Throughout the ages, snoring has been a social problem that has led to spousal friction in the bedroom. Snoring has caused literally millions of marriages to breakdown throughout the world, and in extreme cases has even led to murder. At the very least in my case for example, it has been the cause of a greatly diminished sexual libido.

Face it, after listening to my husband snoring all night, the last thing I feel like is having sex. For starters, I am absolutelty exhausted from lack of sleep and find my husband most unattractive after what he has put me through.

One day a friend of mine, with the same problem suggested he should try SnoreMate. It worked from day one and I am so thankful that both of us are now getting a full nights sleep. When we wake up in the morining we are like newly weds and our marriage has been rejuvenated. Thank goodness for SnoreMate it really is fantastic.

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Thanks to SnoreMate

I received your snoremate the other day (very quickly I might add) and
wanted to thank you for having just what I was looking for. I have OSA and am being treated with CPAP, but my problem was that I had a tendancy to mouth breath. Head staps didn't work for me and neither did full face masks, so I had resorted to taping my mouth shut at night. Your product allows me to seal my mouth much more easily! I had tried to make something similar from a sports mouth guard but it was not as comfortable.

So thanks!

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SNORING nearly ruined my life!!

MY LAST RESORT

Paul tells his story....

" People that have never snored will find it difficult to understand the crushing blow that the ego takes when this event happens". Paul's story is similar to the millions of snorers out there in the world. "Banished to the spare bedroom I had reached an important crossroad in my marriage & my life", Paul leans back thinking of the difficult snoring days and states "At first I went for a surgical solution, however dispite this being very expensive and extremely painful the procedure was not successful and the snoring did not stop. I then found SnoreMate and have been using it ever since, with complete success, my life is back to normal and I am feeling great".

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Snoring Overview .. By Mayo Clinic staff

Loud and frequent snoring, on your part or on your partner's, may seem inevitable during your overnight sleep time. But this nighttime annoyance may indicate a more serious health condition and can disrupt your household and strain your relationships.

About one-third of older adults snore. Snoring occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe, creating hoarse or harsh sounds.

To restore peace and quiet as well as domestic harmony, simple changes, such as losing weight or sleeping on your side, can help. In addition, laser surgery may reduce disruptive snoring. However, laser surgery isn't suitable for all people who snore, such as people with sleep apnea, a potentially serious disorder in which breathing stops and starts during sleep.

Causes

As you doze off and progress from a lighter sleep to a deep sleep, the muscles in the roof of your mouth (soft palate), tongue and throat relax. If the tissues in your throat relax enough, they vibrate and may partially obstruct your airway.

The more narrowed your airway, the more forceful the airflow becomes. Tissue vibration increases, and your snoring grows louder.

Having a low, thick soft palate or enlarged tonsils or tissues in the back of your throat (adenoids) can narrow your airway. Likewise, if the triangular piece of tissue hanging from the soft palate (uvula) is elongated, airflow can be obstructed and vibration increased. Being overweight contributes to narrowing of your throat tissues.

Snoring also can be brought on by consuming too much alcohol before bedtime. Alcohol acts like a sedative, relaxing throat muscles. Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may be to blame. Snoring may be an occasional problem, or it may be habitual.

Snoring may also be associated with sleep apnea. In this serious condition, excessive sagging of throat tissues causes your airway to collapse, preventing you from breathing. Sleep apnea generally breaks up loud snoring with 10 seconds or more of silence. Eventually, the lack of oxygen and an increase in carbon dioxide signal you to wake up, forcing your airway open with a loud snort.

When to seek medical advice?

You may not be aware that you snore, but your bed partner likely is. Seeing your doctor about your snoring can benefit both of you.

For you, snoring may indicate another health concern, such as sleep apnea, nasal obstruction or obesity. For your partner, your seeking medical advice about your snoring may result in being able to get a restful night of sleep.

If your child snores, ask your pediatrician about the problem. Nose and throat problems and obesity often underlie habitual snoring in children. Treating these conditions could help your child sleep better at night.

Screening and diagnosis

The severity of your snoring often determines the best treatment. To diagnose its severity, snoring is graded from the bed partner's point of view:

• Grade 1: Heard only if you listen close to the face
• Grade 2: Heard in the bedroom
• Grade 3: Heard just outside the bedroom with the door open
• Grade 4: Heard outside the bedroom with the door closed

Parents are asked about the severity of a child's snoring. As for the person who snores, your doctor likely will perform a physical examination and take a medical history. Your doctor may then refer you to an ear, nose and throat (ENT) doctor (otolaryngologist) or sleep specialist for additional studies and evaluation. This may require that you stay overnight at a sleep center, where you undergo an in-depth analysis of your sleep habits by a team of specialists.

