Respiratory - Snoring

Why does it happen?

Snoring is noisy breathing through the mouth and nose during sleep. It happens when air doesn’t move smoothly through your air passages, making tissue in your mouth, nose and throat vibrate as the air passes through.

During sleep there is relaxation of the muscles in the tongue, throat and roof of your mouth which narrows the passage for air to move through. The relaxed muscles vibrate causing the sound of snoring and this gets louder the narrower the airway becomes.

Nearly half of the UK snores at sometime and a quarter are regular snorers.

Things that can cause snoring or make it worse

• If you are overweight excess fat around the neck and throat can cause the tissues to sag, narrowing the airway
• Alcohol and certain drugs (such as sedatives) cause extreme relaxation of your muscles, including those in your throat
• Smoking can cause inflammation of airway tissue
• Sleeping on your back can make snoring worse because your tongue falls backwards into your throat which can narrow your airway and partly block airflow
• Nasal blockages caused by allergies, colds or a damaged nose can limit airflow through your nose. This causes you to breathe through your mouth which has more of the tissues that sag
• Some people have narrowed airways because of enlarged tonsils or adenoids, a long uvula (the piece of skin that hangs down in the back of your throat between your tonsils) or if the soft part of the roof of your mouth is a bit low or thick

How can snoring be treated?

Lifestyle measures

You can improve your snoring by thinking about the things that make it worse and trying to improve your lifestyle. Support is available through your GP practice and via www.gmhealthhub.org/

• Try to keep to a healthy diet and weight – this helps reduce the fat in your throat tissues and improves your general health
• Eating mindfully rather than on the go or whilst doing something else like watching TV or scrolling on a phone can help you listen to body’s signals of when you are full and help you to not overeat
• Eat home cooked, unprocessed or minimally processed foods whenever possible. Heavily processed foods are designed to make you want to eat more of them
• Limit sugary drinks or snacks which will tend to make you have ups and downs in your energy levels and can make you hungrier
• Try to get a regular bedtime and get up time and prioritise enough time in bed to get enough sleep. Not enough sleep makes it difficult to make good healthy choices
• Try to make sure you look after your own mental health. This could include meditation, yoga or journaling. Try to spend time in nature. High levels of stress raise the levels of a hormone called Cortisol which makes it hard to lose weight
• Find physical activities you enjoy and can fit into your lifestyle and routine. For example, you could try taking the stairs instead of the lift or escalator, get off the bus a stop early or park further away to get in some extra steps
• Strength exercises such as squats, lunges and push ups help build muscle and stronger muscles burn more calories. A short routine that doesn’t need any equipment can have a big effect if done very regularly. There are lots of free follow-along videos on You-tube such as the body coach
• Stop smoking
• Always try to sleep on your side, not your back
• Avoid alcohol before bedtime
• Get treatment for nasal congestion/allergies

Snoring tends to be worse when you are sleeping on your back and when your head is bent forward. Try propping your head up with pillows and you can try sewing a tennis ball into the back of your pyjamas to stop you lying on your back. Pillows are available for snorers, which may help your sleeping position.

Nasal decongestants that you can buy over the counter can be used on a short-term basis (7 days). If your symptoms are persisting it is worth discussing with your pharmacist or GP. They may suggest nasal steroids which can be bought over the counter.

Making the changes to your lifestyle is the first thing you should try but they may not always be effective.

Mouth devices

• These are the treatment of choice for snoring when lifestyle measures have been taken but snoring persists

These are gum shield-like devices (mandibular repositioning devices) which help keep the airway open by moving the jaw forward.

There are a number of companies that make reasonably priced mouth devices for snorers. They can help some people with snoring but may lose their effect after a while as they are not fitted individually. Websites of companies that make these are given below; we do not recommend any particular type.

www.snorban.co.uk
www.sleeppro.com

Devices that are fitted by a maxillofacial surgeon or trained dentist are more effective. Dentists will charge for this, but you can discuss this with your doctor as it may be possible to refer you to an NHS maxillofacial surgeon. It may not be possible to fit a device if you have dental problems.

Surgery

It is rare that surgery resolves snoring. ENT surgeons will consider it for snoring if you have a specific nose or throat problem such as very enlarged tonsils. You will need to be referred to an ENT surgeon and you may need a nose endoscopy (telescope) test to assess whether surgery would be likely to help your snoring problem.

Most surgery won’t have any major side effects and has a quick recovery period. However, some techniques can cause a painful throat for about a week afterwards and occasionally alter your voice, so it is important to discuss the surgery fully with the ENT surgeon.
 
Surgery may not always be a successful long-term treatment as the benefits usually don’t last for ever. In people who are obese this is no evidence of long-term benefit from surgery. It is not a recommended initial treatment for obstructive sleep apnoea and certain surgeries can make this condition more difficult to treat. It can be considered for obstructive sleep apnoea if other treatments are not tolerated. Tonsillectomy is considered if tonsils are large and body mass index is below 35.

Persistent snoring

Snoring can be difficult to treat and may still persist even when the above lifestyle changes and treatments are tried. In severe, persistent cases a treatment called CPAP may be tried (see explanation below) although this is not available on the NHS.

Obstructive sleep apnoea (OSA)

In some snorers the narrowing of the air passage during sleep can be enough to cause significant reduction of the flow of air into the lungs or briefly stop airflow altogether. This leads to the person briefly waking to open up the air passage. They are not aware of this, but it means they don’t sleep properly and often feel tired during the day. This condition is diagnosed by a sleep study and your doctor will refer you for this if they suspect this OSA.

The treatment of choice for this is continuous positive airway pressure (CPAP). This is a machine that blows air into the upper airway via a mask over the nose and the air pressure helps keep the airway open. Fitted mouth devices can help with this condition too but may not be suitable for people with some chronic chest conditions, nasal blockage or dental problems.

Useful websites

www.sleep-apnoea-trust.org

Asthma and Lung UK:
www.asthmaandlung.org.uk

Sleepnet:
www.sleepnet.com

www.thesleepcharity.org.uk