{"id":4435,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/snoring\/"},"modified":"2026-09-04T15:32:03","modified_gmt":"2026-09-04T14:32:03","slug":"snoring","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/nose\/snoring\/","title":{"rendered":"Snoring"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Snoring is rarely a symptom of significant disease. It is noise generated by the upper airways during sleep due to <strong>partial collapse<\/strong> of the soft tissues. It is important to distinguish between simple snoring and obstructive sleep apnoea syndrome (OSAS).&nbsp; OSAS occurs due to <strong>complete collapse<\/strong> of the soft tissues in the upper airway causing an obstruction and apnoeic episodes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please see the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/sleep-disordered-breathing\/\" target=\"_blank\" rel=\"noopener\">Sleep Disordered Breathing page<\/a> for more information, with more detailed advice in its Primary Care Management section.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Snoring is a normal part of ageing and is associated with obesity.&nbsp; Provided the Epworth Sleepiness score is less than 12, there is no nasal obstruction or \u2018hot potato speech\u2019, it is <strong><u>rarely<\/u><\/strong> indicative of pathology. <strong><u>Consider checking thyroid function.<\/u><\/strong> Patients should be advised to lose weight if appropriate, and to avoid sleeping with others after drinking alcohol.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are a variety of devices available for purchase online\/in chemists but the evidence for their use is scanty. The best evidence&nbsp;is for mandibular splint devices which can be supplied by most General Dental Practitioners.&nbsp; They are no longer supplied free by NHS Lothian.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Please note that<\/strong> NHS Lothian no longer offers treatment to simple snorers without daytime nasal obstruction.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Surgery for Snoring<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Surgery for snoring, is rarely required, though may help in carefully selected patients. This can only be decided after careful assessment and appropriate counselling.&nbsp; Surgery must be tailored to individual patient&#8217;s anatomy, using the Friedman tongue position model.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Surgery on appropriate patients is successful in 80-90% provided weight remains stable and normal. Any palatal\/tongue base surgery can only be done if the patient has a clear nasal airway and is <strong><u>not provided by NHS Lothian.<\/u><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Surgically correctable contributors to snoring:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Nasal pathology\n<ul class=\"wp-block-list\">\n<li>Significant septal deviation<\/li>\n\n\n\n<li>Turbinate hypertrophy<\/li>\n\n\n\n<li>Adenoidal hypertrophy<\/li>\n\n\n\n<li>Nasal valve collapse<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Oral\/oropharyngeal pathology\n<ul class=\"wp-block-list\">\n<li>Oral mass<\/li>\n\n\n\n<li>Gross tonsillar hypertrophy<\/li>\n\n\n\n<li>Lingual tonsillar hypertrophy<\/li>\n\n\n\n<li>Palatal laxity<\/li>\n\n\n\n<li>Tongue base hypotonicity\/bulk<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Laryngeal\/hypopharyngeal pathology\n<ul class=\"wp-block-list\">\n<li>Laryngomalacia (rare)<\/li>\n\n\n\n<li>Pharyngeal masses.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.M &#8211; 4-9-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">RED FLAG SYMPTOMS<\/mark><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Any patient with new onset symptoms of severe snoring plus any of the following:<\/mark><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Otalgia<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Globus<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Odynophagia<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Dysphagia<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Voice change<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sore throat<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Hot potato speech.<\/mark><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">These patients must be assessed urgently to rule out a mass in the oropharynx\/larynx\/hypopharynx.<\/mark><\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If patient also has nasal obstruction, before referral consider:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>What is the patient&#8217;s motivation for requesting help?\n<ul class=\"wp-block-list\">\n<li>Exclusion of underlying disease \u2013 reassure<\/li>\n\n\n\n<li>Social disharmony \u2013 coping strategies<\/li>\n\n\n\n<li>Advice regarding treatment options \u2013 see below<\/li>\n\n\n\n<li>Cure (rarely possible) \u2013 counsel accordingly<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Is the patient prepared to consider surgery on the nose? If not, consider whether the referral is necessary.