Snoring

This page is for snoring in ADULTS

Click here for Snoring in CHILDREN

Click here for info on Obstructive Sleep Apnoea (OSA)

• Do you snore?
• Does your bed partner complain about your snoring?
• Do you suffer from poor quality sleep?
• Do you feel tired or unrefreshed when you wake up?
• Do you struggle to wake up (keep pressing the “snooze” button)?
• Would you like to stop snoring?
• Would you like to enjoy better quality sleep?
• Would you like to wake up feeling fresh and full of energy?

Read this page to find out how to stop snoring and improve your sleep quality

What causes my snoring?

Snoring is caused by blockage of the air passages during sleep.

Where does the blockage occur?

Blockage can occur at one or more sites.

In most people, the blockage occurs at multiple sites.

Sites where blockage can occur include:

• The nose
• The adenoids
• The tonsils
• The soft palate
• The uvula (The bit that dangles at the back of the throat)
• The tongue base
• The lingual tonsil
• The throat
• The voice box
• The epiglottis (Lid of the voice box)

Can anything else contribute to snoring?

Snoring can be made worse by the following:

• Being overweight
• Alcohol and sedative drugs
• Excessive tiredness
• When the jaw is too far back (“receeding” chin)
• Certain conditions within the central nervous system

How can I find out what is causing my snoring?

Always see your GP first. Your GP will look inside your nose and mouth and may order some tests or prescribe some treatments. If your GP cannot fix your snoring, ask your GP for a referral to see Dr Singh.

What if my GP can't find the cause of my snoring?

Ask your GP for a referral to see Dr Singh.

How can Dr Singh find out what is causing my snoring?

Dr Singh specialises in treating snoring. Dr Singh uses special tests to find out exactly what is causing your snoring.

What tests can Dr Singh perform?

Dr Singh may order a CT scan, a sleep study, allergy tests and nasal function tests, which show the amount of airflow through your nose.

Our practice is unique as we have a CT scanner on-site and a trained nurse in-house. This means all of the following tests can be performed on-site, without the need for multiple appointments at multiple locations:

• CT scan
• Skin prick tests
• Blood tests
• Rhinomanometry and Acoustic Rhinometry (Nasal airflow tests)
• Sleep study
• Drug-induced sleep endoscopy (DISE) – This is performed with sedation in a hospital operating theatre, not in our office

In addition, Dr Singh will examine your nose, mouth and throat using special instruments.

Dr Singh will also pass a special super-fine camera into your nose and throat to look at the septum, turbinates, adenoids, tonsils, soft palate, uvula, tongue base and voicebox (everything is made numb first using a special numbing spray). You can watch the camera on a TV monitor and see for yourself exactly what is causing your snoring.

Despite all the tests and high-technology available, the most accurate tool is your doctor's knowledge, training and experience!

Can my snoring be fixed?

Yes.

In almost every case of snoring, the cause can be found and treated.

How is snoring treated?

The treatment used will depend on the cause.

Anatomical blockages can be fixed with surgery. You will be asleep during the procedure (general anaesthetic). Please follow the links to find out more about each procedure:

Nose

• Deviated septum: This is fixed with a Septoplasty operation
• Large Inferior Turbinates: These are fixed with a Turbinoplasty operation
• Nasal polyps: These are fixed with a Polypectomy operation
• Nasal valve collapse (Collapse of the side walls of the nose): This is fixed with a Functional Rhinoplasty operation
• Bent or twisted nose: This is fixed with a Rhinoplasty operation

Adenoids

• Large Adenoids: These are fixed with an Adenoidectomy operation

Tonsils

• Large Tonsils: These are fixed with a Tonsillectomy operation

Soft palate

• Soft palate that is too far back: This is fixed with a Modified-UPPP operation

Uvula

• Uvula that is too long: This is fixed with a Modified-UPPP.

Tongue base

• Too much bulk in the tongue base: This is fixed with Coblation tongue chanelling

Lingual tonsil

• Too much bulk in the lingual tonsil: This is fixed with Coblation to the lingual tonsil or TORS to the lingual tonsil/ tongue base.

Epiglottis

Epiglottis that collapses backwards: This is fixed with Epiglottopexy

Drug-induced sleep endoscopy (DISE)

• Dr Singh often performs this procedure to assess the exact sites of obstruction during sleep

Jaw (Maxilla/ Mandible)

• Jaw that is too far back: This is fixed with a Maxillo-Mandibular advancement (MMA) procedure. Dr Singh does not perform this procedure but can recommend Maxillo-Facial surgeons who do perform it.

