• Non-Surgical Treatments for Snoring
Over the years, many ideas have been presented as "cures for snoring".

Various types of pillows, nasal sprays, chin straps, exercises and even 'throat lubricants' have been promoted as an effective non-surgical solution.

Recent innovations have included technological marvels such as vibrating wristbands which are activated by the noise of snoring, and deliver a shock or vibration to the wearer. These assume a snorer can be 'trained' not to snore. Even when they work, the problem with this treatment is obvious … the snorer might reduce their snoring, but only because they’re being constantly woken.

Generally, the low price of these items makes them seem attractive, especially since there is no requirement to visit a doctor before commencing 'treatment'.

Unfortunately, snoring is a complex problem and not something which can be controlled or stopped by the sufferer. Quite simply, if people could stop themselves snoring, they would.

Be wary. If something seems too good to be true, it probably is.


• Self-Help for the Light Snorer
Adults who suffer from mild or occasional snoring may gain relief through a combination of the following self-help remedies. They are certainly worth trying before resorting to painful and/or expensive treatments – especially when most of those treatments are not always effective.

Adopt a healthy and athletic lifestyle to improve muscle tone and shed weight. (Note: If you are unfit, a male over age 40; a women over 50; if you suffer (or are at risk of) chronic health problems such as heart disease, diabetes, or obesity, you should consult your doctor before beginning an exercise program).

• Nasal Congestion
If you have allergies that cause nasal congestion, try an oral or nasal spray decongestant available from your chemist. Be careful not to use these over-the-counter products on a long-term basis. If your nasal congestion doesn't clear up in a few days, see your doctor as you may need stronger medication, or other measures to clear your nasal passages.


• Continuous Positive Airway Pressure (CPAP )
The Continuous Positive Airway Pressure treatment was developed almost 20 years ago by Professor Colin Sullivan in Sydney, Australia. With the exception of some patients with severe nasal obstruction, CPAP has been found to be nearly 100 percent effective, although it does not actually cure the problem. The patient must, therefore, always use the CPAP treatment.

Extensive coverage in medical journals and other media has lead to the CPAP treatment being widely considered to be the most effective non-surgical treatment for the alleviation of snoring and obstructive sleep apnoea.

CPAP delivers air into your airway through a specially designed nasal mask which is attached to a pressure pump. The mask/pump is designed to force air through your airway so that it won't close. The mask does not breathe for you; instead, the flow of air creates enough pressure when you inhale to keep your airway open.

If you decide to undertake this treatment, you may be required to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen.

You will also be required to wear the mask every night. Not surprisingly, some people find wearing a mask in bed every night difficult to tolerate. Some patients (or their bed partners) are unable to tolerate the mask, the hoses and/or the noise of the air pump and decide to cease using it.

As a result, numerous studies have shown that long­ term compliance in wearing the nasal CPAP is only about 70 percent. That is, approximately 30% of SDB sufferers prefer to suffer from the ailment rather than the treatment because they find the device to be claustrophobic, or because they have difficulty using it when travelling.

Suitability for CPAP use is determined after a review of your medical history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications. You will also receive a physical and otorhinolaryngological (ear, nose, and throat) examination to evaluate your airway.

Before beginning to use the treatment, you would need to have the proper CPAP pressure set during a formal "sleep study." This will require an overnight stay in an accredited sleep study centre.

• Oral Appliances (Mandibular Repositioning Devices)
During the 1980’s, most physicians tended to believe that CPAP was the only viable treatment alternative to surgery.

This began to change in the early 1990’s when scientific research projects began to report on the effectiveness of oral appliances (also variously referred to as Mandibular Repositioning Devices (MRD’s), mandibular advancement devices, mandibular splints, intra-oral devices, dental appliances, airway dilators and numerous other names.)

Significant studies included the 1995 American Sleep Disorders Association Review titled “Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea”, and the report “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances”.

The review compared the risk and benefit of oral appliance therapy against the other available treatments and suggested that oral appliances presented a useful alternative for patients with all but the most severe cases of OSA, and especially for those who cannot tolerate CPAP therapy.

Since 1995, numerous studies have confirmed that oral appliances are an appropriate first line treatment for patients with snoring and mild to moderate sleep apnoea. (For full details of these studies, refer to the ‘Research’ section of this site.

