Snoring for Primary Care

Snoring is estimated to affect up to 40% of the population, and patients commonly present to primary care, often encouraged by their bed partner.

Snoring is the sound of the soft tissues in the airway (usually soft palate and uvula) vibrating as patients breathe while asleep. 

Risk Factors

For some people, it is simply due to the shape of their upper airway. Other anatomical factors include very large tonsils and a deviated nasal septum.

Risk factors include:

  • Obesity, as more fat in the neck narrows the upper airway

  • Smoking

  • Alcohol and sedating medications that relax the upper airway muscles

  • Allergies such as hayfever that cause inflammation and narrowing of the upper airway

Assessment

Snoring is frequently a benign condition, but is present in almost all patients with obstructive sleep apnea (OSA). Therefore if a patient presents with snoring it is important to assess them for other symptoms of OSA including:

  • Episodes of stopping breathing during sleep (apneas)

  • Gasping, choking, or gagging during sleep

  • Excessive daytime sleepiness (check Epworth Sleepiness Score)

  • Morning headaches

  • Poor concentration or memory problems

If patients have two or more of these symptoms then you should refer them for a sleep study to assess for OSA.

You should examine the nose and upper airway to check for enlarged tonsils, nasal polyps and septal deviation.

Management

Initial advice will usually include lifestyle measures and simple management techniques:

  • Weight loss

  • Smoking cessation

  • Reduction in alcohol intake 

  • Advising patients to sleep on their side as the airway is narrower in the supine position (for example by sewing a tennis ball into the back of their pyjamas, or using a triangular pillow)

Medication

  • Reducing sedating medications where possible

  • Treating rhinitis with nasal steroids

Specific treatments:

  • Mouth snorers can find improvement with the use of an elasticated chin strap that gently holds the mouth closed during sleep

  • Nasal strips may help keep nasal passages open

  • Mandibular advancement devices (oral appliances) - are also used as a treatment for mild to moderate OSA. The patient wears a gumshield over the top and bottom teeth that clips together and moves the lower jaw forward to open the airway. Patients can buy self-moulded devices or have them custom-made by a dentist

  • CPAP – if patients are diagnosed with OSA, then CPAP is also a highly effective treatment for snoring, although wouldn’t be indicated for simple snoring without OSA

Surgery

A number of surgical treatments are available, with varying success. Surgery for snoring is usually only funded by the NHS in exceptional cases but may be obtained privately.

Surgical procedures include:

  • Laser-assisted uvulopalatoplasty (LAUP) to reduce tissue in the soft palate

  • Somnoplasty – this uses radiofrequency ablation to shrink tissues around the soft palate and tongue

  • Septoplasty straightens a deviated nasal septum

  • Tonsillectomy and adenoidectomy