What can I do about my snoring?

Q. My wife says I snore a lot. I don’t think I have sleep apnea, but I’m not sure. Is there anything I can do for a serious snoring problem?

A. My patients often ask me this question and one thing I routinely tell them is that they need a sleep study.  This is an objective measure of exactly what is happening to you when you are asleep.  No one can accurately report what they do at night, so it’s important to get this test if you think you might have sleep apnea.

People snore when the airways in the nose and throat get too small, so the air rushing in and out as they inhale and exhale gets funneled through a narrower passageway. The noise is mainly from the vibration of loose tissue, often the soft palate, the slender piece of tissue in the back of the throat.

Some people are snorers because they have too much throat and nasal tissue. Others have floppy tissue that’s more likely to vibrate. The tongue can get in the way of smooth breathing. And being overweight is a cause: Extra fat tissue in the neck and throat sometimes presses in on airways.

If you snore with your mouth closed, then it’s probably a problem with your tongue. If you snore with your mouth open, then it’s more likely to be related to tissues in the throat.

The causes of snoring and sleep apnea overlap. But when someone has sleep apnea, the airway gets blocked completely — or very nearly so. All the little interruptions in breathing can lead to a lack of oxygen that puts a strain on the heart. That’s why people with sleep apnea have a higher-than-normal risk for heart attack and heart failure.

Snoring doesn’t pose any health risks, but it’s still a problem if your bed partner can’t sleep! There are some simple things you can try to dial down the decibels:

·         If you sleep on your back, switch to your side. When you are on your back, your tongue and other soft tissues in the back of the throat tend to slide back, creating a narrower airway.

·         If you drink alcohol in the evening, try drinking less. Alcohol is a muscle relaxant, and it may be affecting the muscles around your airways. Sleeping pills sometimes have the same effect.

·         Trying to breathe through a stuffed-up nose can create a small vacuum that pulls the walls of the upper airway in. If you’re stuffed up a lot, you might have allergies that could be prevented or treated.

·         Dental “appliances” that look like the mouth guards worn by athletes can reposition the jaw and the tongue.

If none of this helps or is relevant, there are several operations that can help snorers. Doctors can laser away excess tissue, or shrink it with instruments that deliver high-frequency radio waves. These procedures are reasonably effective, but the sore throat during the recovery period can be pretty painful.

A new procedure that’s the better choice for many snorers involves inserting slender plastic implants that are less than an inch long into the soft palate. Scar tissue forms around the implants, which stiffens up the tissue so it doesn’t vibrate and make noise. The doctor uses a syringe-like instrument to push the implants in. Local anesthesia means there’s little, if any, pain. It’s done in the doctor’s office and takes about 10 minutes.

The brand name is Pillar, so it’s often referred to as the Pillar procedure, not by its generic name, palatal implantation. The implants are also used to treat mild cases of sleep apnea.

So far the results look very good. It helps with snoring, and the sore throat afterward is mild and lasts only a couple of days. In about one in every 100 cases, the implants fall out. 

Expense is an issue. The procedure costs about $2,000. Most health insurance policies won’t cover the procedure if it’s done for snoring because snoring isn’t considered a medical condition. Still, it might be money well spent if your snoring is keeping your spouse awake at night — and has you looking for someplace else to sleep.

What has your experience been with snoring—either your own or a partner’s? How did you get the snoring to stop?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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