤴

My doctor doesn’t seem to listen or take me seriously?

Some people and some doctors, do not take anti-social snoring very seriously.

Question. Is treatment really necessary?

Answer. Both ends of the spectrum deserve treatment. Benign snoring can be far from benign. The social consequences can be extremely distressing, snoring may be a symptom of obstructive sleep apnoea and as such investigation for this possibility is reason enough to take what the patient reports seriously.

The misery of snoring to both the partner and the snorer is not worthy of the joke approach. We can help you inform your Doctor of the serious social consequences, and the economic and longer-term health benefits of the available treatment options.

Snoring FAQs ⤴

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.

Snoring FAQs ⤴

What will the sleep or ENT consultant do?

Upon referral from a doctor, the hospital consultant will examine you and discuss all the treatment options with you.

There are many options available and not all are suitable for everyone. You may need to spend a night at the hospital and be examined while sleeping.

Snoring FAQs ⤴

What will the dentist do?

Upon referral from a Hospital Consultant the Dentist will examine the condition of your mouth and your oral hygiene. You must have good oral hygiene and be prepared to work hard to maintain it.

If you have periodontal problems or extensive crown and bridge work Sleep appliances may not a good idea. You must have sufficient good teeth in both jaws to hold the appliance in place.

Exceptionally in the UK, a sleep-trained dentist may screen your for sleep apnoea (and if they don’t recognise the need for further investigation into your sleep problem) offer you a mandibular repositioning splint without you having to be medically diagnosed beforehand. 

Snoring FAQs ⤴

Why not buy a mandibular repositioning splint on-line or at the local pharmacy)?

It’s essential that the presence or absence of obstructive sleep apnoea (OSA) is established before using any treatment or ‘cure’ for snoring. Why? Because some people with undiagnosed OSA (remember snoring may be a symptom of OSA), do not adequately respond to oral appliance therapy (the typical 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.

Snoring FAQs ⤴

Is sleep apnoea classed as a disability?

The Sleep Apnoea Trust Association 6 state: [new tab]

Untreated, obstructive sleep apnoea can be very disabling. But it is not a disability as the condition can be treated by a simple painless non-surgical approach available entirely free of charge on the NHS. For most patients, the treatment, using a CPAP machine, is wonderfully effective and dramatic. Many users experience a return to energy levels that they have not enjoyed for many years.

The main symptoms such as constant and excessive sleepiness, memory impairment, mood swings, irritability and

under performance at work are quickly eliminated. 2 Longer term benefits are still being intensively researched, but the 20% reduction in life expectancy 3, if not diagnosed and treated, is rapidly mitigated

The best treatment for OSA on the NHS is continuous positive airway pressure (CPAP). This involves wearing a mask over the nose (or nose and mouth) during sleep, connected to a quiet pump beside the bed. It supplies slightly pressurised air to keep the throat open. The mask allows the breathing to return to normal during sleep and usually ends the snoring! Many partners enjoy sleep that they have not experienced for even longer, as they are not disturbed by their partner’s snoring any more.

When successfully treated, any concerns about driving while sleepy disappear, and no driving restrictions are imposed by the DVLA.

Snoring FAQs ⤴

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.

Snoring FAQs ⤴

Do dental mouthguards work for sleep apnoea?

Yes, in selected cases. Over-the-Counter (OTC) gumshields for snoring are NOT the same thing as custom-made, adjustable prescription Mandibular Repositioning Splints (MRS).

There are a few important points to remember:

  • You should be screened for sleep apnoea BEFORE using any ‘mouthguard’
  • Clinical research has established that OTC gumshields are not valid as a trial or therapeutic device5

Adrian has examined how to choose the best anti-snoring device ↗ and also looked at the claims made by OTC dental devices ↗ for snoring manufacturers.

Grab our free Guide about how to choose a mouthpiece to stop snoring.

Snoring FAQs ⤴

What is the latest treatment for sleep apnoea?

The sleep apnoea treatment market is expanding rapidly (as are our waistlines – obesity being a compounding variable for sleep apnoea). The latest treatment today, will be superseded tomorrow.

As of 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. 

Snoring FAQs ⤴

What works best to stop snoring?

There are many variables to consider and everyone is different.

That’s why a ‘One-Size-Fits-All’ approach will never work.

See your GP or a sleep-trained 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?”

Snoring FAQs ⤴

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.

Snoring FAQs ⤴

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).

Snoring FAQs ⤴

Do you know someone who snores?

Share this with them. But first, put the noise to one side for a moment, have you observed periods of silence in between their snores? Are they sleepy when they should be awake?

The silence between snores is when they’re NOT BREATHING. Their chest and stomach rises and falls, as they make increasing efforts to breathe, yet no air enters their lungs.

They’re suffocating. Yes really!

Eventually, they come up from deeper sleep enough to cough, take a breath… and resume snoring.

Repeat. All night, every night.

They wouldn’t tolerate someone strangling them while awake – yet at night the snorer with untreated sleep apnoea – does it to themselves.

Learn how you might help them by reading our Partner’s Guide

Do you know someone who snores?

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 it. Now, it’s time to act.

  • What will you do first?
  • Did this Guide help?

Or maybe you have a question? Let us know by leaving a quick comment below right now.

Thanks, Adrian & Emma.

Finally, we would like to thank Ed Grandi for his kind assistance with US specific information.

Thanks Ed👍 Here’s his blog ↗.

