Snoring Remedy Often a Matter of Trial and Error – “Snoring: What to Do When a Punch in the Shoulder Fails By WALECIA KONRAD Published: December 10, 2010.
A 43-year-old internist in Atlanta and the mother of twin 4-year-old boys, has a common, if sometimes embarrassing, health problem. She snores — loudly. And she has tried to fix it with a variety of things, including a machine that blows air down her throat and an oral appliance that looks something like a mouthguard worn by a hockey player.


Tami Chappell for The New York Times Dr. Elizabeth Walton at her home in Atlanta with an oral appliance she uses for sleep apnea. Well

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More Articles in This Series The appliance works, and Dr. Walton is finally sleeping more easily. (So is her partner.) And because she was told she had obstructive sleep apnea, a more serious disorder than simple snoring, her treatments have been mostly covered by insurance.

Still, she estimates she has spent hundreds of dollars in deductibles, co-payments and fees.

Dr. Walton would have preferred not to go through so much expensive trial and error: ‘Unfortunately, it’s the nature of this condition.’

Almost half of the adult population snores at least occasionally. Snoring occurs when air flows past relaxed tissues in the throat, causing them to vibrate. Nasal congestion can also contribute to the racket.

‘We laugh and joke about snoring,’ said Dr. Nancy A. Collop, president elect of the American Academy of Sleep Medicine, ‘but it can be pretty annoying and disruptive to couples.’

What’s more, while ordinary snoring in itself does not present health problems, it may be a sign of a sleep apnea, as it was in Dr. Walton’s case. Patients suffering from sleep apnea have airways that are so obstructed they stop or nearly stop breathing during sleep.

The lack of oxygen wakens them, usually with a gasp, frequently during the night. ‘All people with sleep apnea snore,’ said Dr. Collop, ‘but not all people who snore have sleep apnea.’

If you find you suffer from plain old snoring and not sleep apnea, do not expect insurance to cover your treatments. How far you decide to go will depend on a combination of what you and your spouse are comfortable with, what works for you and what you can afford.

Here are a few ways to determine which treatment is right for you or the loud sleeper in your family:

THE GIMMICKS Search for snoring remedies on the Web and you will find dozens of products, including special pillows, mouth and nose devices, special throat exercises and even advice on learning to play the didgeridoo, a wind instrument, to strengthen throat muscles and tissues. By and large, these products are marketed without much evidence of results.

‘For the most part, you can save your money,’ said Dr. Collop. Instead, she and other sleep experts recommend that most patients start with lifestyle changes that may reduce or eliminate snoring. All are free or low-cost.

¶Lose weight. Extra weight can restrict throat tissue and cause snoring, so losing weight is often advised for overweight snorers.

¶Sleep on your side. When you lie on your back, the base of your tongue and soft palate fall to the back wall of your throat, often causing snoring.

¶Avoid alcohol before bed. Alcohol or sedatives can relax throat muscles and make snoring worse. Avoiding alcohol three or four hours before going to sleep can help, said Dr. Collop.

¶Clear nasal passages. This is relevant only for people whose snoring starts in their noses. Take a hot shower before bed, or use a saline solution to help clear nasal passages. Check for allergens and dust mites in your bedroom, especially if you are congested only at night. Over-the-counter nasal strips that you put on the outside of your nose before bed may also help. They cost $10 to $12 for a pack of 30.

If none of this eases your snoring, you will need to see a doctor to be evaluated for sleep apnea. About 50 percent of people who snore loudly have the condition. Other symptoms include daytime sleepiness and extensive fatigue.

A SLEEP STUDY To find out if you have sleep apnea, you will most likely need to spend the night in a sleep clinic, where specialists will track your blood oxygen levels, breathing and other movements to see if you are waking frequently at night.

These tests are often covered by insurance if your doctor suspects sleep apnea. They can cost from $1,500 to $3,000, depending on where you live and how extensive your study is.

If you do not have insurance coverage or you cannot afford the co-pay, ask your doctor about performing some of the tests at home with special equipment. If you must go to a sleep lab without coverage, ask for a price similar to what an insurer would pay, not what you would be billed as a private patient.

THE MASK One of the most effective treatments for sleep apnea, continuous positive airway pressure, or CPAP, pronounced SEE-pap, also eliminates garden-variety snoring. But since it is a pressurized mask that forces cold air to the lungs, many patients find it uncomfortable or annoying and end up abandoning the treatment. With a price tag ranging from $1,500 to $2,500 for a CPAP machine, that can be an expensive experiment, especially for uninsured patients.

If you use a CPAP machine, do not give it up without talking to your doctor. He or she may be able to make the device more comfortable by adding a heated humidifier. There are also some newer, more advanced versions that apply less pressure and may be more comfortable.

ORAL APPLIANCES These are form-fitting mouthguards that usually move your lower jaw forward to increase space around your airways. One of these devices finally worked for Dr. Walton.

A dentist who specializes in sleep medicine fits an appliance to your mouth, usually for $1,500 to $3,000. That price should include all follow-up visits and any adjustments that need to be made, said Dr. Sheri Katz, president of the American Academy of Dental Sleep Medicine.

Studies show that custom-fit appliances ease mild to moderate sleep apnea in about 75 percent of patients and snoring in 80 to 90 percent of patients who use them regularly, said Dr. Katz. Dental insurance rarely covers the devices, but medical insurance often will if they are used to treat sleep apnea.

THE LAST RESORT Removal of excess tissue in the throat and nose, whether it is through traditional surgery or newer methods, is a fairly drastic and expensive step. Some procedures can be painful and cause serious side effects.

In a procedure called uvulopalatopharyngoplasty, a surgeon trims and tightens excess tissue in the airway while you are under general anesthetic.

In an outpatient procedure called laser-assisted uvulopalatoplasty, a laser is used to remove your uvula and shorten your soft palate. This procedure has not been proven to improve sleep apnea, but it is used to get snoring under control.

Two newer procedures are available. Somnoplasty relies on radio frequency to remove some of the soft palate. This is also done on an outpatient basis and is generally considered less painful than other snoring surgery. The Pillar procedure involves implanting polyester fibers in the soft palate to stiffen the tissue and decrease vibrations. This is usually done in a doctor’s office under local anesthesia and is less invasive than other surgical treatments.

More data is needed on the long-term effectiveness of the two newer procedures. And like the other treatments discussed, only those surgeries prescribed to help you with a diagnosed case of obstructive sleep apnea will be covered by insurance.”