I have a confession to make at the outset of this article. I am a snorer, apparently, a very loud snorer by all accounts and I come from a familial line of loud snorers, if my father and brother are anything to go by. I say I am a snorer, apparently, because I have never actually heard myself snore. And this is the dreadful conundrum of the snorer. Snoring is a much maligned scourge of modern life. I have found myself critically bemoaned by lovers and friends and a few strangers, as well, due to my apparent snoring. This has hurt me and I share this with you because the snorer is roundly chastised by society at large, but we feel victimised because it is something we do in our sleep. No snorer, I posit, sets out to damage the sleep of a loved one intentionally. No snorer wants to cause a rift between themselves and their nearest and dearest. Snoring is, unfortunately for the non-snorer or the listener to loud snores, just a fact of life. It is caused, in most cases, by an anatomical feature within the snorer’s soft palate. It is not something gleefully unleashed by the wicked upon the sleep of the innocent. Yes, it can be amplified by diet, weight gain, and indulgence in alcoholic drinks. The snorer walks a fine line when the sun goes down and the bed clothes beckon. The sensitive snorer is sometimes treated like the sensitive serial killer – with little sympathy and even less understanding.

“Snoring is a sound produced by the vibrating structures of the upper airway. It is not caused by a single, localized abnormality within the airway. Endoscopic and imaging observations of the upper airway in snorers, during natural or induced sleep, demonstrate that any membranous part of the upper airway that lacks cartilaginous support can vibrate.3 This includes the soft palate, uvula, faucial pillars, pharyngeal walls, and the rest of the upper airway, almost to the level of the vocal cords. This diffuse involvement of the upper airway has made successful treatment of snoring more difficult, as many treatments address only a particular airway segment.”
– Li & Hoffstein, Snoring, 2022

I used to defend myself about my apparent snoring by telling the foundation story of why men snore. Grown men snore loudly to keep the dangerous predators away at night. Back in the day, when we were cave dwellers, the echoing snores emanating from within the darkened cave would frighten other animals off, thinking that all that racket must be coming from a very large beast inside. Thus, snoring was an evolutionary plus and is why it has survived down through the ages. This fictitious narrative would, whilst not ending the argument, buy me some time in the never-ending cycle of complaints. These days, I just sleep alone.

The Medicalisation of Snoring

We live in the scientific age, where the medicalisation of human life continues apace. Sleep disorders and breathing – now part of integrative dentistry. There are no 100% guaranteed universal cures for snoring. Some snorers and their sleeping partners do find things to reduce the negative impacts of snoring but there are plenty more who waste money on promises that turn out to be ineffective. Dentists getting involved in this lucrative market is not surprising because the soft palate is within their turf. Research into this topic has not revealed a lot of good news on the snoring front when it comes to devices claiming to be the solution. Dentists charging thousands of dollars for mandibular advancement devices are all too common, according to the Harvard University health blog. A mouthguard from the chemist can sometimes be as effective for around 2% of the price charged by these dentists. There are tongue restraining devices, which sound like something out of torturer’s kitbag, and again are patchy at best in doing much about snoring. (https://www.health.harvard.edu/blog/dental-appliances-for-sleep-apnea-do-they-work-2021042822476)

Sleep Apnoea is the serious health end of the snoring problem for individuals and can be highly detrimental to the wellbeing of sufferers.

“Sleep related breathing disorders (SRBD) are disorders characterised by disruptions in normal breathing patterns. SRBDs are potentially serious medical conditions caused by anatomical airway collapse and altered respiratory control mechanisms. Common SRBDs include snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnoea (OSA). OSA has been associated with metabolic, cardiovascular, respiratory, dental and other diseases. In children, undiagnosed and/or untreated OSA can be associated with cardiovascular problems, impaired growth as well as learning and behavioural problems.”
– American Dental Association

