Snoring is no joke and could also be a sign of much more serious health problems

DR ELIZABETH Walton, a 43-year-old physician and mother of four-year-old twins, has a common, if embarrassing problem. She snores - loudly. She has tried various remedies and thanks to an oral appliance that looks like a mouthguard, is finally sleeping more easily because she has obstructive sleep apnoea.

Almost half of the adult population snores at least occasionally. "We joke about snoring," says Dr Nancy A Collop, president elect of the American Academy of Sleep Medicine, "but it can be annoying and disruptive to couples."

What's more, while snoring in itself does not present health problems, it may be a sign of a sleep apnoea, as it was in Dr Walton's case. This is where airways that are so obstructed they stop or nearly stop breathing during sleep. Lack of oxygen wakens sufferers, usually with a gasp, frequently during the night. "All people with sleep apnoea snore," says Dr Collop, "but not all people who snore have sleep apnoea."

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If you find you suffer from plain old snoring and not the more serious complaint, how far you decide to go will depend on a combination of what you and your spouse are comfortable with, what works for you and what you can afford. Here are a few ways to determine which treatment is right for you or the loud sleeper in your family. n

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Search for snoring remedies on the internet and you will find dozens of products, including special pillows, mouth and nose devices, throat exercises and even advice on learning to play the didgeridoo, to strengthen throat muscles and tissues. By and large, these products are marketed without much evidence of results. "For the most part, you can save your money," says Dr Collop. Instead, she and other sleep experts recommend most patients start with lifestyle changes that may reduce or eliminate snoring.

One of the most effective treatments for sleep apnea, continuous positive airway pressure, or CPAP, pronounced SEE-pap, also eliminates garden-variety snoring. But since it is a pressurised mask that forces cold air to the lungs, many patients find it uncomfortable or annoying and end up abandoning the treatment. If you use a CPAP machine, do not give it up without talking to your doctor. He or she may be able to make the device more comfortable by adding a heated humidifier. There are also some newer, more advanced versions that apply less pressure and may be more comfortable.

These are form-fitting mouthguards that usually move your lower jaw forward to increase space around your airways, fitted by a dentist who specialises in sleep medicine. Studies show that custom-fit appliances ease mild to moderate sleep apnoea in about 75 per cent of patients and snoring in 80 to 90 per cent of patients who use them regularly.

Removal of excess tissue in the throat and nose, whether through traditional surgery or newer methods, is a drastic step and some procedures can be painful and cause serious side-effects. In uvulopalatopharyngoplasty, a surgeon trims and tightens excess tissue in the airway while you are under general anaesthetic. Alternatively a laser can be used to remove your uvula and shorten your soft palate. This has not been proven to improve apnoea, but will get snoring under control.

Two newer procedures are also available. Somnoplasty relies on radio frequency to remove some of the soft palate. Done on an outpatient basis, it is generally considered less painful than other snoring surgery.

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The Pillar procedure involves implanting polyester fibres in the soft palate to stiffen the tissue and decrease vibrations. This is usually done in a doctor's office under local anaesthesia and is less invasive than other surgical treatments.

Lose weight, sleep on your side and avoid alcohol before bed. Those whose snoring stars in their noses could also try clearing nasal passages with a hot shower or by using a saline solution. Check for allergens and dust mites in your bedroom, especially if you are congested only at night, while over-the-counter nasal strips you put on the outside of your nose before bed may also help.

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If none of this eases your snoring, you will need to see a doctor to be evaluated for sleep apnea. About 50 per cent of people who snore loudly have the condition. Other symptoms include daytime sleepiness and extensive fatigue.

To find out if you have sleep apnoea, you will spend the night in a sleep clinic, where specialists will track your blood oxygen levels, breathing and other movements to see if you are waking frequently at night.

This article was first published in Scotland On Sunday, 19 December, 2010