Snoring and sleep apnoea are often multi-factorial conditions with a variety of contributory factors, hence there will never be one single universal cure for snoring. Therefore, accurate assessment is essential to guide appropriate treatment.
General lifestyle measures – This is the mainstay of treatment in the majority of simple snorers. Weight loss, reduction of alcohol intake, stopping smoking and stopping any sedative medication can all be useful. In particular, weight loss alone can cure many cases of snoring.
Treatment of nasal blockage – including medical treatment of rhinitis with decongestants, nasal steroid sprays and nasal douches (Sterimar™ / SinuRinse™); the use of nasal splints such as ‘Nozovent™’ and ‘Breathe Right™’ nasal strips to open the nasal airway.
Mandibular positioning devices – dental splint which you can wear at night and holds the lower jaw forward. This stops the tongue from collapsing backward and blocking the airway.
Nasal continuous positive airways pressure (CPAP) – Gold standard treatment for sleep apnoea. Air under pressure is delivered via a tight fitting nasal mask. This acts as a pneumatic splint holding the airway open thus preventing snoring and obstruction.
It should be emphasised that surgery for snoring is only considered as last resort and only when conservative measures have failed. Furthermore, the results of surgery are poor in those individuals with BMI > 30.
Nasal surgery – To deal with septal deviation, turbinate enlargement, nasal polyps or enlarged adenoids may help snoring by overcoming nasal obstruction.
Palatal surgery – Limited uvulopalatoplasty with or without tonsillectomy. This involves partial excision of the uvula (the structure that dangles at the back of the throat and which normally vibrates to create the noise of snoring), as well as scarring of the soft palate by creating gutters on either side of the uvula. This can also be done using laser or low-temperature radiofrequency energy delivered via a needle into the soft palate (Somnoplasty™). This results in an area of scarring and hence stiffening of the soft palate. In individuals with large obstructive tonsils, these can also be removed as part of the procedure if necessary. In children with sleep apnoea, most cases are adequately dealt with by removal of the adenoids and tonsils as this is usually the site of obstruction.
Tongue base surgery – Reduction of tonsil tissue at the tongue base (lingual tonsils) can be useful in a small number of patients with significant lingual tonsil enlargement. This is normally performed in conjunction with other procedures and rarely in isolation.