Comment or write a review about how you will stop snoring permanently
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Darren Umbers (Former Regional Director UK & Ireland, Philips Respironics)

Well done Adrian, anything that helps people find help and navigate the confusing terminology and landscape to better understand what they need to reclaim their days and nights is a win with me. There are both too many people not getting the help that they need, as well as too many people being mis-sold the help that they don’t need. I think that your guide will be a help to close the information inequality gap for many people.

Darren Umbers How to Stop Snoring (The Definitive Guide) October 25, 2018

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Mike McEwan, (Former VP Europe – ResMed)

An excellent overview and specific advice. Very useful.

Mike McEwan How to stop snoring Guide October 6, 2018

Add your review

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


References

  1. Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol. Stradling J. and Dookun R. BDJ Mar 2009 Available here: https://www.nature.com/articles/sj.bdj.2009.214 [accessed 25 Feb 2019]
  2. Find GP services: https://www.nhs.uk/Service-Search/GP/LocationSearch/4 ↗ [accessed 25 Feb 2019]
  3. NHS e-referral website. Available here: https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-e-referral-service/ ↗ [accessed 29th March 2019] Updated to reflect new NHS URLs coming in July 2019
  4. 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]
  5. 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]
  6. Is sleep apnoea a disability? Available here: http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/sleep-apnoea-frequently-asked-questions/#obstructive-sleep-apnoea-osa-disability-equality-act-2010 ↗ [accessed 25 Feb 2019]

Our related expert reviews and ‘How-to’ Guides:

Here are some more high quality reviews about anti-snoring devices, snoring and sleep apnoea / apnea products, chin straps, pillows, cures and aids!

Signposting™ is a CE mark marked, Clinical Decision Support System, Software as a Medical Device. The Manufacturer is Snorer.com Ltd. registered with the UK Medicines and Healthcare Products Regulatory Authority.

CE marking is a certification mark that indicates conformity with health, safety, and environmental protection standards for products within the European Economic Area.

The signpost icon is made by Freepik from www.flaticon.comand is licensed by CC 3.0 BY

Page created by Adrian Zacher and Emma Easton. All rights reserved. Last updated 22nd May 2019.

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:

Guidelines for the Medical Profession? Oral Appliances for Snoring/OSA

Guidelines for the Medical Profession? Oral Appliances for Snoring/OSA

UK Guideline development

This past decade has seen further clarity develop around the provision of mandibular repositioning devices (oral appliances for snoring and sleep apnoea).

In 2012, the British Society of Dental Sleep Medicine’s (BSDSM) screening protocol (first published in 2009) [i] was elevated to ‘authoritative guidelines’ by Dr Rob Jagger when reviewing a paper by Jauhar et al examining the Kushida Index in the British Dental Journal [ii]

The same year saw the BSDSM protocol further endorsed by the Association of Respiratory Technology and Physiology in their Standards of Care position statement [iii]. This was updated in 2018 to version 4. [iv].

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

Adrian Zacher MBA

Snoring & Sleep Apnoea Care Navigator

Californian Dental Association

The Californian Dental Association (CDA) [v] determined in 2012 that it is appropriate for dentists to screen patients for the signs and symptoms of sleep disordered breathing (SDB) and work with physicians to diagnose and treat SDB.

The CDA also stated that SDB is a medical condition and its diagnosis is outside the scope of the practice of dentistry.

This is all excellent progress towards appropriate patient assessment, screening and where appropriate provision of an MRD by a dentist.

 

However, two further issues remain:

1 Self diagnosis and fitting of Over-The-Counter ‘Boil & Bite’ devices (people need help and a proper assessment for OSA to determine the most appropriate therapy – not exploiting and delaying patients from effective treatment)

2 How to discourage the medical profession from supplying or by lack of guidance endorsing, use of ‘Boil & Bite’ devices.

Summary

A multi-disciplinary, holistic view of the patient that breaks down the current silo approach to patient care surely makes ethical and financial sense.

Perhaps raising awareness that effective treatment options for OSA exist and consensus development of guidelines that dentistry is not within the purview of a physician is required?

Let’s not even talk about professional indemnity…!

References and related Guidelines

Professor Stradling and Mr Grant Bates proposed GP Guidelines 'Management of sleep apnoea and snoring, suggested guidelines for General Practitioners and other interested medical professionals'. I would note that this document was created prior to the BSDSM Pre-treatment Screening Protocol.

[i] British Society of Dental Sleep Medicine, Pre-treatment screening protocol. British Dental Journal, 2009  http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html new-window [accessed 1 February 2012]
[ii] Jauhar et al (2012) The Kushida Index as a screening tool for obstructive sleep apnoea-hypopnoea syndrome, http://www.nature.com/bdj/journal/v212/n1/full/sj.bdj.2012.2.html new-window [accessed 1 February 2012].
[iii] Association of Respiratory Technology and Physiology (2012) ARTP Standards of Care for Sleep Apnoea Services (Mandibular Repositioning Devices) http://www.artp.org.uk/en/sleep/sleep-standards/index.cfm new-window [accessed 1 February 2012]
[iv] ARTP standards of care for mandibular repositioning devices http://www.artp.org.uk/en/sleep/sleep-standards/sleep-documents.cfm/sleep-standards-iods new-window [accessed 23 Oct 2018]
[v] California Dental Association (2012) http://www.cda.org/Portals/0/journal/journal_022012.pdf? new-window [accessed 6th Mar 2013]

Created by Adrian Zacher. Last updated 21st May 2019.

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