Complications

Habitual snoring may be more than just a nuisance and a cause of daytime sleepiness. Untreated, persistent snoring may raise your lifetime risk of developing such health problems as diabetes, high blood pressure and even heart failure and stroke. In children, snoring may increase their risk of attention-deficit/hyperactivity disorder (ADHD).

Treatment

When lifestyle changes don't eliminate snoring, your doctor may suggest:

• Traditional surgery. You're given general anesthesia while your surgeon tightens and trims excess tissues — a type of face-lift for your throat. The procedure reduces the intensity of snoring most of the time. It's a painful procedure and requires one to three days' hospitalization and about a two-week recovery.

• Laser surgery. In an outpatient surgery for snoring called laser-assisted uvulopalatoplasty (LAUP), your doctor uses a small hand-held laser beam to shorten the soft palate and remove the uvula. Removing excess tissue enlarges your airway and reduces vibration. Treatments are based on the severity of your snoring. You may need two to five sessions, each lasting about 30 minutes. These treatments occur four to six weeks apart. Laser surgery isn't advised for occasional or light snoring, but it's an option if your snoring is loud and disruptive. Laser surgery isn't recommended for sleep apnea.

• Radiofrequency tissue volume reduction (somnoplasty). In this type of surgery, doctors use a low-intensity radiofrequency signal to remove part of the soft palate to reduce snoring. It's an outpatient procedure performed using local anesthesia. The technique causes slight scarring of the soft palate, which may help to reduce snoring. The effectiveness of this newer procedure needs further study.

• Dental devices and nasal strips. Dental devices (SnoreMate) are form-fitting mouthpieces that help advance the position of your tongue and soft palate to keep your air passage open. Nasal strips help many people increase the area of their nasal passage, enhancing their breathing.

• Continuous positive airway pressure (CPAP). This approach involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway to keep it from collapsing. CPAP (SEE-pap) eliminates snoring and prevents sleep apnea. Although CPAP is the preferred method of treating sleep apnea, many people find it cumbersome and uncomfortable.

Self-care

To prevent or quiet snoring, try these tips:

• If you're overweight, lose weight. Being overweight is the most common cause of snoring. Flabby throat tissues are more likely to vibrate as you breathe.

• Sleep on your side. Lying on your back allows your tongue to fall backward into your throat, narrowing your airway and partially obstructing airflow. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.

• Treat nasal congestion or obstruction. Allergies or the partition between your nostrils being crooked (deviated septum) can limit airflow through your nose. This forces you to breathe through your mouth, increasing the likelihood of snoring. Use an oral or spray decongestant for no more than three days in a row for acute congestion. Ask your doctor about a prescription steroid spray if you have chronic congestion. Adhesive strips applied to your nose widen nasal passages and may help reduce congestion or obstruction. To correct a deviated septum, you may need surgery.

• Limit or avoid alcohol and sedatives. Sedatives and hypnotics (sleeping pills) and alcohol depress your central nervous system, causing excessive relaxation of muscles, including the tissues in your throat. In addition, they can increase the duration of stoppages of breathing by blunting the brain's ability to arouse from sleep and restart breathing.

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Snoring and sleep apnoea

IS SNORING JUST A JOKE?

Snoring and the disturbance it causes used to be (and frequently is still) regarded as a joke, about which little could be done. We now know that snoring may be a pointer to abnormalities with breathing at night which may be harmful to the health of the snorer. During sleep all the muscles of the body relax and become more floppy. With relaxation of the muscles which help hold open the throat, a partial collapse and narrowing results. Even in non-snorers this narrowing increases the resistance to the flow of air when breathing in but is usually of no significance. When the narrowing during sleep is greater than normal, the airway behind the tongue may collapse transiently. This gives rise to a fluttering of the throat tissues producing sounds which we recognise as snoring. Should the collapse be complete and longer lasting, no air can be drawn into the lungs and the sufferer is literally without breath - that is experiencing apnoea. Were this situation to persist, the individual would asphyxiate!

Evolution has equipped us with a remarkably sensitive ability to detect impending throat closure. This ability does not seem to be influenced by the depth of sleep. Had we not developed this mechanism the human race would have choked to death in the night and joined the dinosaurs a long time ago! So our snorer, sensing impending doom, rouses briefly, avoids suffocation, takes a few deep breaths and rapidly returns to sleep. This pattern may be repeated 300 - 500 times during the night without recollection in the morning! It is the fragmentation of the normal sleep architecture consequent upon these arousals which is the cause of the daytime symptoms of tiredness and drowsiness with diminished alertness and performance.