If you are overweight, you will also need to lose weight. Your GP can help with this and may recommend a diet and exercise program.

Are there any alternative treatments to surgery?

Yes. There are always options and it is always your choice as to whether to have surgery. In general, you can try other options first and choose surgery if nothing else works. Non-surgical options include:

1. Do Nothing. If your problem is not severe, you may choose not to have any treatment at all.
2. Simple treatments. In general, most of the simple treatments do not work for most people. The reason for this is that most people have multiple sites of blockage and simple treatments only partially treat one site. You can try all of the simple treatments first and choose surgery if they don’t work for you:
   Nasal strips: these are stuck on the outside of the nose every night and hold the nose open. They only work for people who have blockage at the very front of the nose.
   Nasal splints and springs: these are stuck inside the nose every night and hold the nose open. They only work for people who have blockage at the very front of the nose.
   Dental splints: These are worn inside the mouth every night, like a footballer’s mouthguard. They work for people who have blockage caused by the jaw being too far back or collapse of the tongue base/ epiglottis. If you wish to try a dental splint, cheap versions can be bought over the internet as a trial only. However, these are usually not very effective, are usually uncomfortable and should NOT be used long-term as they can cause significant problems with the teeth and jaw joints. For long-term use, always see a trained dentist/ orthodontist, who will provide you with a custom-made splint.
   Weight loss: If you are overweight, you will need to lose weight. Your GP can help with this and may recommend a diet and exercise program.
   If you are extremely overweight and have tried diet and exercise without success, your GP may prescribe some of the new weight loss medications or refer you for "Bariatric" surgery.
3. Medications. Try Nasal steroid sprays and antihistamine tablets/ sprays from your pharmacy or from your GP. They work best for people with allergy but may sometimes help people without allergy.
4. CPAP: This is high-pressure air that is forced into your nose and mouth using a mask strapped to your face every night. It is used for people with obstructive sleep apnoea (OSA). It is “overkill” for people with simple snoring alone.
5. Unproven treatments (eg anti-snoring pillows, magnetic pillows, anti-snoring rings, accu-pressure rings, anti-snoring herbs, anti-snoring aromatherapy, anti-snoring throat and nose sprays, special breathing techniques, books which claim to teach you to stop snoring): There is very little to no scientific evidence that any of these treatments work. You may choose to try these treatments, but, in general they are usually not effective.

We recommend that you see your GP first and consider trying these non-surgical options (1-4). Then see Dr Singh when you are ready for surgery. There is a long waiting list to see Dr Singh and it is best if you see Dr Singh for surgery after the non-surgical treatments have failed.

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks… but we still cross the street. Dr Singh will explain the risks of your operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

What should I do next?

See your GP. If your GP is unable to fix your snoring, ask your GP for a referral to see Dr Singh

I have already seen a doctor - I was told nothing could be done for my snoring. What should I do?

Most cases of snoring can be fixed or significantly improved. Dr Singh specialises in treating snoring and has expertise in difficult and complex cases.

Consider asking your GP for a referral to see Dr Singh.

More info on snoring and Obstructive Sleep Apnoea (OSA)

What problems can be caused by snoring?

Snoring can cause significant problems for your bed partner. It disturbs their sleep and can affect your relationship. Snoring is a significant social problem in certain situations, for example:

• Staying at a friend’s house
• On aeroplanes, trains and buses
• On work trips and holidays

Is snoring dangerous to my health?

Simple snoring alone is probably harmless to your health. However, if you feel tired, unrefreshed or sleepy at any time during the day, snoring could be harming your health and wellness. As snoring becomes more severe, it can develop into Obstructive Sleep Apnoea (OSA). OSA is a serious medical problem and carries many significant risks.

What is Obstructive Sleep Apnoea (OSA)?

Obstructive Sleep Apnoea (OSA) is a severe form of snoring, when the air passages become completely blocked, stopping the flow of oxygen.

Typically, the complete blockage only occurs for an instant. When the blockage occurs, the level of oxygen in the blood drops. The body detects the low oxygen level and causes a “mini-wake-up”. The mini-wake-up temporarily opens the air passages and the oxygen level returns to normal, before the cycle repeats.

In severe cases of OSA, this cycle can occur 50-100 times per hour!

Is OSA dangerous to my health?

OSA is a serious medical problem and carries many significant risks, including:

• Much higher risk of heart attack and stroke
• High blood pressure
• Depression
• Long term, gradual impairment in brain function (due to reduced oxygen)
• Car accidents from falling asleep at the wheel
• Higher risk of death

How can I tell if I have simple snoring alone, or Obstructive Sleep Apnoea (OSA)?