Society and its medical arm identifies and diagnoses a medical disorder as the first step in the medicalisation process. There are snorers who do suffer these serious and sometimes life threatening breathing difficulties in their sleep but the vast majority of snorters do not. What happens, however, is that the category grows ever larger as more snorers are lumped in via the medicalisation process. This has happened in the massive overprescribing of mental health drugs like SSRIs, with something like 1 in 5 Australians now taking an antidepressant medication. Even the name of the drug is subsumed by the name of the disorder, as a marketing ploy by big pharma. The proliferation of mood altering drugs is a direct result of cultural presumptions about how existential experiences of unhappiness, grief, and psychological growing pains should be managed. The economy demands constant application by all of us and time off to process internal problems is rarely granted or encouraged. Snorers, thankfully, do it in their sleep, but they do impact negatively on their partner’s performance the next day at work.

Oral Appliance Therapy

Medical jargon plays an important part in the successful marketing of treatments. Integrative dentistry moving into sleep disorders and breathing is another smart move by those guiding the fortunes of dentists everywhere. Cosmetic dentistry has been a hugely profitable extension of the dental sector and snoring could be the wake up call for another new market motza.

“Dentists can and do play an essential role in the multidisciplinary care of patients with certain sleep related breathing disorders and are well positioned to identify patients at greater risk of SRBD. SRBD can be caused by a number of multifactorial medical issues and are therefore best treated through a collaborative model. Working in conjunction with our colleagues in medicine, dentists have various methods of mitigating these disorders. In children, the dentist’s recognition of suboptimal early craniofacial growth and development or other risk factors may lead to medical referral or orthodontic/orthopaedic intervention to treat and/or prevent SRBD. Various surgical modalities exist to treat SRBD. Oral appliances, specifically custom-made, titratable devices can improve SRBD in adult patients compared to no therapy or placebo devices. Oral appliance therapy (OAT) can improve OSA in adult patients, especially those who are intolerant of continuous positive airway pressure (CPAP). Dentists are the only health care provider with the knowledge and expertise to provide OAT.”
– ADA, The Role of Dentistry in the Treatment of Sleep Related Breathing Disorder, 2017

“A few years ago, I was diagnosed with nasal polyps, and I regularly snored like a wild boar. I’ve had the polyps removed, but the snoring continued. I’m not alone: According to a chapter on snoring in Principles and Practice of Sleep Medicine (Fifth Edition), “about 40% of the adult population” snores.”
– New York Times

There are no universal cures for snoring but dentists are well placed to become the leading experts in the field. There are dozens of different devices designed to reduce snoring and its negative effects upon bed partners. Snoring used to be considered an irritant, whereas it is now a fully fledged medicalised disorder. I haven’t mentioned anti-snoring fanatics but I have come across a fair few in my time. The medicalisation of snoring will give them more ammunition with which to persecute their victims. Sleep apnoea (OSA) for those who do have this issue is a very real and dangerous condition.

“Continuous positive airway pressure (CPAP), generally administered through the nose, is the primary treatment for OSA and is the recommended first-line treatment for patients with moderate-to-severe forms of the disease. However, some patients are unable to tolerate CPAP because of mask discomfort, while others cannot accept sleeping throughout the night attached to a mechanical device. Objective data collected from patients have shown a compliance rate with CPAP of <50%. In these cases, surgical management aimed at addressing anatomical obstruction may be warranted.”
– RACGP.com.au

There are smart phone apps that record your snoring for you. Pillows that link to these apps and electronically move to discourage snoring positions and or serenade you with music. There are good old nose strips designed to keep your nasal passages open. Dentists and orthodontists will be customising mandibular devices designed to promote better breathing and less snoring. I wish their best endeavours well in the seemingly never ending battle against the evils of snoring.

References

https://www.racgp.org.au/afp/2016/august/surgery-for-adult-patients-with-obstructive-sleep
https://www.sciencedirect.com/science/article/abs/pii/B978141606645300102X
https://www.nytimes.com/wirecutter/blog/anti-snoring-devices/
https://www.nytimes.com/wirecutter/blog/anti-snoring-devices/
https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/the-role-of-dentistry-in-sleep-related-breathing-disorders.pdf

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