Our understanding of why we sleep is remarkably poor. [Horne J. Why we sleep. Oxford: Oxford University Press, 1988.] The only obvious reason we sleep is to prevent sleepiness! It appears that we need about two hours worth of quality deep sleep to remain alert and function at our best during waking hours. It takes time to drift down into this stage of sleep and we collect it in chunks - a few minutes here and half an hour or so there. As long as the overnight aggregate is about 2 hours we wake refreshed by our sleep. With fragmentation of the sleep pattern due to multiple arousals it becomes impossible to harvest the required two hours of quality sleep. Little wonder that after even more than ten hours of so called sleep, sufferers describe themselves as feeling shattered on waking! It can be conceived of as equivalent to the telephone having rung hundreds of times during the night.

What causes sleep apnoea?

The factors causing sleep apnoea do so by increasing the normal narrowing of the throat during sleep. Anything rendering the throat narrower to start with (for example enlarged tonsils or a set-back lower jaw) makes it more likely that the throat will close off more and obstruct the airway. A partially blocked nose causes lower pressures in the throat during breathing in and this tends to suck the walls of the throat together. Probably the most important factor is being overweight with a consequent thickened neck. We are not yet certain why it is that obesity produces sleep apnoea. It seems most likely that the inertial mass loading of the neck by increased fat deposition overcomes the ability of the throat muscles to keep the airway open when the muscle tone falls off during sleep. Certainly one of the best predictors of this effect is a neck circumference of 17 inches (43 cm) or more. [Stradling JR. et al. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46:85-90]

Who gets sleep apnoea?

The sort of person we most commonly see with heavy snoring and sleep apnoea is a middle-aged man who is overweight with a big neck, taking a size 17 inch collar or more. Many people with sleep apnoea are not particularly overweight and in some we simply do not understand why they have sleep apnoea. In children the commonest cause is enlarged tonsils. Nowadays sleep apnoea is the commonest reason for recommending that a young child has a tonsillectomy. [Rosenfeld RM et al. Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhinol Laryngol 1990; 99:187-91]

Sleep apnoea and heavy snoring, severe enough to interfere with sleep quality, is much more common than generally realised. The prevalence of snoring increases with age and is more common in men than women. About 25% of men and 10% of women aged 35 - 65 years snore. Probably more than five in every hundred men have significant sleep apnoea. There is a strong correlation between snoring and daytime sleepiness as a result of the sleep fragmentation caused by snoring alone without obstructive sleep apnoea. In terms of sheer numbers, there are probably more suffers from daytime sleepiness as a result of snoring than as a result of obstructive sleep apnoea. Obstructive sleep apnoea may be associated with greater risk of high blood pressure, stroke, heart attacks, heart failure and thickening of the blood all of which can reduce the quality and duration of life.

[Spriggs DA. et al. Historical risk factors for stroke: a case control study. Age, Ageing 1990; 19: 280-7. Telakivi T. et al. Snoring and cardiovascular disease. Compr Ther 1987; 13: 53-7] It is clearly related to an increased risk of road traffic accidents. [Haraldsson PO et al. Sleep apnea syndrome symptoms and automobile driving performance before and after uvulopalatopharyngoplasty. J Otorhinolaryngol Relat Spec 1991; 53: 106-10] [Daily Telegraph. 8th January, 1997.]

Symptoms of sleep apnoea

Because sleep can be so disrupted by the body having frequently to rouse briefly to reverse the upper airway obstruction, sufferers experience severe daytime sleepiness. To start with this occurs only during potentially boring activities such as reading, watching television or driving on motorways. However when the sleepiness gets worse it begins to interfere with most activities, with the individual falling asleep talking or eating. Poor work performance can lose the sufferer his or her job and of course sleepiness whilst driving can be fatal (sleep apnoea sufferers are about seven times more likely to have car accidents). Snoring will usually have been present for many years and have gone well beyond a joke within the family. There are many other symptoms, as one might expect in someone who is seriously sleep deprived, (irritability for example) but the twin symptoms of snoring and daytime sleepiness are the best pointers to the diagnosis.

