Snoring

Signs of Snoring

Snoring occurs when the soft tissue structures of the upper airway collapse during sleep. This partial collapse can occur during any stage of sleep. 
When the throat tissues vibrate against each other, it produces the sound known as snoring. The sound is a sign that the airway is partially blocked. It can come through the nose, mouth, or both the nose and mouth. Usually, the narrower the airway space, the louder the snoring sounds. A narrow airway can be caused by a large tongue or tonsils or excess fat in the throat.

Some people snore louder than others. Quiet snoring may not disrupt one’s overall quality of sleep. But loud snoring can wake the snorer or disturb a bed partner’s sleep. Snoring may also cause dry mouth or an irritated throat upon waking up.

Who Snores?

Snoring can affect almost anyone. Habitual snoring has been found in an estimated 24 percent of adult women and 40 percent of adult men. Both men and women are more likely to snore as they age. Men, however, become less likely to snore after the age of 70. Snoring is more common in people who are overweight. There is a greater amount of fat in the back of the throat that vibrates during sleep. This excess weight can press down on the airway. Pregnancy can also increase a woman’s chance of snoring. It can even affect children. An estimated 10 to 12 percent of children snore. Snoring appears to run in families, but there are some ways to reduce one’s likelihood of snoring. Alcohol, drugs, muscle relaxers and tobacco products can all contribute to snoring. So avoiding these triggers can decrease the problem.

Is Snoring a Cause for Concern?

Snoring itself does not endanger one’s health. But snoring can be a sign of a more serious condition called obstructive sleep apnea (OSA). About 50 percent of people who snore loudly have sleep apnea. OSA happens when the tissue in the upper-airway blocks the entire airway, causing a pause in a person’s breathing. This blockage keeps air from getting into the lungs, lowering a person’s blood-oxygen levels. This pause in breath can happen for 10 to 30 seconds, sometimes for one minute or more, hundreds of times a night.

Snorers who suffer from OSA often snore loudly and frequently. They may make gasping, choking or snorting sounds as they try to breathe and feel drained of energy during the day. People who experience loud snoring and excessive daytime sleepiness should visit a sleep center accredited by the American Academy of Sleep Medicine (AASM). Visit www.sleepcenters.org to locate a sleep center. Patients can undergo a sleep study, or polysomnogram, to determine if their snoring indicates OSA. This test charts a person’s brain waves, heart beat, and breathing as they sleep. It also records a person’s arm and leg movements.

Treating Snoring

Snoring without OSA can be treated in several ways. Medical factors may affect treatment, so it is important to speak with a physician.

Behavioral Therapy

Because excess weight can cause or worsen snoring, weight loss can decrease the severity of snoring or apnea. Weight loss alone may help some, but not all people with snoring. Avoiding alcohol, drugs, muscle relaxers and tobacco products can also help reduce or eliminate the presence of snoring.

Positional Therapy

Positional therapy involves side-sleeping instead of sleeping on one’s back. This shift keeps the weight of a person’s neck from collapsing on his or her airway. It may help some, but not all people with snoring.

Oral Appliance Therapy

Oral appliances are worn in the mouth to treat snoring and OSA. These devices are similar to sports mouth guards but are fitted by dentists trained in dental sleep medicine. Oral appliance therapy (OAT) involves the selection, design, fitting and follow-up care of a custom-made oral appliance that is worn during sleep. This appliance maintains an opened, unobstructed airway by repositioning the lower jaw and tongue forward. It also stabilizes the lower jaw and tongue, increasing the tongue’s muscle tone.

Many appliances have been FDA-approved for the treatment of snoring and/or sleep apnea. Dentists trained in this therapy are familiar with the various designs of appliances. They know which appliance will work best for each patient’s specific needs. They can also adjust the appliances to avoid side effects, such as jaw or teeth pain. Dentist work with physicians and sleep specialists as part of a medical team in each patient’s diagnosis, treatment, and on-going care. A list of dentists trained in oral appliance therapy can be found using the AADSM’s Find-A-Dentist feature.

