Snoring Treatments
Mandibular Advancement Splints (generic name).
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Mandibular Advancement Splints (MAS) are customised devices made for each patient to be worn at night time.
The Sleepwell ™ MAS is clinically proven to work and offers maximum comfort, retention and full patient adjustability. |
Losing weight
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Loss of weight can reduce or alleviate snoring and there are numerous other health benefits but it should be gradual.
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Surgery
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There are a number of surgical options but they are not always successful and are usually extremely painful.
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Intra-oral appliances
Mandibular advancement splints (MAS)
The MAS is by far the most common form of intra-oral appliance used in the management of SBD (Schmidt-Nowara et al., 1995; Johal and Battagel, 2001). There is considerable variation in the design of MAS, but all posture the mandible forwards, to a varying extent, with a degree of vertical opening. Sleepwell ™ is the most clinically proven and effective.
Elimination of aggravating factors
Regardless of the severity of the SBD, it is prudent to eliminate co-existent conditions that either predispose to or worsen upper airway dysfunction during sleep. Subjects should therefore abstain from alcohol and caffeine during the evening, avoid the use of central nervous system depressants and ensure adequate control of any co-existing chronic obstructive airway disease, asthma or hypothyroidism. Furthermore, in subjects with a BMI above 25, research has demonstrated a weak correlation between the amount of weight loss and the clinical response (Smith et al., 1985; Kuna and Sant Ambrogio, 1991). A Cochrane review of lifestyle modifications for subjects with OSA could not identify any randomised controlled trials to support their use and concluded that there was no strong evidence to prevent instituting therapies of proven effectiveness, such as N-CPAP (Shneerson and Wright, 2002).
Changing sleeping posture
Research has demonstrated that, in a proportion of subjects, the frequency of SBD is substantially greater during sleep in the supine position compared with the lateral recumbent position (Cartwright, 1984). That author proposed that the effect of gravity on the tongue and enlarged soft palate collectively could lead to upper airway occlusion. Methods used to help subjects to sleep in the lateral recumbent position include the use of a tennis ball sewn into the back of their sleeping garment and positional alarms. In subjects whose symptoms are enhanced in the supine position, such treatment modalities have been demonstrated to reduce the AHI by 50 per cent (Cartwright et al., 1991).
Removal of nasal obstruction and nasal dilating devices
The presence of any nasal obstructions (see section 2.6.2) will lead to an increase in nasal airway resistance, which in turn will further promote collapse of the upper airway during inspiration. Despite the unpredictable direct effects of relieving nasal obstruction on SBD (Elsherif and Hussein, 1998), some authors suggest the removal of any obstructions as first line care in facilitating other treatment regimes (Kuna and Sant Ambrogio, 1991). The use of external nasal dilating devices to reduce nasal resistance has been shown to have beneficial effects in reducing the severity of snoring (Hoffstein et al., 1993; Ulfberg and Fenton, 1997).
In addition a range of surgical procedures address snoring however success varies. Short term results using surgical procedures have shown limited success, the long term results show that the snoring can return. Procedures include Tracheostomy, Nasal surgery, Pharyngeal surgery, Maxillo-facial surgery and Tongue base resection. In summary Uvulopalatopharyngoplasty (UPPP) is proven to be 50-90% successful for snoring but problems with the procedure include, pain, nasal regurgitation, swallowing problems and speech disturbances. Laser assisted uvulopalsty (LAUP) is 55-90% successful for snoring with similarly difficult side effect for the patient. |
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