In Search of Snoring Solutions

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Like clockwork, the sound of the freight train came roaring through our bedroom in the middle of each night. Or at least what sounded like a freight train.

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

Unfortunately, snoring frequency and volume 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 significantly reduce the annoyance to one’s bed partner caused by all that nighttime snorting and wheezing.

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 benign result of an obstructed airway.

As we age, the uvula — that soft, floppy, fingerlike projection in the back of the throat — gets softer and floppier. At the same time, muscles under the tongue get lax. And the condition is exacerbated if we are overweight or drink too much alcohol.

“With age, the muscle tone of our airways decreases. That decreased tone allows the tissues to move more readily and become more prone to collapse and to vibrate,” said Dr. Michael D. Olson, an ear, nose and throat doctor and sleep surgeon in the Mayo Clinic’s department of head and neck surgery. In addition, if the size of the airway decreases, air pressure increases, allowing for tissue vibration and snoring.

“Combine that with nasal congestion, a big tongue and body fat, and that leads to an excessive collapse of the airways,” Dr. Olson said.

Another cause of snoring: teeth extraction, a particular issue for baby boomers who had braces in their youth. With the removal of four bicuspids as a common practice at the time, boomers may now be suffering snoring because of 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 issue for couples. I have people come to my office crying that they haven’t been able to be in the same bed for years,” Dr. Olson said.

One cure for snoring is surgery: Uvulopalatopharyngoplasty, or UPPP, rearranges tissues to increase airway size. But the surgery can have complications, including swallowing problems or the uncomfortable sensation that there’s something permanently lodged in the airway.

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

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

Mouth 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 recently flooded the radio airwaves, but when it comes to results, one size will not fit all.

And for some, none may prove to be a good fit. To work effectively, the device needs to stay in one’s mouth all night and be used continually. Some users may never get used to the feeling of having a large object in their mouths, preventing their jaws from closing.

Because these devices push the lower jaw forward, users typically wake to 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 do not fix the problem,” said Dr. Nina Shapiro, an ear-nose-throat specialist in the department of head and neck surgery at the University of California, Los 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 on it to form a tooth impression, which helps make for a secure fit when inserted in the mouth.

ZQuiet, $80, uses an open tray approach; it does not require teeth impressions to be formed. As a result, it’s smaller and less obtrusive, 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 employ a tongue strap, but the $99 device does allow the user to open up the airway further by moving the lower jaw section forward in 1 millimeter increments.

I tried all of them and found none of the devices to be as comfortable as having nothing in my mouth; it always felt as if there was something large and bulky preventing me from completely relaxing and speaking coherently. It was a relief to remove each one when I would invariably wake up at 4 a.m.

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

More important, however, each one reduced or completely eliminated my snoring — even though I did experience most of the side effects. (“You haven’t slept this quietly in years,” my wife said.)

For those who can’t tolerate or even contemplate sleeping with something in their mouth, a nasal dilator may be the answer.

By propping open the nostrils, it becomes easier to breathe through the nose, thereby reducing the vacuum and associated tissue vibration that occurs when breathing only through the mouth, said Peter VanZile, principal scientist for GSK, maker of Breathe Right, one such nasal dilator.

By securing a semirigid adhesive patch across the bridge of the nose, Breathe Right pulls open the nostrils as the strip tries to straighten out.

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

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

While less intrusive than the mouth appliances, the Mute device had no effect on my snoring, even though I could breathe more easily through my nose.

Smart Nora, a $329 product from Canada, works by inflating an under-pillow bladder every time the included microphone detects a snore starting. Quickly raising the sleeper’s head a few degrees opens the airway.

For the first few days I was continually awakened each time my head rose, but eventually the movement faded into the background. Other loud noises can trigger the pillow movement as well, which is why it’s important to place the microphone carefully.

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

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

“To my knowledge, there have not been any independent, peer-reviewed, non-company-funded studies on these products,” Dr. Shapiro said. “Product reliability and efficacy studies would be tough to fund externally, especially when company funding is offered.”

If you are comparing products based on cost, be aware that with the exception of the Smart Nora pillow, most need to be replaced between one and four times per year; the $28 three-pack of Mute devices lasts for just one month.

Which product will work for you? “It may come down to user preference,” said Dr. VanZile. Or more to the point, the preference of your sleeping partner.