Snoring Facts and Treatment Options
What Causes Snoring?1,2,3
- Snoring happens when air can’t flow easily through the mouth or nose. Snoring happens when muscles in your tongue, roof of your mouth, and throat relax and constrict airflow. When the air is forced through an obstructed area, soft tissues in the mouth, nose and throat bump into each other and vibrate. The vibrations make a rattling, snorting or grumbling sound.
- More commonly, the root cause of the obstruction – and the snoring that results – is the soft palate, (roof of the mouth), and the uvula (back of the mouth) resting against the back of the throat.
- There are also other causes, including allergies, the shape of your throat, weight gain, large tonsils or adenoids, or sometimes sleep apnea, a condition that causes pauses in breathing while you sleep.
- Aging causes the throat muscles to relax more, and this is why many older folks are more likely to snore.
- Obesity also contributes to snoring since there is more fatty tissue in the neck area.
- Loud, long-term (chronic) snoring can be a sign of a serious disorder called obstructive sleep apnea or OSA.
- A wide range of surgical and nonsurgical treatments can stop or reduce snoring.
Is Snoring Common?
- Approximately 45% of people snore at least sometimes and 25% of people snore regularly at volumes high enough to disturb sleeping partners.1,11
- In the U.S., 90 million Americans suffer from snoring, with over 37 million snoring regularly.1, 12
- About 40% of men habitually snore, compared to 24% of women. 12
- Only about 59% of snorers say that they snore. 12
What is Obstructive Sleep Apnea (OSA)? 1,2,3
Of audible snorers, approximately 10% suffer from obstructive sleep apnea (OSA), a condition in which tissues of the nasopharynx fall into positions that block the airway, restricting breathing during sleep to an extent that causes the patient to experience repeated cycles of breathing cessation (apnea) and subsequent gasping for air without regaining consciousness. The OSA patient is deprived of restful sleep and suffers from poor tissue oxygenation, impaired memory, cognition, and daytime mental functioning, and in extreme cases runs the risk of sudden death from oxygen deprivation (asphyxiation) during sleep.
Remedies for OSA start with prescribed weight loss, as approximately 20% of OSA patients can be cured by losing significant fat around the neck. The majority of OSA patients, however, are not obese. For them, the “gold standard” therapy is continuous positive airway pressure (CPAP) treatment. This non-surgical approach to treating OSA requires the patient to wear a head-mounted electric-powered breathing apparatus every night, which mechanically forces air down the patient’s windpipe, blowing open the floppy tissue that would otherwise be obstructing the nasopharynx with each breath cycle. The obvious disadvantage of CPAP therapy is that it can be unpleasant at best and psychologically debilitating at worst – having a serious impact on a patient’s nightlife, not to mention being uncomfortable to wear.
Does Snoring Cause Health Issues?
- Snoring not only impacts the snorer’s health but also impacts the snorer’s partner. Snorers can cause their partner to become frustrated and lose a good night’s sleep.
- 56% of partners sleeping with a snorer claim that snoring has an adverse effect on their wellbeing.
- Partners of a frequent and heavy snorer lose at least one hour of sleep per night due to secondhand snoring. A study found that the partners’ sleep quality improved when snoring was alleviated or reduced.
- Approximately 25 percent of American couples slept separately to get a good night’s sleep. 68% of those older than 58 years report snoring was their deciding factor to sleep separately.
As for the snorer, the immediate negative effects include 2,3
- excessive daytime sleepiness
- increased agitation
- decreased productivity
- difficulty concentrating
Even more concerning is the long-term negative impact that snoring has on an individual’s health by increasing the risk of
- Obstructive Sleep Apnea (OSA) 2, 3
- Heart attack 2, 3
- High blood pressure 2, 3, 4
- Carotid Artery thickening and atherosclerosis caused by snoring- associated vibration 6,7,8
- Stroke, often caused by carotid artery thickening 4
- Atrial fibrillation 5
- Type 2 diabetes 2, 3, 4
- Thinning of retinal thickness that causes reduction of visual acuity 9
Treatment Options for Snoring 2,3,14
If Lifestyle changes are not effective in reducing your snoring, your doctor may recommend other treatments.
When one considers the advantages and disadvantages of the many potential treatments listed below, it is apparent why Zelegent was driven to provide an alternative for those patients seeking relief from snoring who are not interested in wearing an oral appliance at night and do not wish to undergo invasive, often hospital based, surgery.
Elevoplasty is a minimally-invasive procedure that is performed in a doctor’s office. Using specially-shaped sutures, the procedure lifts and stiffens the soft tissue at the top and back of the mouth, (the soft palate) to reduce or eliminate snoring.
