“In the past, we used to think that all snoring came from the uvula and soft palate, so that’s where a lot of treatments were focused,” Dr. Gillespie said. “Now, through the use of drug-induced sleep endoscopy and observation of the airway in real time, we realize that there are multiple areas of vibration in the upper airway that can create the snoring sound, including the soft palate, the uvula, the lateral walls of the throat, tongue tissues, and epiglottis. Certainly, nasal congestion and a tight nasal cavity can also contribute. Our goal is to find which sites are contributing and try to treat those.”
Explore This IssueApril 2017
An overall assessment of the patient’s health and lifestyle is also essential, because obesity, alcohol use, allergies, acid reflux, and sleep position can also contribute to snoring. If any of these lifestyle factors are evident, it’s prudent to suggest lifestyle modifications before turning to invasive treatment.
“The reality is that intervening surgically on somebody who needs to lose 10 pounds isn’t the best way to proceed,” said David Volpi, MD, a sleep specialist based in New York City. And, because primary snoring treatment is typically not covered by health insurance, many patients are willing to try low-cost lifestyle changes first.
Nasal-Based Snoring Treatments
For patients who report nasal congestion, allergies, or mouth-breathing during sleep, the nose may be the most appropriate site of intervention. Nasal steroid sprays, oral anti-inflammatory medication, and antihistamines are often used as first-line treatments.
If physical exam shows narrowed nasal passages or anatomic obstruction, such as a deviated septum or enlarged adenoids, nasal surgery may be the best approach; however, otolaryngologists should be careful about offering nasal surgery as the primary intervention for snoring, said Brian Rotenberg, MD, associate professor and division chief of rhinology at Western University in London, Ontario.
“In and of itself, it’s unlikely to be effective,” Dr. Rotenberg said. Additional procedures may be needed to address other contributing factors. “Coupling nasal surgery with the appropriate throat and palate procedures can really help people have a much better night’s sleep and improve their snoring.”
If the tongue appears to contribute to snoring, patients can try an oral appliance to bring the mandible forward during sleep. Although some otolaryngologists will prescribe and fit oral appliances, many send patients to a dentist who specializes in sleep disorders.
Radiofrequency ablation of the tongue is another option for patients with excess tissue.