Diagnosis of sleep apnoea

The severe morbidity of sleep apnoea coupled with the ready availability of effective treatment means that recognition and diagnosis are important. Already public awareness is increasing following press and television publicity but much remains to be done to increase this awareness. The presence of significant sleep apnoea may be strongly suspected from the symptoms. Snoring, excessive daytime sleepiness, early morning headache and poor concentration should alert patient and doctor alike. These symptoms may be embarrassing or be attributed simply to laziness or ageing. Often the individual's partner has read an article about sleep apnoea and recognises the problem. Often the diagnosis of sleep apnoea can be made on the basis of the history alone. Confirmation of the diagnosis by means of some form of study is important. Unlike most medical problems which can confidently be diagnosed from history and physical examination alone, with sleep apnoea these traditional methods are poor indicators of the severity of the underlying problem. A variety of things can be measured during sleep without having to use any painful needles or devices.

The simplest special test is to make continuous recordings of blood oxygen levels and heart rate during a normal night's sleep and this need not necessarily involve coming into hospital. Analysis of these recordings may provide enough information to exclude the presence of obstructive sleep apnoea without resorting to more complex measures. Even in the presence of normal findings for oxygen levels it may be possible to detect clear evidence of multiple arousals by examining the continuous record of heart rate. [Stradling JR. Handbook of sleep related breathing disorders. Oxford Medical Publications 1993]

The above simple investigation may be supplemented by a continuous overnight video recording (under infrared light) along with audio recording. Processing of the video signal allows movement to be detected and analysed. Computer analysis of these records allows a rapid review of an overnight recording to identify periods of abnormal sleep and the times at which they occur. The corresponding times on the video recording can then be inspected to clarify the diagnosis.

In recent years there has been a move away from the complex multiple measurements known as polysomnography. This involves the application of electrodes over the brain along with sensor devices detecting chest and limb movement along with devices to detect air flow through the nose. These highly expensive and labour intensive techniques are now used only rarely in the UK. Full polysomnography misses snoring induced arousals and is no longer regarded as a good gold standard.

Treatment

It is essential that treatment is tailored to the patient's needs. Treatment is focused upon correcting the daytime symptoms which result from sleep fragmentation. When the sleep disturbance is not severe simple approaches can help. Losing some weight, not drinking alcohol after 6.00 p.m. (alcohol relaxes the upper airway muscles even more), keeping the nose as clear as possible, and sleeping on one's side or semi-propped up can all help and sometimes be dramatically beneficial. Carefully chosen individuals can be helped by simple dental devices which slightly advance the lower jaw during sleep and help to keep the airway open. In selected cases medication can be very effective.

When snoring is very objectionable, with the individual and the partner desperate for a solution, then an operation on the back of the throat may help - but this is a very last resort and should only be done when a sleep study has shown snoring alone with very little, or no, sleep apnoea. Surgery has NOT been shown to be beneficial for people with sleep apnoea and is best avoided for this condition until we learn more about the mechanisms behind it. The worry is that some patients treated surgically for apnoea have been made worse. Also, the permanent alteration of the throat structure denies the individual the benefit of the definitive treatment of nasal CPAP. The only clear indication for surgery is the removal of enlarged tonsils which obstruct the airway.

For individuals with severe sleep related breathing problems and disabling symptoms the highly effective treatment of nasal CPAP can be offered.[Sullivan CE. et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1: 862-5] This acronym stands for nasal continuous positive airway pressure. The throat which threatens to narrow is gently held open by blowing air via the nose at slightly increased pressure. A mask is worn during sleep fitting snugly and comfortably over the nose. The mask is connected to a small, quiet pump beside the bed. Breathing is then able to return to normal during sleep with the air gently blowing through the nose and holding open the throat.

The response is usually dramatic with greatly improved sleep and disappearance of the daytime sleepiness. Although these devices seem cumbersome to wear and hardly improve appearance, the benefits far outweigh the disadvantages and the vast majority of sufferers happily use their machines every night at home after a one night trial in hospital. The benefit can be dramatic, transforming a previously unmotivated individual into one alive again and determined to lose weight etc.. Research has shown that nasal CPAP improves life expectancy and reverses heart failure.[He J. et al. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988; 94: 9-14.]

How to get help

If any of the above has a familiar ring for you or those close to you, how should you seek help?
Until recently there was only a handful of sleep centres in the UK. However, there is now an increasing interest in these problems and more and more hospitals are setting up sleep units. There should be a sleep unit within relatively easy reach of where you live and referral via your General Practitioner is the standard method in the UK.

http://www.priory.com
Is Snoring just a Joke?
James Lyall MD FRCP?Consultant Physician, Battle Hospital,Reading.


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