Alcohol avoidance

Alcohol aggravates the situation. Sleep study units are constantly asked to review obese, moderate to heavy-drinking males with a snoring problem. Treatment for most of these individuals is entirely in their own hands, with success being directly proportional to motivation and willpower.

Posture

A common observation made by snorers and their sleeping partners is that the condition is significantly worsened when the offender lies flat on his back. The observation has prompted several investigations into the effects of posture on snoring. Without doubt, improvement brought about by either lying to one side or by raising the head and shoulders can be attributed to the mobility of structures like the tongue and soft palate which present less of an obstruction to the airway in these positions than in the lying (supine) position. There is disagreement on the effects of posture on those patients who experience occasional complete airway closure during sleep, with some reports of significant improvement in nocturnal symptoms while others claim no improvement at all. Experimentation with various sleeping positions would have to be the simplest and one of the first modes of treatment considered by any snorer, and can be employed while other measures (such as weight loss) are being taken.

Surgery

Medical attention is justified when simple measures offer little or no improvement. Surgery is appropriate in some instances but the range of surgical techniques is as varied as the underlying causes. An operative procedure known as uvulopalatopharyngoplasty, thankfully shortened to UPPP, has been employed successfully to treat heavy snoring. It involves extensive removal of soft tissue from the oropharynx but should by no means be considered minor surgery. There are conflicting reports on the efficacy of UPPP in the treatment of snoring and upper airway obstruction. There would seem to be a role for the procedure in the treatment of “uncomplicated” snoring but there is considerable disagreement on its usefulness for the sleep apnoea syndromes. In most cases, however, the severity of snoring is diminished after UPPP.

Other forms of surgery aim to either correct or remove structural anomalies which encourage snoring. Examples include mandibular reconstruction for a small or poorly positioned jaw, removal of nasal polyps and other corrective procedures to improve nasal breathing, and the removal of enlarged tonsils and adenoids in both children and adults.

Treatment of underlying disease

Occasionally, patients suffering metabolic disturbances caused by a hormonal imbalance will experience generalized symptoms such as fluid retention or excessive bone growth. Hypothyroidism (myxoedema) is one such example in which fluid retention, particularly around the neck, combined with a decrease in muscle tone, promotes snoring. Specific medication is the cure for hypothyroidism and associated snoring.

Other devices

Mouth appliances, inserted like a mouth guard, are now available which force the user to breathe through the nose by occluding the mouth, thereby bypassing the upper segment of the soft palate. These devices may well work for some but are unlikely to help where a large proportion of the upper airway is prone to collapse or if there are coexisting structural impediments to breathing below the nasopharynx. They are not recommended for the treatment of obstructive sleep apnoea.

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