The blog of Xeno, a slightly mad scientist
Primary snoring, defined as snoring in the absence of obstructive sleep apnea/hypopnea OSA, is a very common problem that can significantly worsen the sleep quality of the bed partner and has been linked to important medical conditions. Health- care providers are frequently asked by their patients for snoring treatment recommendations. Unfortunately, although there are a variety of over-the-counter therapies available that claim to treat snoring, few if any have demonstrated objective clinical efficacy. This report introduces a novel, FDA-cleared device called Theravent™ Snore Therapy, which represents an important new class of snoring therapy utilizing nasal expiratory positive airway pressure EPAP. This report summarizes the device’s mechanism of action and available clinical data.
Snoring is a ubiquitous complaint of bed partners worldwide and leads to many patient requests for treatment recommendations. Snoring is the audible signature of increased resistance to airflow during sleep, and is part of a spectrum of sleep- disordered breathing conditions that includes OSA.The sound of snoring is created by turbulent airflow-induced vibration of tissues in
the collapsible portion of the upper airway. Any unsupported tissue lining the upper airway down to the vocal cords can vibrate and make noise. This includes the soft palate, uvula, pharyngeal walls and tongue – a diffuse sound generator that renders successful local treatment difficult.1 Sleep normally reduces the activity of the dilating musculature that otherwise opens and stabilizes the pharyngeal passageway during inspiration.2 If the pharyngeal passageway is abnormally narrow or floppy, then airflow into the lungs must speed up, further lowering the pressure in the airway, creating a turbulence which vibrates soft tissue.3 The vibrating tissue creates the harsh noise of snoring.EpidemiologyIn the United States, habitual snoring has a reported prevalence of 34% to 44% in men and 15% to 28% in women. Higher prevalence of snoring was reported in two Canadian studies, in which 71-86% of men and 51-57% of women were found to snore.1
These differences in reported prevalence reflect the subjective nature of reported snoring and different methods used to gather the information. The correlation between self-reported snoring and objectively measured snoring can be poor.4Studies by Young5 and Bliwise4 were rigorous and large, so their estimate that about one third of the adult population in the United States snores most nights of the week is widely accepted. However, a recent prevalence report in the United States suggested a higher rate of snoring: 59% of 1506 respondents both sexes snored, 54% at least 3 nights per week, and 40% every night or almost every night.6 This apparent increase in snoring prevalence might reflect the increase in obesity prevalence in the United States as obesity is a risk factor for snoring. Indeed, this trend could be expected to continue.
Snoring is more prevalent in men for reasons that are still not fully explained. The major risk factors for snoring are similar to those for OSA, such as obesity and increased neck circumference. In addition, a number of studies have reported that the prevalence of snoring decreases after the age of 70, a finding that is somewhat counterintuitive. Poor hearing acuity in the elderly, fewer elderly with bed partners, or diminished survival of snorers have been offered as possible explanations.
I still snore with Breathe Right strips. Theravent is the next step up. If non-perscription Theravent doesn’t work, a perscription for Provent may do it. Provent has 5 times as much pressure as Theravent according to the supplier. Or I could just try singing exercises every day:
Alise Ojay designed a programme of singing exercises which targeted the throat and stopped both chronic snoring and sleep apnoea, which causes people to stop breathing during deep sleep.
Her finding prompted a major study at Exeter University and the Royal Devon and Exeter NHS Foundation Trust. It saw 30 snorers try the exercises for a few minutes every day for three months. By the end of the trial, their snoring had significantly improved compared to 30 others who didn’t try the treatment.
Malcolm Hilton, a consultant otolaryngologist who led the research, said: ‘Alise told me that a number of people had benefitted from the singing exercise programme she had devised to strengthen the throat muscles.
‘I then set up this trial and the results have been really interesting.’
‘The conclusion that we came to was that the three month programme of daily singing exercises reduced the frequency and severity of snoring, and improved overall quality of sleep.’
“Singing for Snorers” is a do-it-yourself three month programme comprising of three CDs and an explanatory booklet. You sing along with the exercises on each CD for a month, and the exercises gradually get more demanding on the snoring-relevant-muscles in the throat.
The exercises use simple sounds and tunes which, when you sing them, make you engage the relevant muscles. There are different sounds and tunes to work the soft palate, the palatopharyngeal arch (that’s the arch at the back of your mouth that the little uvula hangs from), the tongue and the nasopharynx.
I use such purposeful sounds to act like ‘press-ups’ for the throat muscles. The tunes are all simple and repetitive so that you can concentrate on the movements in your throat and make the same movement a number of times to really work the targeted muscles. There’s a voice to sing along with – mine! – and I’ve added a variety of more complex and variety-full instrumental backing tracks so that the overall experience of each exercise is more enjoyable and fun.
Here’s an example of a sound I use to move the soft palate up and down. If you say “ung”, you will feel your soft palate come down and touch the back of your tongue, and now if you say “gah”, you will feel your soft palate lift up and away. Now try singing “ung-gah” over and over and you will feel your soft palate going down and up … and probably becoming a little tired!
As you can tell from this example, the sounds have not been chosen for their aesthetic beauty, alas, but rather for their therapeutic action, so you will definitely need a sense of humour and either a secret place or an understanding and supportive family. Once you know what you’re doing the exercises take 12 minutes a day for the first month and 18 for the 2nd and 3rd month.
Many people who have done my programme have chosen to sing through the exercises first thing in the morning as they say they act as a real tonic and are both cheering and enlivening!
Incidentally as a happy by-product of doing the exercises you should find your singing voice becomes stronger and more agile. The diaphragm and other breathing muscles are also well exercised. Indeed a number of my customers have reported discovering a love of singing and have gone on to join choirs.