Medications for Snoring
There are no effective medications recommended for the treatment of snoring. The European Respiratory Society explicitly states that pharmaceutical agents cannot be recommended for snoring treatment, and extensive systematic reviews have failed to identify any drug therapy with sufficient evidence for clinical use 1, 2.
Why Medications Don't Work for Snoring
The fundamental problem is that snoring results from mechanical vibration of upper airway soft tissues during sleep, triggered by relaxation of dilator muscles 3. While various drugs have been proposed to address this through different mechanisms—increasing upper airway muscle tone, suppressing REM sleep, or reducing airway resistance—none have proven clinically effective 1.
Evidence from Systematic Drug Trials
A comprehensive Cochrane review examined 30 trials of 25 different drugs in 516 patients with obstructive sleep apnea and snoring 2. The findings were uniformly disappointing:
Protriptyline (tricyclic antidepressant): Showed no impact on respiratory indices despite theoretical benefits for REM-predominant cases, though adverse effects like dry mouth and urinary symptoms were common 1
SSRIs (paroxetine): Demonstrated only modest reductions in apnea-hypopnea index without improvement in daytime symptoms 1
Mirtazapine: Initial promising results could not be reproduced in larger multicentre trials, and the drug caused significant weight gain and sleepiness—both of which worsen snoring 1, 2
Fluticasone (nasal steroid): Only effective in patients with concurrent allergic rhinitis, reducing AHI from 30.3 to 23.3, but this addresses nasal obstruction rather than primary snoring 2
The European Respiratory Society reviewed this evidence and concluded that pharmaceutical agents cannot be recommended for snoring treatment due to lack of efficacy 1.
What Actually Works: Evidence-Based Alternatives
First-Line Interventions
Weight reduction should be the primary recommendation for overweight patients who snore, as this addresses a fundamental causative factor 4, 3. The German Society of Otorhinolaryngology emphasizes that weight loss should be achieved in every overweight subject who snores 3.
Positional therapy can be considered for patients who snore exclusively in the supine position 3.
Mechanical Interventions
Mandibular advancement devices (MADs) receive the highest level of evidence (Grade A) from the European Respiratory Society for mild-to-moderate obstructive sleep apnea and can be effective for snoring when custom-made 4, 5, 6.
CPAP therapy remains the gold standard if the patient has obstructive sleep apnea rather than simple snoring 7, 5, 6.
Surgical Options
Minimally invasive surgery of the soft palate can be considered when individual anatomy appears suitable, though the European Respiratory Society does not recommend injection snoreplasty due to insufficient evidence 4, 3.
Critical Diagnostic Caveat
Before any treatment, you must distinguish between simple snoring and obstructive sleep apnea 6, 3. This requires:
- Sleep medical history, preferably with bed partner interview 3
- Clinical examination of nose, oropharynx, larynx, hypopharynx, tongue size, and facial skeletal morphology 3
- Objective sleep studies if the history or examination suggests sleep-disordered breathing, if relevant comorbidities exist, or if treatment is requested 3
Simple snoring without OSA has no medical indication for treatment, as it is not associated with medical hazard 3. However, if OSA is present, treatment becomes medically necessary due to cardiovascular morbidity and mortality risks 5.
Common Pitfalls to Avoid
Do not prescribe stimulants for snoring—they are only indicated for excessive daytime sleepiness in conditions like narcolepsy, not for snoring itself 1, 8
Avoid sedating medications including benzodiazepines and sedating antidepressants, as these worsen upper airway muscle tone during sleep and can exacerbate snoring 1, 3
Do not recommend over-the-counter antihistamines or herbal supplements like valerian or melatonin, as these lack efficacy and safety data for snoring 1
Nasal dilator strips should not be used—the European Respiratory Society gives a Grade D recommendation against them for reducing snoring, as they do not improve outcomes despite increasing nasal cross-section 9