Snoring causes distress and lack of sleep for both the snorer and anyone sharing the same room. Additionally, it has been linked to numerous metabolic disorders, including cardiovascular disease.
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Snoring treatments can be surgical or non-surgical. which type is adopted depends on the etiology of snoring.
Inspiration is characterized by the creation of negative pressure and partial collapse of the pharyngeal airways in snorers. The reason for snoring is upper airway obstruction. Nasal devices can help keep it open and relieve snoring. The Afrin test is a method of identifying patients who may benefit from these devices.
Nasal snoring is often helped by the use of nasal anti-snoring devices, namely nasal strips or nasal dilators. These two elements keep the nostrils open during sleep.
Nasal strips are strips of adhesive tape designed to spread the nostrils.
Nasal dilators are made of plastic or metal and work by pushing the nostrils open during sleep. Either of these can be used as their effectiveness has not been directly compared.
Obstructive sleep apnea syndrome (OSAS)
OSAS can be treated by one of the following modalities:
- Continuous Positive Airway Pressure (CPAP)
- Oral appliances
Oral appliances may be used instead of CPAP, or if CPAP fails or is not acceptable to the patient. They may also be indicated in mild or moderate OSAS without daytime sleepiness.
Chin strips are strips of self-adhesive tape attached under the chin to keep the mouth closed while sleeping.
This plastic device is fitted inside the mouth to obstruct airflow and promote nasal breathing, which often prevents snoring.
These two devices are comparable in terms of available research.
Mandibular Advancement Devices (MADs)
These devices are used to prevent snoring caused by vibrations of the base of the tongue. They push the lower jaw and tongue forward to increase space for airflow in the pharynx, thereby preventing tongue vibration in this region.
A thermoplastic MAD can be purchased ready-made and custom-fitted at the patient’s home. These devices may not be suitable or tolerated by people with a strong gag reflex or those who cannot sleep with devices in their mouths. This can cause pain in the face and jaw for the first few days. A custom-made MAD by a dentist is recommended for people with OSAS, however, these are much more expensive.
Modern MADs are lighter, less bulky and even micro-adjustable, allowing each person to adjust the amount of jaw protrusion to stop snoring without causing undue stress on the jaw and facial muscles. These devices will need to be replaced approximately once every 18 months.
Tongue Retaining Devices (TRD)
The TRD is another oral device that prevents tongue dropping which often occurs during sleep and causes snoring in many people. It holds the tip of the tongue in place with a slight negative suction. The associated mouthpiece also creates mandibular protrusion, but this is reduced to comfortable levels based on patient feedback.
This can also be increased if snoring persists despite use. The TRD has side vents to allow mouth breathing in case of a stuffy nose. It may create some initial pain, but it is quite safe and effective for many snorers. In addition, it reduces sleep apnea and daytime sleepiness.
Advantages and disadvantages of oral appliances
Oral appliances can cause discomfort, foreign body sensation, excessive drooling, or dry mouth. They should generally be used after a sleep study has been completed to identify risk factors for OSAS and to diagnose it, if present, as well as to provide a baseline against which to assess progress in using the devices. They are reversible, simple to use, affordable and effective, and thus offer an alternative to CPAP in many patients.
Adjustable oral appliances require orthodontic skills and are therefore much more expensive than fixed appliances. They take longer to form and build up tolerance is slower; however, they are more effective in reducing snoring in all types of patients with OSAS. The highest success rates are seen in younger patients with a leaner build and lower BMI, who have mild to moderate OSAS.
Fixed appliances are relatively less expensive, easy to install by the patient and act more quickly. They cannot be adjusted to provide more or less mandibular protrusion and therefore do not correct snoring.
Overall, oral appliances are more acceptable than CPAP in people with OSAS.
A newer device is based on the ability to learn a conditioned reflex. It starts to vibrate as soon as snoring appears, which pushes the sleeper to turn on their side. It helps improve daytime sleepiness, without affecting or improving sleep quality.