sleep disorders
brain, spinal cord, and nerve disorders
Snoring
Causes of snoring, such as chronic nasal obstruction and Obstructive sleep apnea (OSA), are treated. For snoring itself, treatment includes general measures to eliminate risk factors and physical methods to open the upper airway and/or stiffen the involved structures. Several general measures may help reduce primary snoring. None are effective in everyone, but some people may benefit. Measures include Sleeping with the head elevated Lying on one side (rather than the back) Losing weight Avoiding alcohol and sedating drugs for several hours before bedtime Losing weight Treatment —for example, with decongestants and/or a corticosteroid nasal spray The best way to elevate the head is to put blocks under two of the bed's legs to raise the head of the bed or to use a wedge pillow that slants the whole upper body. People should not use pillows to raise only the head. Bed partners may benefit from using earplugs or white-noise machines. Sometimes alternate sleeping arrangements (such as a separate room) are necessary. Oral appliances are worn only during sleep. They include Mandibular advancement splints Tongue-retaining devices These appliances, which must be fitted by specially trained dentists, can help keep the airway open during sleep in people with obstructive sleep apnea (OSA) and may help reduce snoring. Mandibular advancement splintsare small plastic devices that fit in the mouth like a mouth guard or orthodontic retainer. They pull the lower jaw (mandible) and tongue forward and thus help keep the airway open during sleep. Many of these devices can be adjusted in small increments to ensure the best results. Adjustable devices are more effective than those that cannot be adjusted. Tongue-retaining devicesuse suction to keep the tongue forward. If the tongue moves back in the mouth, it can block the airway. These devices are more uncomfortable than mandibular advancement devices. Oral appliances may be used alone or with other treatments for sleep-related breathing disorders, such as weight management, surgery, or continuous positive airway pressure. Oral appliances can cause discomfort and excess salivation, and teeth may be pushed out of alignment. But most people tolerate them well. With CPAP, people breathe through a small mask applied to the nose or to the nose and mouth. The mask is attached to a device that supplies air at a pressure that helps prevent the airway from narrowing or collapsing when people breathe in (which is when most snoring occurs). CPAP provides very effective relief of obstructive sleep apnea (OSA) and helps reduce snoring, but it is rarely used to treat snoring without OSA. Some people find CPAP devices uncomfortable or inconvenient, but most people with OSA are comfortable using these devices. Close follow-up by a health care practitioner is needed during the first 2 weeks of use to make sure the CPAP mask fits correctly and to encourage people as they learn to sleep with the mask. People with OSA tend to be more motivated to use CPAP than those whose only problem is snoring because untreated OSA can cause significant symptoms and increase the risk of heart disorders and stroke. Some upper airway obstructions that contribute to snoring, such as nasal polyps, enlarged tonsils, and a deviated septum, can be treated surgically. But whether and how well such procedures reduce snoring have not been proved. In addition, a number of surgical procedures have been developed specifically to treat OSA, and some can help reduce snoring. These procedures reshape tissues of the palate and/or uvula or stiffen the palate using implants or injections. They include uvulopalatopharyngoplasty, laser-assisted uvuloplasty, injection snoreplasty, radiofrequency ablation, and palatal implants. More studies are needed to determine whether these surgical procedures effectively treat snoring in the long term. Inuvulopalatopharyngoplasty, tissues of the palate and uvula are surgically reshaped. Excess tissue is removed, and the airway is widened. This procedure requires a general anesthetic and a stay in the hospital. It can reduce snoring, but its effects may last only a few years. The following procedures do not require a hospital stay and require only a local anesthetic. Forlaser-assisted uvuloplasty, a laser or high-energy microwave device is used to reshape tissue, so this procedure is less invasive than uvulopalatopharyngoplasty. However, whether it can reduce snoring has not been proved, although some people seem to benefit from it. Forinjection snoreplasty(a form of sclerotherapy), a substance that irritates the tissues and causes fibrous scar tissue to form is injected into the soft palate. As a result, the soft palate and uvula become stiffer and less likely to vibrate. Whether this procedure can reduce snoring requires further study. Forradiofrequency ablation, a probe is used to deliver heat (from an electrical current) into the soft palate. This procedure shrinks and stiffens tissues. It can reduce snoring, but further study is needed. Palatal implants, made of polyethylene, can be surgically placed in the soft palate to stiffen it. Three small implants are used. Whether these implants are useful for snoring alone has not been proved. A recently developed, removabletongue muscle stimulatoris intended to help tongue muscles function better in people with snoring or OSA. The device is worn in the mouth and contains electrodes that stimulate nerves and muscles in the tongue. It can be used during the day. However, more studies are needed to determine how effective it is. 