Surgical Procedures

Dentists who are oral and maxillofacial surgeons may use a variety of methods to treat upper airway obstruction. These specialists can treat snoring using minimally invasive procedures as well as more complex surgery. Additionally, an Ear Nose and Throat specialist may remove any excess tissue in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.

Oral Appliances
 Snoring and Obstructive Sleep Apnea


Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be the sign of a more serious medical condition known as Obstructive Sleep Apnea (OSA).When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen. The condition known as Upper Airway Resistance Syndrome (UARS), is midway between primary snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA but require special sleep testing techniques.

Standards of Care

Oral appliance therapy is indicated for:

  • 
Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep-position change.
  • Patients with moderate to severe OSA should have an initial trial of nasal CPAP, due to greater effectiveness with the use of oral appliances.
  • 
Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP. Oral appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy and adenoidectomy, cranofacial operations, or tracheostomy. 
Oral Appliances
Oral appliances that treat snoring and obstructive sleep apnea are small plastic devices that are worn in the mouth, similar to orthodontic retainers or sports mouth guards. These appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake.

 

Currently, there are approximately 70 different oral appliances available. Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery, or CPAP.

Types of Oral Appliances

With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.

Tongue Retaining Appliances

Tongue retaining appliances function by holding the tongue in a forward position by means of a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.

Mandibular Repositioning Appliances

Mandibular Repositioning Appliances function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. It also holds the lower jaw and other structures in a stable position to prevent opening of the mouth.


Oral Appliance Therapy

Oral Appliance Therapy involves the selection, fitting, and use of a specially designed oral appliance worn during sleep that maintains an opened, unobstructed airway in the throat.
 Oral appliances work in several ways:

  • Repositioning the lower jaw, tongue, soft palate and uvula
  • 
Stabilizing the lower jaw and tongue
  • 
Increasing the muscle tone of the tongue

 

Dentists with training in oral appliance therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. Determination of effective treatment can only be made by joint consultation of your dentist and physician. The initial evaluation phase of oral appliance therapy can take from several weeks to several months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.

Other Treatment Options


In addition to lifestyle changes, such as good sleep hygiene, exercise and weight loss, there are three primary ways to treat snoring and sleep apnea. The most common way is with therapy delivered through a Continuous Positive Air Pressure machine. CPAP is usually applied through a tube to a mask that covers the nose. The air pressure that is generated splints the structures in the back of the throat, holding the airway open during sleep. Treatment can also be accomplished with surgery to the soft palate, uvula, and tongue to eliminate the tissue that collapses during sleep. More complex surgery can reposition the anatomic structure of your mouth and facial bones. Many of these procedures can be performed by an AADSM member trained as an oral and maxillofacial surgeon.
On-going Care
On-going care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.

Advantages of Oral Appliance Therapy


Oral Appliance Therapy has several advantages over other forms of therapy:
- Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance. 
- Oral appliances are small and convenient making them easy to carry when traveling. 
- Treatment with oral appliances is reversible and non-invasive.

Self Test


The only way to be sure if you have obstructive sleep apnea is to have a sleep test either at home from a qualified sleep physician or in a hospital sleep center, but a score of 9 or above on this test is an indication that you should see your doctor.
Please feel free to print this test, fill it out and take with you to your physician.
The Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations?


Choose the most appropriate number for each situation:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Activity Score



Sitting and Reading _____
Watching TV _____
Sitting, inactive in a public place (theater, meeting, etc.) _____
As a passenger in a car for an hour without a break _____
Lying down to rest in the afternoon when circumstances permit _____
Sitting and talking to someone _____
Sitting quietly after lunch without alcohol _____
In a car, while stopped for a few minutes in traffic _____
Total _____

A score of 9 or above indicates you may be having a problem with daytime sleepiness but below 9 does not necessarily mean that you don’t have a problem. See your healthcare professional for advice if you snore, have been told that you awake gasping for breath or if you are sleepy during the day.