Snoring 

I would like to explore a common problem that is not normally associated with the dentist.

Snoring is caused by the restriction of the airway when you are sleeping and the “rattling” of the soft tissues at the back of the throat. 


Sleep Apnoea 

This is a more severe form of breathing difficulty when the limitation of air intake restricts oxygen  and requires active intervention from your health team to prevent further health problems developing.

When you breathe, air on its way to the lungs travels by the tongue, the soft palate, the uvula, and the tonsils. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place and prevent them from collapsing and vibrating in the airway. Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. The structures involved are the uvula and soft palate, and the irregular airflow is caused by an oropharyngeal and/or nasopharyngeal passageway blockage, usually due to one or more of the following:

  • Throat weakness, causing the throat to close during sleep
  • Malpositioned lower jaw, often caused by tension in the muscles
  • Adipose (fat) gathering in and around the throat
  • Anatomic obstruction in the nasal passageway.
  • Obstructive sleep apnea
  • Relaxants such as alcohol or drugs relaxing pharyngeal muscles
  • Sleeping on one’s back, which may result in the tongue falling to the back of the oropharynx
  • Enlarged tonsils

Points to consider 

  • Sleeping alone. If you or your partner snores, you might decide to sleep alone. That only makes for a lack of physical intimacy and a strained relationship. And if you’re the one snoring, you might feel lonely, isolated, and frustrated about something you feel you have no control over.
  • Snoring spats. It’s common to be irritable when lack of sleep is an issue. But try reining in your frustration. Remember, you want to attack the snoring problem—not your sleep partner.
  • Partner resentment. When a non-snorer feels they do everything possible to sleep through the night (ear-plugs, noise-machines, etc.) but their partner does nothing to combat their own snoring, it can lead to resentment. Working as a team to find a snoring cure can prevent future fights.
  • The National Sleep Foundation (NSF) estimates that nearly one in three Americans snores occasionally, and 37 million are habitual snorers. Habitual snorers can be at risk for serious health problems. Obstructive sleep apnea is an illness that is often associated with chronic snoring. This condition creates several problems, including:
  • Long interruptions of breathing (more than 10 seconds) during sleep caused by partial or total obstruction or blockage of the airway. Serious cases can have total blockage episodes hundreds of times per night.
  • Frequent waking from sleep, even though he or she may not realize it.
  • Blood oxygen levels are often lowered, which causes the heart to pump harder and blood pressure to rise. The result is a poor night’s sleep, which leads to drowsiness during the day and can interfere with the persons quality of life. Prolonged suffering from obstructed sleep apnea will result in higher blood pressure and may cause enlargement of the heart, with higher risks of heart attack and stroke.
  • The stress of not getting enough oxygen causes the body to produce adrenalin, a chemical that helps our bodies fight and cope with stressful situations. Adrenalin also causes blood sugar to rise, which may eventually lead to diabetes.


How can a dentist help?

I have an experiment for you to do now while you read this. 

I want you to breath normally through your month for a few seconds. 

Now I want you to push your bottom jaw forward as far as you comfortably can do and hold it there while you breath through your mouth again. This simple act opens your airway, and both increases air intake and prevents the soft tissues of your throat from “rattling” while you sleep.

Snoring really isn't sexy. Neither is cardiovascular disease, high blood pressure, diabetes, stroke, depression. Nor are the accidents caused by the drowsy driving related to sleep apnea.

Alertness and efficiency at work will naturally be enhanced by a good night’s sleep. 

Lack of quality sleep contributes to poor concentration and irritability, for both partners, the snorer and partner.

Many studies have shown that loud snoring itself can contribute to other serious health problems. 

An article published in March, 2008 stated that loud snorers had 40% greater odds of having hypertension, 34 % greater odds of having a heart attack and 67 % greater odds of having a stroke than people who did not snore.

Oral devices are acknowledged by experts to be one of the most effective treatments for snoring and sleep apnoea.

This technique is achieved with a “Mandibular Advancing Device” and has been used in dentistry for many years. The early versions had limited success as most were made of acrylic, the plastic used in dentures and were relatively bulky. All of these work if the patient will wear them, but the bulk of the appliance can make them cumbersome to wear. 

The latest  and most successful ( easily worn ) version we have used is the Somnowell. It is a thin metal frame made from Chrome Cobalt . This is a slim lightweight surgical metal, precision appliance that fits to both top and bottom teeth. It can be comfortable to wear and you can still talk and drink wearing it. Once in place it will achieve the goal. Move you bottom jaw forward and open the airway. Hey presto….. you can breath easier.


The Somnowell is the first oral device of its type made from chrome cobalt alloy, and is widely regarded as the Rolls Royce of oral devices. The Somnowell is the culmination of over 15 years research and development. In a recent study 93% of patients reported the Somnowell device as being a success.

First steps:

1. Download the App "Snorelab":

This is a simple to use app that you can use by your bed to see how much you actually do snore. It will record the whole night, monitor your sleep activity, encourage simple solutions and test their effectiveness ( eg extra pillows, the effects of alcohol ) and you can input factors such as weight, tiredness, night-time shower, blocked nose, medicines, time of evening meal, caffeine levels.

2. Seek advice. Ask your dentist for a consultation. 


Testimonials:

1. Chris tried a plastic oral device but found it too uncomfortable to wear and it kept coming in and out. In his words it was "absolutely horrible", "feels like a tennis ball in the mouth", "feel like going to suffocate".

Once a Somnowell was fitted:

Chris: “It was easy. It’s not uncomfortable, fits perfectly and been designed uniquely for my particular mouth, and I'd wholly recommend them to everyone.

Chris’s partner: “It makes a big difference to both our  lives basically, actually waking up feeling really good waking up in the same room, Charlie feeling pretty good as well, and actually smiling".


2. Jeff has had his Somnowell appliance now for 10 year. 

Here is what he had to say:

07/07/2014

Dear Paul,

Perhaps this will be of help to some of your other patients who want to solve snoring problems and are considering Somnowell . . .

Through a sleep test I was diagnosed with "moderately severe" obstructive sleep apnoea.  Before administering the test, the doctor told me that a mandibular advancement device "might" work for me, naming SleepPro II as the device.  But when the sleep test results came in, the doctor had me fitted for CPAP right away.  (The sleep test showed that I was snoring 49% of the night.)  CPAP definitely works, but only if you're able to keep the mask on throughout the night, which I could rarely do.  So for €150 I ordered SleepPro II.

SleepPro substantially reduced snoring, frequently to less than 5% per night.  I measured it using an iOS app that records snoring and shows the percentage of time snored (the app is "SnoreLab").

A problem with SleepPro is that it's quite bulky. I imagine some people will have difficulty keeping it in throughout the night.  (One reviewer likened it to having tennis ball in your mouth.)  Another problem is that SleepPro is self-fitted and I would have been more comfortable with a device fitted by a dentist. Also, SleepPro has to be replaced periodically.  

But I learned that a mandibular advancement device does work for me, and the doctor agreed.  So I had you fit me for Somnowell.  It's comfortable throughout the night . . . I know that it's properly fitted because you did it . . . the device will last for years . . . and it works!  

A "bad" night with Somnowell has me snoring at 5% of the night, but most nights it's under 3%.  And zero percent snoring is not uncommon.

Thanks for all your help,

Jeff