Snoring Treatments

Snoring occurs during sleep when the soft palate, uvula, and tongue root in the throat region relax and vibrate with the airflow. This vibration increases with the air turbulence that occurs in the narrowed airway, and the snoring sound emerges. While simple snoring is limited to sound, in the case of obstructive sleep apnea, the airway is partially or completely blocked, resulting in breathing pauses (apnea) and drops in blood oxygen.
Main causes:
• Obesity (fat accumulation in the neck circumference)
• Nasal congestion (deviation, allergy, sinusitis)
• Sagging of the soft palate and uvula
• Enlargement or backward positioning of the tongue root
• Alcohol, cigarettes, muscle relaxants
• Aging and genetic factors
If snoring is not treated, it impairs sleep quality, disturbs the partner, and increases the risk of cardiovascular disease in sleep apnea. With early intervention, many cases can be brought under control.

Oral appliances are a non-invasive (non-surgical) treatment option. These devices, worn while sleeping at night, reduce snoring and mild-moderate sleep apnea by keeping the airway open. They are especially ideal for patients who cannot tolerate a CPAP device or avoid surgery.

Types of Oral Appliances:
• Mandibular Advancement Device (MAD): The most common type. It slightly pushes the lower jaw forward, preventing the base of the tongue from falling back and widening the airway. There are custom-made or ready-made (boil-and-bite) models. Custom-made ones are more effective and comfortable.

• Tongue Retaining Device (TRD): Opens the airway by drawing the base of the tongue forward with a vacuum. It is used as an alternative to the Mandibular Advancement Device, especially in those with jaw problems.

• No surgical risk, painless and reversible.
• Portable, quiet, and easy to use (ideal for travel).
• 50-70% success rate in mild-moderate sleep apnea; significantly reduces snoring.
• Higher compliance rate compared to CPAP (patients use it more regularly).
• Improves quality of life: Better sleep, reduced daytime fatigue.

• Jaw pain, excessive salivation, dry mouth, or tooth sensitivity may occur in the first weeks (usually temporary).
• Risk of bite change (occlusal change) in the long term (10-20%).
• Cannot be used in those with insufficient dental or temporomandibular joint problems.
• May be insufficient on its own in severe sleep apnea. Oral appliances are prepared by dentists. Custom production is made in many dental clinics in Turkey. Effectiveness is increased with regular check-ups.

Surgery is preferred in cases that do not respond to other treatments or have anatomical problems (large tonsils, sagging palate, crooked nose). The aim is to widen the airway and eliminate obstruction. The success rate is between 40-80% depending on the patient’s condition, but there is a risk of recurrence.

Main surgical methods:
Uvulopalatopharyngoplasty (UPPP): Partial removal of the soft palate, uvula, and tonsils. Classical method; 60-70% success in simple snoring, 40-50% in sleep apnea has been reported.

Radiofrequency Ablation (Somnoplasty): It is the process of shrinking the soft palate or tongue base with radio waves. It can be done in office conditions, with local anesthesia; it is not an aggressive procedure.

Laser Assisted Uvulopalatoplasty (LAUP): It is the process of reducing the palate with a laser. It can be effective in snoring, but its effectiveness in apnea is limited.

Tongue Base and Jaw Surgeries: Tongue base reduction, hyoid suspension, or maxillomandibular advancement (bringing the jaw forward); used in severe apnea.

Nasal Surgery: Deviation (nasal septum curvature) correction or nasal concha reduction; provides additional treatment in nasal obstruction that contributes to snoring.

Advantages of Surgery:
• Potential for permanent solution (especially in anatomical problems).
• No drug or device dependence.
• Rapid recovery in mild cases.

Disadvantages and risks of Surgery:
• Severe sore throat after surgery, difficulty swallowing, nasal regurgitation (velopharyngeal insufficiency).
• Complications such as bleeding, infection, loss of taste.
• The success rate may decrease in the long term (50% recurrence).
• Risk of general anesthesia, hospitalization.
• May not be sufficient on its own in severe apnea.
The level of obstruction is determined with sleep endoscopy and polysomnography before surgery. Weight loss is mandatory if there is obesity.

Intraoral appliances: May be suitable for mild-moderate snoring/apnea. It may be the first choice for those who cannot tolerate CPAP (mask treatment) and those who avoid surgery.
Surgery: Can be preferred in young patients, those with significant anatomical problems, and those who do not want other treatments. Both methods should be supported by lifestyle changes (weight loss, not sleeping on the back, quitting alcohol).