Professionally prepared appliances also have some important advantages over other treatments. According to the Queen Victoria Hospital Sleep Studies Unit:

“Although this service is available at the Queen Victoria Hospital it is not commonplace in all sleep centres in the U.K. In America this mode of treatment has been recognised as very effective in managing selected cases and there is a Sleep Disorder Dental Society specifically for the treatment of sleep disorders through the use of splints. Mandibular intraoral advancement devices may offer several advantages over other therapy choices because they are non-invasive, reversible, quiet, and generally well accepted by patients.”

In addition to these advantages, professionally prepared appliances are much less expensive than surgery or CPAP treatment. The appliances are also highly transportable and do not require any form of electrical power, which is a significant advantage over the CPAP therapy and particularly important for anyone who travels.

Oral appliances come in many different shapes and forms – but while the appliances can vary in design, they all have the same purpose in the end; namely, to assist in maintaining an open airway for the patient while they sleep. In most cases, the appliance is an orthodontic retainer (similar in some ways to a mouthguard) or an orthodontic splint (a removable plate with wire attachments which fit over the teeth, similar to dental braces). In both cases, these appliances fit in the patient’s mouth and pull the lower jaw forward to open the airway during sleep.

The principle behind this treatment is not new. Records show that the first oral appliance to keep the lower jaw forward and assist in airway dilation was used back in the 1930’s. However, mandibular repositioning oral appliances have only recently been widely available and used.

A recent study in Switzerland found oral appliances highly effective in treating sleep apnea. A similar study in the UK of 25 heavy snorers found that use of mandibular advancement appliances was effective in reducing snoring loudness for 84 per cent of the subjects while 76 per cent said they were snoring on fewer nights per week.

Different oral appliances produce different results and so the results of these studies may actually be understating the effectiveness of the treatment. According to the Queen Victoria Hospital Sleep Studies Unit:

“Our success rate with these devices has been high…. To date 80% of the patients referred ... have been found suitable for splints, of which 95% have been successfully treated. Only two patients have failed to tolerate the splints, one of whom had a severe gag reflex.”

Most patients tolerate professionally prepared appliances exceptionally well, taking less than a fortnight to become completely comfortable sleeping with the appliance in the mouth.

Some side effects have been noted in some cases, although these were described as being only "mildly disturbing". Listed side effects were mucosal dryness, tooth discomfort, jaw soreness, and excessive salivation. These side effects usually passed within a few hours of waking and removing the appliance. The symptoms usually passed completely in well under 3 weeks. In the interim, some particularly sensitive patients chose to use simple pain relievers (aspirin and paracetamol) to gain relief from the tooth/jaw discomfort.

Professionally prepared (as distinct from ‘over the counter’) oral appliances are now a recognised treatment for snoring, sleep apnoea, and upper airway resistance syndrome. This is highlighted by the fact that the Federal Drugs Administration recently upgraded its classification of the treatment.

The following excerpt is from The Academy of Dental Sleep Medicine, News Update, December 2002:

• FDA Final Rule on Classification of Intraoral Devices
The Food and Drug Administration has announced its final rule that changes the classification of intraoral devices for the treatment of snoring and obstructive sleep apnea to Class II (special controls). This rule is effective December 12, 2002.

Formerly, these appliances remained unclassified as medical devices by the FDA. According to Dr. Susan Runner, of the Center for Devices and Radiological Health, the regulation will help increase the legitimacy of oral appliance therapy for the treatment of sleep disordered breathing. This may also add to the recognition of oral appliances by insurance providers, thus increasing the possibility for reimbursement to practitioners performing these procedures.

Class II refers to medical devices requiring special controls in order to ensure public health and safety, such as intraoral soreness, TMD, obstruction of oral breathing, loosening or flaring of lower teeth, general tooth movement, and others defined by a FDA Guidance Document. Mandating these considerations will add medical validity to the use of these appliances and significantly reduce the number of unmitigated devices.

Dental laboratories expressed concern over the Guidance Document, however labs currently conform to these rules. This ruling will not alter their regulatory requirements. Dr. Harold A. Smith, President of the Academy of Dental Sleep Medicine, states, "The FDA classification of oral devices is a forward step in the future of oral appliance therapy, but more importantly, will ensure the effective treatment and overall health of patients."

Many designs of MRD’s exist, including some ‘over the counter’ or ‘via the internet’ do-it-yourself versions, but it is universally recognised that it is essential the appliances be individually designed and custom fitted for each patient by qualified professionals in order to be optimally effective.

If patients are considered suitable for this treatment, impressions of the mouth and teeth are taken, together with a bite recording. The appliance is then custom-made and fitted about a week later.

Professionally manufactured devices are very hard wearing and should last up to 3 years.