Snoring is perhaps more of a social problem than a medical problem.
However, about 15% of people who snore may also have obstructive sleep
apnea, which can be a medical problem. Unfortunately, there is no good
way to distinguish between those patients who simply snore from those
who snore and also have sleep apnea. Thus, if you snore, you may want
to read the section in this website regarding sleep apnea, and discuss
with your doctor whether you should be tested for this disorder.
What Causes Snoring?
Snoring is caused by the vibration of the soft palate as air passes between
the nose and the throat while sleeping. In some people it can also be
caused by vibration of the back of the tongue. The reason this occurs
only during sleep (thankfully!) is that while we are awake, there is a
slight amount of muscle tone present that keeps these structures from
falling against the back of the throat, even if we are laying on our back.
However, as we drift into deep sleep, this muscle tone goes away, and
the palate and tongue can partially collapse and start to vibrate as we
struggle to pull air through the suddenly narrowed breathing passage.
If they collapse enough to completely block the throat, apnea can
occur (see above). Snoring and sleep apnea are more common in obese patients
(because the fat in the neck narrows the breathing passage) and are also
somewhat more likely in persons with a long soft palate, a large uvula,
or a thick tongue. They are also more common in older patients, probably
because of the decrease in muscle tone as one gets older. Both are also
made worse by the use of muscle relaxants or alcohol before bedtime.
If you have an Internet account, you have probably been bombarded with
emails touting various cures for snoring. Also, you may have seen ads
in many newspapers and magazines. Here’s a tip: none of these
products work. Breathe-Rite strips (the flexible sticky strips you
put on your nose) may work on a limited number of people who can’t
breath through their nose at night, but otherwise there are currently
no medicines (prescription or otherwise) that cure snoring. There are
a number of other treatments that may help snoring however, ranging from
taping a tennis ball to your back (this keeps you from sleeping on your
back) to various surgical therapies.
If you’re overweight, the best treatment is to lose some weight.
Research has shown that unfortunately, the relationship between snoring
and weight loss is not linear. That is, a little weight loss will not
result in a little decrease in your snoring. Rather, there appears to
be a “set-point” for each individual, so that if you are above
this weight you’ll snore, and below it you won’t. For those
of you who started snoring as adults, think back on about how much you
weighed when you didn’t snore, and you can get a rough idea of your
If your set-point is many pounds ago, there are some other treatments
for snoring available. First, there are dental appliances that fit in
your mouth at night to help to keep your tongue from falling back. While
these work for some individuals, the resultant jaw discomfort often causes
most people to abandon their use. That leaves surgical treatments, of
which there are a number available. An important consideration is that
except for uvulopalatopharyngoplasty (UPPP), most of these procedures
are fairly new, and there is little data regarding their long-term effectiveness.
Results at one year have been included for most of the procedures, however.
Please see below for a summary of their approximate costs, advantages
What’s involved: The palate is anesthetized with
Novocaine and an electrocautery (“electric knife”) is used to remove most
of the uvula. The palate is then burned across its surface so that the
resulting scar tissue tightens and stiffens the palate.
Where done: Clinic
Advantages: Has been well-studied short-term. Few complications.
Initial success rate (reduction in snoring of 50% or more) about 90%,
success rate at one year about 75%.
Disadvantages: Can result in moderately severe pain and
swelling that can last for several days.
What’s involved: Same as above, except a laser
is used instead of electrocautery.
Where done: : Clinic. Was originally fairly popular,
but because of poor long-term results (see below), I don’t know
anyone in the Triangle that is still doing these.
Advantages: None when compared to other procedures.
Disadvantages: Significant pain and swelling. May have
to be repeated several times before desired effect is obtained. Initial
success rate of 85% drops to 55% after 18 months.
Cost: approx. $900.00
What’s involved: Uses electrocautery delivered
through a needle inserted in the palate. A special feedback circuit allows
the needle to heat up enough to scar the palate, but not to burn. The
resulting scar stiffens the palate and reduces snoring.
Where done: ENT clinic at UNC Hospitals.
Advantages: Very little pain. Takes about 30 minutes,
and may return to work the same day.
Disadvantages: High cost. May also require more than
one treatment before desired effect is obtained. Only one study of long-term
success has been reported. This showed that initial success rate of >90%
drops to about 60% after one year. Procedure may be repeated, however.
Cost: approx. $1400.00 for first session, $500.00 for
each subsequent session.
What’s involved: A chemical is injected into the
palate that causes a loss of blood supply to the central portion of the
palate. This area turns black-and-blue and then becomes scar tissue over
the next 4-6 weeks and stiffens the palate.
Where done: Clinic.
Advantages: Somewhat less pain than uvulupalatoplasty.
Low cost (see below).
Disadvantages: Is the newest of the snoring procedures.
Seems to be more variability in results than seen with other procedures.
In my hands (I have done about eight of these) short-term success rate
is about 60%. Long-term success rate unknown at this time.
What’s involved: Major surgical procedure under
general anesthesia. The uvula and a portion of the palate are removed
and the edges of the palate sutured together. If tonsils are present,
they are also removed.
Where done: Operating room with overnight stay.
Advantages: Only procedure presently approved for sleep
apnea. Has never been directly compared to the other procedures listed
above for snoring alone, but probably has greatest likelihood for long-term
Disadvantages: Requires 5-7 days recovery. Long-term
success for snoring ~ 55%.
Cost: Approximately $5700.00. This includes surgeon’s
fee, use of operating room, and one night hospitalization. Is usually
covered by insurance if you have sleep apnea.
As you can see, there is presently no foolproof treatment for snoring.
Certainly weight loss is the best solution if you have the willpower to
stick to a diet, increase your amount of exercise, and not expect quick
results. If you are not overweight, one of the surgeries listed above
would probably be your best option. Which one depends primarily on the
amount of money you are willing to invest and how much discomfort you
are willing to tolerate to reduce your snoring.