REMEDY : BNSSG referral pathways

Snoring

Checked: 09-08-2018 by vicky.ryan Next Review: 09-08-2019

Snoring - overview

Our ENT GPSI advice is as follows:

This is always a tricky problem for which the ENT surgeons, unfortunately, usually have little to offer. Nasal obstruction rarely contributes significantly to snoring (which as I'm sure you are aware is the uvula vibrating against the soft palate), so fixing this rarely helps.

The GPSI’s discussed this with the ENT department and currently they do not advocate surgery for snoring. New onset snoring may need investigation for an underlying cause.

Surgical treatment to reduce the impact of snoring is not routinely commissioned. The funding policy for snoring can be found here: Surgical intervention for simple snoring

Most of the online evidence for surgery for snoring is for people with obstructive sleep apnoea - the latest Cochrane review (admittedly 2008) does not advocate its use. NICE in January did publish their guidance on ablation of the uvula in which they also state evidence is poor.

It may be worth trying a mandibular advancement device (e.g. "snoreeze" device available online or from Boots - costs about £35)? These act to gently pull forward the jaw and are like a big gumshield. There is a Cochrane review on these for sleep apnoea which concludes they may be of some benefit. They can also be obtained from the internet for example here:

http://www.sleeppro.com/ or here http://www.britishsnoring.co.uk/shop/mandibular_advancement_devices_MADs.php.

If the patient is overweight, obviously weight loss is likely to be of benefit. Other conservative measures include stopping alcohol, avoiding sedatives, and considering sleep position.