Snoring

• Consult your doctor and dentist if you have tried the self-help approaches without success.
• You should also see your doctor if nostril dilators have relieved the problem, because it could mean that you have nasal obstruction that could be dealt with by surgery.
• You should also see your doctor if you have any of the symptoms of sleep apnoea.

Your dentist can advise you about ‘mandibular advancement splints’ that you place in your mouth for sleeping. Made-to-measure splints are better than the types you buy over the counter. They consist of splints that fit closely over the upper and lower teeth, and are linked by a tension band to pull the lower jaw forward. But they are expensive, costing several hundred pounds in the UK, and will probably have to be replaced after 18 months. Also, they do not always work (they reduce snoring in about 75% of people), and they may make your jaw ache and cause dry mouth or excessive saliva production. A few dentists have been trained to fit them. If your dentist has not had this training, he or she can refer you to a specialist orthodontist.

Your doctor can advise you about other treatments.

Uvulopalato-pharyngo-plasty. In the 1980s, an uvulopalato-pharyngo-plasty operation was a common treatment for people who could not lead normal lives because of their snoring. In this procedure, a 1-cm strip is removed from along the entire free edge of the soft palate, including the uvula. As it heals, it scars, and this stiffens the palate so that it cannot vibrate. The disadvantages are that it is very painful, recovery takes several weeks, it will not cure the problem if the base of the tongue vibrates as well as the palate, the voice may change (which is especially noticeable in singers) and cure may not be permanent. After the operation, 5–10% of people find that fluid goes up into the nose when they drink.

Laser surgery. In the 1990s, laser treatment became popular. This burns away part of the uvula and soft palate to produce the desired scarring. It takes about 15–20 minutes and can usually be done under a local anaesthetic. This technique (laser palatoplasty) has fewer side effects; there will be pain and discomfort in the throat for about 2 weeks afterwards, and some people have a slight feeling of dryness in the throat for several months. These operations improve snoring in about 85% of cases, but the cure is not always permanent, so the long-term success rate is about 66%. A similar technique uses a fine, heated needle (diathermy palatoplasty).

Radiofrequency ablation (somnoplasty) is another method of stiffening the fleshy soft palate. It uses radio waves to heat, stiffen and shrink the tissue. Each treatment takes about 20 minutes and about 10 treatments are needed. It is done under a local anaesthetic. It may not be very effective in the long term; 18 months after the treatment, 78% of patients said that they were still snoring heavily (Journal of Laryngology and Otology 2002;116:116–8).

Other methods of stiffening the soft palate have been tried. ‘Chemical snoreplasty’ involves injecting a chemical called tetradecyl sulphate into the soft palate to cause scarring and stiffening; after about a year, the scar may soften, so another injection may be needed. Implants of Dacron threads are a more recent idea. These methods are not generally available.

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• What causes snoring?
• Is snoring dangerous?
• What you can do
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