In search of solutions against snoring

Like clockwork, the sound of the freight train roared through our room in the middle of each night. Or at least what looked like a freight train.

In reality, it was me, snoring. And according to my wife, this freight train had gotten considerably noisier over the years.

Unfortunately, the frequency and volume of snoring is exacerbated by age, among other factors. While there’s nothing I can do about getting older, there are products and procedures available that can eliminate or greatly reduce the discomfort to her bed partner caused by all that nighttime sniffling and whistling.

Snoring and sleep apnea are not the same, although severe snoring can be an indication of apnea. If sleep apnea is not present, snoring is simply the mild result of airway obstruction.

As we age, the uvula — that soft, flexible, finger-like projection at the back of the throat — becomes softer and more flexible. At the same time, the muscles under the tongue relax. And the condition is exacerbated if we are overweight or drink too much alcohol.

“As we age, the muscle tone of our airways decreases. This decrease in tone allows tissues to move more easily and become more prone to collapse and vibrate,” said Dr. Michael D. Olson, otolaryngologist and sleep surgeon in the Department of Surgery at the head and neck from the Mayo Clinic. Also, if the size of the airways decreases, the atmospheric pressure increases, which leads to tissue vibrations and snoring.

“Combine that with nasal congestion, a big tongue, and body fat, and it leads to excessive airway collapse,” Dr. Olson said.

Another cause of snoring is tooth extraction, a particular problem for baby boomers who wore braces in their youth. With the removal of four premolars as common practice at the time, baby boomers can now suffer from snoring due to a larger tongue in a smaller mouth.

Snoring alone is not dangerous and does not disrupt restful sleep, but it can have serious social consequences.

“Snoring can be a significant problem for couples. I have people who come to my office crying that they haven’t been able to be in the same bed for years,” Dr Olson said.

One of the cures for snoring is surgery: uvulopalatopharyngoplasty, or UPPP, reorganizes the tissues to increase the size of the airways. But surgery can lead to complications, including problems swallowing or the uncomfortable feeling that there is something permanently lodged in the airways.

Somnoplasty, an outpatient procedure, uses microwaves to remove or shrink the soft tissues of the palate. Complications include voice changes and the procedure may not work for more than a few years or at all, due to tissue re-lengthening.

Fortunately, there are less drastic and less expensive oral products that either eliminate or reduce snoring and its volume. They tend to have less severe, or at least reversible, side effects than surgery.

Oral appliances, known as mandibular advancement devices, push the lower jaw (and tongue) forward, opening the airway and reducing or eliminating snoring.

Advertisements for these products have flooded the radio airwaves recently, but when it comes to results, one size won’t fit all.

And for some, none may prove to be a good fit. To work effectively, the device must be left in the mouth overnight and used continuously. Some users may never get used to the feeling of having a large object in their mouth, preventing their jaw from closing.

Because these devices push the lower jaw forward, users typically wake up with a misaligned bite; often it corrects within minutes of removing the device. Drooling, sensitive teeth, and tooth movement may also occur.

“Oral products help, but they don’t solve the problem,” said Dr. Nina Shapiro, an ear, nose, and throat specialist in the Department of Head and Neck Surgery at the University of California, Los Angeles. Angeles.

SnoreRX and Zyppah, two such products, are “boil and bite” devices. You place the product in boiling water to soften the attached resin, then bite down hard to form a dental impression, which provides a secure fit when inserted into the mouth.

ZQuiet, $80, uses an open-top approach; it does not require the formation of dental impressions. As a result, it is smaller and less intrusive, allowing the sleeper to open or close the jaw at will.

Zyppah uses an additional feature; the $99 mouthpiece includes an elastic strap that holds the tongue down to prevent it from blocking the airway.

SnoreRX does not use a tongue strap, but the $99 device allows the user to further open the airway by moving the lower jaw section forward in 1 millimeter increments.

I’ve tried them all and found none of the devices as comfortable as having nothing in your mouth; I always felt like there was something big and bulky that kept me from fully relaxing and speaking coherently. It was a relief to take each one off as I invariably woke up at 4am

With all three devices, I had jaw misalignment and toothache when I got out of bed, but they always went away within minutes of removing the mouthpiece.

More importantly, however, each reduced or completely eliminated my snoring – although I experienced most of the side effects. (“You haven’t slept this soundly in years,” my wife said.)

For those who cannot tolerate or even consider sleeping with something in their mouth, a nasal dilator may be the answer.

By opening the nostrils, it becomes easier to breathe through the nose, reducing the vacuum and associated tissue vibrations that occur when breathing only through the mouth, said Peter VanZile, principal scientist for GSK, maker of Breathe Right. , such a nasal dilator .

By attaching a semi-rigid adhesive patch to the bridge of the nose, Breathe well open their nostrils as the band tries to straighten up.

Breathe Right, which costs around $12 for a box of 30 strips, worked for me right off the bat. Over the next few days, my wife only reported one or two brief sniffles per night.

Another approach, the $28 Mute, from Rhinomed in Australia, is an internal nasal dilator. By inserting a small silicone ring in the nose, it acts like a stent opening an artery.

Although less intrusive than the mouthpieces, the Mute device had no effect on my snoring, although I could breathe more easily through my nose.

Smart Nora, a $329 product from Canada, works by inflating a bladder under the pillow whenever the included microphone detects the onset of snoring. Quickly raising the sleeper’s head a few degrees opens the airway.

For the first few days, I was continuously awake every time my head went up, but eventually the movement faded into the background. Other loud noises can also trigger pillow movement, so it’s important to place the microphone carefully.

And if you’re the type of person who likes to squeeze a pillow into a ball, Smart Nora won’t work because the bladder needs to stay flat.

Unfortunately, independent studies that can prove the effectiveness of any of these products are lacking.

“To my knowledge, there have been no independent, peer-reviewed, non-company-funded studies on these products,” Dr. Shapiro said. “Studies of product reliability and efficacy would be difficult to fund externally, especially when corporate funding is offered.”

If you’re comparing products based on cost, know that with the exception of the Smart Nora pillow, most need to be replaced between one and four times a year; the $28 Mute three-device pack only lasts a month.

Which product will work for you? “It can be summed up as user preferencesaid Dr. VanZile. Or more specifically, your sleeping partner’s preference.