Unfortunately, as we get bigger so does our snoring problem. Growing levels of obesity are now believed to be causing ballooning snoring levels, with 45 per cent of the adult UK population now thought to be sufferers.
Snoring happens when muscles in the neck relax during sleep. This allows the soft tissue in the upper throat to vibrate, creating the sound we all know, perhaps too well, as snoring. While it is often the butt of a joke, snoring is no laughing matter. In the long term it can lead to the break up of relationships. It has been reported that as many as 25 per cent of UK adults say it is ruining their sex lives.
The symptoms of simple snoring are most obvious to the partner of the sufferer, and most snorers get a good night's sleep if their partner doesn't complain. For a non-apnoeic sufferer, symptoms are audible snoring caused by vibration of the soft palate, velopharynx and upper oropharynx. Some sufferers also experience headaches during the night or in the morning, and may wake themselves and their partner with the noise of their snoring.
If left untreated, snorers may continue to have disrupted sleep and some may begin to experience apnoeas. Apnoeas or Obstructive Sleep Apnoea (OSA) is a far more serious condition which is caused when the airway closes completely during sleep, preventing the sufferer from breathing.
Those with OSA often experience headaches, depression and psychological dysfunction, sexual problems, daytime sleepiness, nocturia and choking and gasping on awakening.
These symptoms are largely due to physical stress placed on the subject during sleep. As the patient relaxes into a deeper sleep, the muscles become inactive. This allows the mandible to drop backwards, particularly if the subject is lying on their back, compromising the airway either partially or completely. This reduces oxygen intake, which invariably leads to a disturbed and unrefreshing sleep.
With more prolonged apnoeas the patients' body is put under even more stress. Each time the patient stops breathing, the brain is starved of oxygen and the heart has to work harder to push the oxygen around the body, leading to an increase in blood pressure.
As the pattern is repeated, sufferers will typically be woken at least partially on several occasions during the night. They might not always be aware of this but can often wake fully and may need to visit the toilet (nocturia) as a result of the abdominal movements associated with struggling for breath. All of these activities add up to disturbances in the sleep of both the sufferer and their partner.
Luckily, there are actions that sufferers can take to reduce the impact of OSA on their quality of life. Lifestyle changes that can benefit OSA sufferers include giving up smoking, reducing alcohol intake and losing weight. All of these should have a positive effect on reducing snoring.
There is also a plethora of products available which claim to cure snoring and OSA. However, only two of these are proven to be effective non-invasive methods of treatment.
The most effective form of treatment for snoring is Mandibular Advancement Splint (MAS) therapy. There are many different kinds of splint available, with the most effective being those which are custom made and fitted by a dentist. The benchmark treatment for OSA is Nasal Continuous Positive Airway Pressure (nCPAP).
While nCPAP devices are becoming more comfortable to wear and quieter to use, many patients still find them difficult to wear and are 'non-compliant', meaning the only real alternative for these people is an MAS. Current legislation does not permit dentists to prescribe MAS for OSA sufferers without a referral from a GP or hospital physician. This necessitates a multi-disciplinary approach as the patient would need to return for a follow up sleep study to check the efficacy of the device. Fortunately, simple non-apnoeic snorers can get effective help immediately from their dentist with a MAS device.
According to Dental Protection Limited, members will be entitled to apply for assistance for the provision of such appliances if they meet the correct criteria. These include proving they have attended a documented training course in the provision of anti-snoring appliances, which must include training in appropriate screening for OSA. Training usually means just one day out of practice at a seminar such as Snoring: A role for the GDP. This seminar is presented by Ama Johal, senior clinical lecturer and honorary consultant at Barts & The London. It includes an overview of sleep related breathing disorders and covers patient screening and provision of MAS in line with GDC and Dental Protection Ltd requirements.