The S.I.Le.N.C.E Clinical Study has shown that 30 days after the Elevoplasty procedure, 3 out of 4 patients saw a reduction in snoring and improvement of sleep quality and daytime alertness. 16
Flexible bands stick to the outside of your nose and keep nasal passages open. May temporarily reduce snoring due to infrequent nasal blockage or sinus congestion, but there is little evidence to suggest that nasal strips help treat or prevent more chronic snoring related to structural or sinus tissue-based complications
Continuous Positive Airway Pressure (CPAP)
The most common, or “gold standard,” therapy is continuous positive airway pressure (CPAP). This non-surgical approach to treating OSA requires the patient to wear a head-mounted electric-powered breathing apparatus every night, which mechanically forces air down the patient’s windpipe and keeps your upper airway passages open. The obvious disadvantage of CPAP therapy is that the mask can be cumbersome, uncomfortable, or loud, and have a serious impact on a patient’s nightlife.
Mouthpiece (oral device)
Oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea, or for people with severe sleep apnea who can’t use CPAP.
These devices are designed to keep your throat open. Some devices keep your airway open by bringing your lower jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.
A dentist experienced in dental sleep medicine appliances provides the fitting and follow-up therapy. Some patients find these mouthpieces uncomfortable or difficult to keep in place.
Surgery or other procedures
Surgery is usually considered only if therapies like those listed above haven’t been effective or haven’t been appropriate options for you. Surgical options may include:
Surgical Removal of Tissue
Uvulopalatopharyngoplasty (UPPP) and Laser-assisted uvulapalatoplasty (LAUP) are in-patient surgical procedures requiring general anesthesia in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids may be removed as well. UPPP usually is performed in a hospital and requires a general anesthetic.
Enlarged tonsils and adenoids are a common cause of snoring and sleep disruption in children. The tonsils are clusters of lymphoid tissue in the back of the throat or tongue, while the adenoids are a similar mound of tissue in the back of the nose. Although less enlarged in adults, some adults can receive excellent resolution of snoring through removal of tonsils and/or adenoids.
As opposed to the office-based palatal procedures listed above, tonsillectomy/adenoidectomy is an outpatient surgery performed in the operating room under general anesthesia. Most patients require a recovery time at home of approximately one week.
Radiofrequency (RF) Ablation (Somnoplasty)
Somnoplasty is an in-patient surgical procedure requiring general anesthesia for treating snoring and obstructive sleep apnea. It works by shrinking, stiffening and/or removing tissue in the upper airway, including the uvula, soft palate or base of the tongue using radiofrequency energy. This enlarges the throat and nose space, allowing for improved breathing.
A chemical is injected into the soft palate. The subsequent inflammation and scar tissue stiffen the palate, therefore, may decrease vibration and snoring.
Jaw surgery (maxillomandibular advancement)
In this in-patient surgical procedure requiring general anesthesia, the upper and lower parts of your jaw are surgically divided, and plates and screws are used to secure and move the jaw forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely.
- Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging nasal air passages, including surgery to:
- remove polyps
- straighten a crooked partition between your nostrils (deviated septum)
- treat a narrow or collapsible side wall (nasal valve)
- correct anatomical issues, e.g., “inferior turbinate reduction”
1 National Sleep Foundation, 2 mayoclinic.org, 3 my.clevelandclinic.org, 4 Djonlagic et al.Expert Rev. Neurother. 10(8), 1267–1271 (2010) 5 Carvalho et al. ESC Congress 2022 – Barcelona, Spain 6 Lee et al. SLEEP, Vol. 31, No. 9, 2008 7 Cho et al. SLEEP, Vol. 34, No. 6, 2011. 8 Salepci et al. Sleep Breath. May 2014. 9 Xiao et al. Front Physiol. 2022 Aug 5 10 Friedman et al. A new office-based procedure for treatment of snoring. Laryngoscope Investigative Otolaryngology. 2020;1–7. 11 Kapur VK, Respiratory Care, Vol. 55, No. 9, Sept. 2010 12 Rakicevic M, 36 Alarming Snoring Statistics and Facts for 2022, https://disturbmenot.co/snoring-statistics/January 9, 2022 13 BSC 2021 State of America’s Sleep Results Reveal America’s Sleep Divide, bettersleep.org, May 17, 2021. 14 https://www.enthealth.org/be_ent_smart/treatment-options-for-adults-with-snoring/.15 Elevo kit snoring intervention device. Premarket notification 510(k) K181107. 16 Friedman et al. A new office-based procedure for treatment of snoring – The S.I.Le.N.C.E study. Laryngoscope Investigative Otolaryngology. 2020;5:24–30.
* Indications for Use: The Elevo® Kit Snoring Intervention Device is intended for use in stiffening the soft palate tissue; which may reduce the severity of snoring in some individuals.