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prior to Referral<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Does the patient have disruptive snoring? If so, try the following before any referral:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Reassurance &#8211; simple snoring is rarely a symptom of significant disease (see red flag symptoms above)<\/li>\n\n\n\n<li>Treatment &#8211; treat underlying nasal disease (try also if patient wakes with a dry mouth):\n<ul class=\"wp-block-list\">\n<li>10-day trial of a nasal decongestant AND 2 MONTH trial of intranasal corticosteroids<\/li>\n\n\n\n<li>saline douches to reduce mucus viscosity<\/li>\n\n\n\n<li>trial of nasal dilator strips from chemist<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>General advice:\n<ul class=\"wp-block-list\">\n<li>reduce weight to normal BMI<\/li>\n\n\n\n<li>stop smoking<\/li>\n\n\n\n<li>reduce alcohol intake especially at night<\/li>\n\n\n\n<li>stop sedative medications<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Coping strategies\n<ul class=\"wp-block-list\">\n<li>bed partner wearing ear plugs<\/li>\n\n\n\n<li>trial of mandibular advancement splint from dentist (will need to pay)<\/li>\n\n\n\n<li>change sleeping position (lie on side not back)<\/li>\n\n\n\n<li>increase hydration, especially in the evening<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to Refer<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Epworth Sleepiness Score &gt;11, or witnessed frequent apnoea episodes with loud \u2018rescue\u2019 breaths \u2013 please see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/sleep-disordered-breathing\/\" target=\"_blank\" rel=\"noopener\">Sleep Disordered Breathing \u2013 RefHelp<\/a><\/li>\n\n\n\n<li>Patients without nasal obstruction<\/li>\n\n\n\n<li>Morbid obesity (BMI &gt; 40) \u2013 consider weight management referral.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to Refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">SCI Gateway to ENT at Lauriston Building<br><br><strong>Include on referral:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Obstructive sleep apnoea excluded<\/li>\n\n\n\n<li>Therapy trialled<\/li>\n\n\n\n<li>BMI (&gt; 40 consider weight management referral)<\/li>\n\n\n\n<li>Collar size\u00a0(women &gt; 15&#8243;, men &gt; 17&#8243;\u00a0associated with OSAS)<\/li>\n\n\n\n<li>BP<\/li>\n\n\n\n<li>Nose \u2013 external deviation?\u00a0Septum deviation?\u00a0Turbinates enlarged?<\/li>\n\n\n\n<li>Mouth\/oropharynx\u00a0\u2013 tonsil size<\/li>\n\n\n\n<li>Oral pathology<\/li>\n\n\n\n<li>Dentition<\/li>\n\n\n\n<li>The patient&#8217;s expectations of the consultation.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">Please see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/sleep-disordered-breathing\/\" target=\"_blank\" rel=\"noopener\">Sleep Disordered Breathing \u2013 RefHelp<\/a>.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/ENT-Snoring_Advice_for_Patients.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/ENT-Snoring_Advice_for_Patients.pdf\" target=\"_blank\" rel=\"noopener\">Snoring Advice \u2013 Patient Information Leaflet<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/britishsnoring.co.uk\/\">British Snoring &amp; Sleep Apnoea Association<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Snoring is rarely a symptom of significant disease. It is noise generated by the upper airways during sleep due to partial collapse of the soft tissues. It is important to distinguish between simple snoring and obstructive sleep apnoea syndrome (OSAS).&nbsp; OSAS occurs due to complete collapse of the soft tissues in the upper airway causing<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4183,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[155],"class_list":["post-4435","page","type-page","status-publish","hentry","category-snoring"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entadult\/nose\/snoring\/\" rel=\"tag\">Snoring<\/a>","rttpg_excerpt":"Snoring is rarely a symptom of significant disease. It is noise generated by the upper airways during sleep due to partial collapse of the soft tissues. It is important to distinguish between simple snoring and obstructive sleep apnoea syndrome (OSAS).&nbsp; OSAS occurs due to complete collapse of the soft tissues in the upper airway causing","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4435","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4435"}],"version-history":[{"count":11,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4435\/revisions"}],"predecessor-version":[{"id":29856,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4435\/revisions\/29856"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4183"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4435"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4435"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}