How can I stop snoring?

How to Stop Snoring

Weight reduction is the most effective non-invasive intervention for reducing snoring, alongside positional therapy and addressing potential obstructive sleep apnea. 1

First Step: Determine if Snoring is Primary or Secondary to OSA

Screening for Obstructive Sleep Apnea (OSA)

• Use the STOP questionnaire to screen for OSA risk 1:
  • Snoring loudly
  • Tiredness/fatigue during daytime
  • Observed apnea episodes
  • Pressure (high blood pressure)
• A score of 2 or higher indicates high risk for OSA and requires further evaluation

When to Seek Medical Evaluation

• If you have any of these symptoms alongside snoring:
  • Excessive daytime sleepiness
  • Observed breathing pauses during sleep
  • Morning headaches
  • High blood pressure
  • Snoring that disrupts your or your partner's sleep

Effective Interventions for Snoring

1. Weight Loss (Grade C Evidence)

• Most effective non-surgical intervention 1
• Even modest weight loss (≥3 kg) can significantly reduce snoring frequency 2
• Some individuals who lost an average of 7.6 kg showed near elimination of snoring 2

2. Positional Therapy (Grade C Evidence)

• Sleep on your side rather than back 1
• Use specialized pillows or devices that prevent rolling onto your back
• Most effective for younger, less obese patients with mild snoring 1
• Note: Long-term compliance with positional therapy is often poor 1

3. Reduce Nasal Resistance

• Use nasal decongestant sprays if nasal congestion contributes to snoring 2
• Consider intranasal corticosteroids if allergic rhinitis is present 1
• Note: Nasal dilators alone are not recommended for treating OSA (Grade D evidence) 1

4. Lifestyle Modifications

• Avoid alcohol and sedatives before bedtime 3
• Establish regular sleep schedule
• Avoid heavy meals within 3 hours of bedtime

Medical Devices for Persistent Snoring

Mandibular Advancement Devices (MADs) (Grade A Evidence)

• Highly recommended for mild to moderate OSA 1
• Custom-made and titrable devices are more effective than over-the-counter options 1
• Must be fitted by a qualified dentist 1
• Regular follow-up needed (every 6 months for first year, then annually) 1

CPAP Therapy

• Gold standard for moderate to severe OSA 1
• Consider if other methods fail and OSA is confirmed 1

Surgical Options (When Non-Surgical Methods Fail)

For Adults:

• Tonsillectomy if tonsillar hypertrophy is present (Grade C evidence) 1
• Uvulopalatopharyngoplasty (UPPP) only in carefully selected patients (Grade C evidence) 1
• Nasal surgery alone is not recommended for OSA (negative Grade C evidence) 1

For Children:

• Adenotonsillectomy is first-line treatment for pediatric OSA with adenotonsillar hypertrophy 4

Important Cautions

1. Snoring may progress to OSA over time if left untreated 5
2. Severe snoring may be associated with serious health conditions including:
   • Pulmonary and systemic hypertension
   • Secondary polycythemia
   • Cardiac arrhythmias 5
3. Treatments that help snoring may not adequately treat underlying OSA
4. Tongue muscle training improves snoring but is not effective for sleep apnea (negative Grade B evidence) 1

Treatment Algorithm

1. Screen for OSA using STOP questionnaire
2. If high risk for OSA → Seek medical evaluation and possible sleep study
3. If low risk for OSA or primary snoring:
   • Start with weight loss program
   • Implement positional therapy (side sleeping)
   • Address nasal congestion if present
4. If these fail → Consider MAD from qualified dentist
5. If snoring persists with MAD → Reevaluate for OSA and consider CPAP
6. Surgical options only after non-surgical approaches fail

Remember that snoring is not just a social nuisance but may indicate underlying sleep-disordered breathing that requires proper evaluation and treatment to prevent serious health consequences.