This requires assessment by a trained medical professional. However, tell-tale signs that you MAY have OSA include:

• Heavy snoring
• Breathing stops at night
• Choking episodes at night
• Difficulty waking up
• Feeling tired, drowsy and unrefreshed on waking up, even after a good 8 hours’ sleep
• Excessive tiredness or sleepiness during the day
• Taking naps during the day
• Falling asleep while watching TV
• Falling asleep during the day when left alone in a quiet place
• Falling asleep when a passenger in a car, or when driving and stopped at traffic lights

How do I get tested and treated for OSA?

Always see your GP first. Your GP will take your history, look inside your nose and mouth and may order some tests or prescribe some treatments. If necessary, ask your GP for a referral to see Dr Singh.

How can Dr Singh test and treat me for OSA?

Dr Singh specialises in treating anatomical causes of snoring and OSA. Dr Singh uses special tests to find out exactly what is causing your problems.

What tests can Dr Singh perform?

Dr Singh may order a CT scan, a sleep study, allergy tests and nasal function tests, which show the amount of airflow through your nose.

Our practice is unique as we have a CT scanner on-site and a trained nurse in-house. This means all of the following tests can be performed on-site, without the need for multiple appointments at multiple locations:

• CT scan
• Skin prick tests
• Blood tests
• Rhinomanometry and Acoustic Rhinometry (Nasal airflow tests)
• Sleep study
• Drug-induced sleep endoscopy (DISE) – This is performed with sedation in a hospital operating theatre, not in our office

In addition, Dr Singh will examine your nose, mouth and throat using special instruments.

Dr Singh will also pass a special super-fine camera into your nose and throat to look at the septum, turbinates, adenoids, tonsils, soft palate, uvula, tongue base and voicebox (everything is made numb first using a special numbing spray). You can watch the camera on a TV monitor and see for yourself exactly what is causing your snoring.

Despite all the tests and high-technology available, the most accurate tool is your doctor's knowledge, training and experience!

What is a sleep study?

A sleep study is performed to determine if you have OSA. The sleep study shows how many times in the night your air passages become blocked, along with your oxygen level and several other measurements.

What is the difference between a “home” sleep study and a “lab” sleep study?

There are 2 types of sleep study.

Lab sleep study. This is performed in a sleep centre, usually within a hospital, under the care of a specialist sleep physician. You are continuously monitored by a sleep technician. Lab sleep studies are especially useful for patients with complex or unusual disorders.

Home sleep study. This is performed at your home. You connect all testing equipment by yourself. The advantage of a home study is that you are sleeping naturally in your own bed, rather than in a hospital bed with a technician watching you. A good quality home sleep study is almost as accurate as a lab study and is all that is needed for most uncomplicated patients.

The decision as to which test you need should be made by a trained medical professional. Do not try to self-diagnose or self-treat. Always see your GP first. Your GP may refer you to Dr Singh and/or to a sleep physician.

In our practice we have a trained nurse on-site who can perform a high-quality home sleep-study for you, avoiding the need for multiple appointments at multiple locations.

Do I need to see a sleep physician?

Dr Singh is an expert in treating the anatomical blockages causing snoring and OSA. However, not all sleep problems are caused by anatomical blockage. Dr Singh or your GP may refer you to see a sleep physician in some of the following cases:

• Non-anatomical causes of sleep disturbance (eg: Narcolepsy, Central sleep apnoea)
• Severe OSA
• OSA that cannot be treated with surgery, a splint or weight loss
• OSA that requires CPAP

How is OSA classified?

OSA can be classified as mild, moderate or severe.

Mild OSA can usually be treated with surgery alone.

Moderate OSA can be treated with surgery alone or surgery followed by other treatments, such as dental splints, weight loss or CPAP.

Severe OSA almost always requires CPAP treatment, although surgery can be useful in clearing the air passages to improve CPAP comfort and effectiveness.

What is CPAP?

CPAP (Continuous Positive Airway Pressure) is a machine that pumps air through the nose and/or mouth via a mask at night. The pressurised air stops the air passages from blocking. This prevents OSA from occurring.

Does Dr Singh provide CPAP?

No. If you need CPAP, Dr Singh will refer you to one of his sleep physician colleagues for treatment. Dr Singh works with only the most experienced and expert sleep physicians in Sydney.

Does Dr Singh provide Dental splints?

No. If you need a dental splint, Dr Singh will refer you to one of his dental colleagues for treatment. Dr Singh works with only the most experienced and expert dentists in Sydney.