Commentary: Treatments for Severe Snoring

Dec. 12, 2001 -- Very loud snoring can often be heard from another room, and possibly even from another apartment.

Relatively frequently, there are patients whose motivation to see their physician comes from neighbors complaining of their snoring. It is understandable, since people's snores have been measured to be as loud as 90 decibels — roughly the equivalent of a jet at takeoff.

There are also studies suggesting that snorers have a higher incidence of hearing loss — possibly due to listening to their own snoring. I would estimate that eight out of 10 couples consulting our center for snoring sleep apart because of the disturbance to the non-snoring partner, and snoring is often cited as a reason in many divorces.

Snoring can be frustrating to a sleep partner, sometimes even evoking anger and violence. Snorers often tell me that they're coming in to get their sore ribs fixed because their sleep partner keeps poking them with an elbow in an attempt to quell the noise. Some snorers end up with pillows thrust over the faces or rolled off of the bed onto the floor before getting their walking papers to the living room couch.

Snoring Treatments

There are 101 home remedies for snoring, ranging from wrapping a scarf around the nose and mouth to using certain drinks or sprays. Most don't work. The first line of treatment may be as simple as avoiding sleeping in the supine position, losing weight, or avoiding sedatives and alcohol prior to bedtime. Using decongestants, nasal steroid sprays, and other allergy treatments to relieve nasal congestion also may help.

Accepted medical treatments for snoring are limited to oral appliances and upper airway surgery. There are many different oral appliances on the market, ranging from do-it-yourself models that can be self-molded in boiling water and costing $20 to more sophisticated models that dentists make.

Studies suggest that they "decrease" snoring in most cases, but in life it is difficult to know in which patients they will prove effective.

Oral appliances are small, unobtrusive devices whose side effects are limited to jaw joint pain from moving the lower jaw forward or tooth movement from anchoring the device.

CPAP, or continuous positive airway pressure, is a breathing device that is more frequently used to treat sleep apnea. Although it also relieves snoring, its cumbersome use prevents it from being commonly prescribed for treatment of snoring alone.

Surgical Remedies for Severe Snoring

Upper airway surgeries include laser-assisted uvulopalatopharygeoplast (LAUP), in which the surgeon uses a laser to cut away part of the soft palate, including the uvula. The soft palate is the major component in creating the snoring sound because it flutters as air passes through a narrowed pharyngeal airway (the throat).

The surgeon may also remove other tissue (such as tonsils) or open the nasal passageways if those structures also contribute to the snoring. LAUPs are said to be 90 percent effective in "decreasing" snoring, but their success rate in treating sleep apnea may be as little as 60 percent, so patients should be evaluated for apnea if they consider this procedure.

Somnoplasty is a newer procedure that uses a radiofrequency probe, a needle with a microwave tip that heats a small amount of surrounded tissue and essentially melts it. The needle can be placed in the soft palate, the tongue, and the nasal turbinates (inner foldings of the nose) to shrink them. Somnoplasty has the advantage of a significant reduction of pain compared to the laser procedures. It's a newer procedure so we are still waiting to see how it works in the long run. It is said to be as effective as LAUP.

A Word About Snoring Treatments

Studies of snoring treatments often use subjective factors when touting a "decrease" in the sound. So a procedure may be said to be 90 percent effective — but the snoring was "reduced," i.e., it's not as loud. Subjective assessments, especially when relying on a sleep partner, may be nothing more than a matter of opinion. Essentially, the surgeries are most reliable in reducing snoring, but are not a cure-all.

People should also know that there is often a recurrence of snoring after surgeries that may occur from six months to six years after the procedure.

A final word of caution. People should know that snoring is a symptom of sleep apnea, which is disease that has long-term health consequences such as hypertension, heart attack, strokes, etc. Since most of the above treatments (except CPAP) are much less effective in treating apnea than they are at treating snoring, people often require evaluation in a sleep center with a sleep test prior to their snoring treatment, and sometimes afterward.

Dr. Peter A. Fotinakes is medical director of the sleep disorders center at the University of California, Irvine.