{"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":"2023-08-30T11:03:45","modified_gmt":"2023-08-30T10:03:45","slug":"snoring","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/nose\/snoring\/","title":{"rendered":"Snoring"},"content":{"rendered":"\n

This page was last reviewed 12-07-20<\/strong><\/p>\n\n\n\nSnoring<\/title>\n\n\n\n<p>Snoring is rarely a symptom of significant disease<br><em><\/em><strong>Definition<\/strong> \u2013 snoring 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).  OSAS occurs due to <strong>complete collapse<\/strong> of the soft tissues in the upper airway causing an obstruction and apnoeic episodes. Because of poor quality sleep patients are frequently tired during the day.<\/p>\n\n\n\n<p><strong>Please note:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>NHS Lothian no longer offers treatment to simple snorers without Daytime nasal obstruction.<\/li>\n\n\n\n<li>Mandibular splints are no longer supplied on the NHS<\/li>\n<\/ul>\n\n\n\n<p><\/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<h3 class=\"wp-block-heading\">Who to refer<\/h3>\n\n\n\n<p><strong>RED FLAG SYMPTOMS<br><\/strong>Any patient with new onset symptoms of severe snoring plus any of the following:<br>Otalgia<br>Globus<br>Odynophagia<br>Dysphagia<br>Voice change<br>Sore throat<br>Hot Potato speech<\/p>\n\n\n\n<p>These patients must be assessed urgently  to rule out a mass in the oropharynx \/ larynx \/ hypopharynx<\/p>\n\n\n\n<p>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’s motivation for requesting help?<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exclusion of underlying disease \u2013 reassure<\/li>\n\n\n\n<li>Social disharmony – 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\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<h3 class=\"wp-block-heading\">Prior to Referral<\/h3>\n\n\n\n<p>Does the patient have disruptive snoring? If so, try the following <strong>prior<\/strong> to referral:<\/p>\n\n\n\n<p><strong>Reassurance <\/strong>– simple snoring is rarely a symptom of significant disease (see red flag symtoms above)<\/p>\n\n\n\n<p><strong>Treatment <\/strong>– treat underlying nasal disease (try also if patient wakes with a dry mouth):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>10 day trial of Oxymetazoline (Otrivine) <strong>AND<\/strong> 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\n\n\n<p><strong>General advice-<\/strong><\/p>\n\n\n\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\n\n\n<p><strong>Coping strategies<\/strong>–<\/p>\n\n\n\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\n\n\n<p>Please check thyroid function<\/p>\n\n\n\n<p>Provide patients with patient advice leaflet<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Surgery for Snoring<\/h3>\n\n\n\n<p>Surgery for snoring is rarely required.<\/p>\n\n\n\n<p>In carefully selected patients surgery may help.  This can only be decided after careful assessment and appropriate counselling.  Surgery must be tailored to individual patient’s anatomy (see<em> <\/em><em><a href=\"\/files\/sites\/2\/ENT-Friedman-Tongue-Position.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Friedman Tongue Position<\/a><\/em>)<\/p>\n\n\n\n<p>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.  <strong>This is not provided by NHS Lothian.<\/strong><\/p>\n\n\n\n<p> <strong><\/strong>Surgically correctable contributors to snoring:<\/p>\n\n\n\n<p><strong>Nasal pathology<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"letter-spacing: -0.1px\">Significant septal deviation<\/span><\/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\n\n\n<p><strong>Oral \/ oropharyngeal pathology<\/strong><\/p>\n\n\n\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\n\n\n<p><strong>Laryngeal \/ hypopharyngeal pathology<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Laryngomalacia (rare)<\/li>\n\n\n\n<li>Pharyngeal masses<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Who not to refer<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Epworth Sleepiness Score >11<\/li>\n\n\n\n<li>Witnessed frequent apnoeas with loud “rescue” breaths<\/li>\n\n\n\n<li>Day time sleepiness<\/li>\n\n\n\n<li>Poor concentration<\/li>\n\n\n\n<li>Morning headaches<\/li>\n\n\n\n<li>Restless \/ sweaty during sleep.<\/li>\n\n\n\n<li>Patients without  nasal obstruction<\/li>\n\n\n\n<li>Morbid obesity (bmi>40) – consider weight management referral<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">How to refer<\/h3>\n\n\n\n<p>SCI Gateway to ENT at Lauriston Building<\/p>\n\n\n\n<p><strong>Include on referral:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OSAS excluded<\/li>\n\n\n\n<li>Therapy trialled<\/li>\n\n\n\n<li>BMI (>40 consider weight management referral)<\/li>\n\n\n\n<li>Collar size (women >15″,  men >17″ associated with OSAS)<\/li>\n\n\n\n<li>BP<\/li>\n\n\n\n<li>Nose – external deviation? septum deviation?  turbinates enlarged?<\/li>\n\n\n\n<li>Mouth \/ oropharynx  – 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’s expectations of the consultation<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><\/h3>\n\n\n\n<p><a href=\"\/refhelp\/guidelines\/SleepDisorders\" target=\"_blank\" rel=\"noreferrer noopener\">See Referral to the Sleep Disorder Service<\/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\">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>The following is a guide and will allow you to safely reassure most patients, but we recognise that some are bothered by their symptoms to such a degree that they need secondary care management.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Snoring: <\/h3>\n\n\n\n<p>This is a normal part of ageing and is associated with obesity. <\/p>\n\n\n\n<p>Provided the Epworth Sleepiness score is less than 12, there is no nasal obstruction or “hot potato speech, it is <strong>rarely<\/strong> indicative of pathology. <strong>Consider checking thyroid function.<\/strong><\/p>\n\n\n\n<p>Patients should be advised to lose weight if appropriate, and to avoid sleeping with others after drinking alcohol. <\/p>\n\n\n\n<p>There are a variety of devices available for purchase online\/in chemists but the evidence for all is scanty. The best evidence is for mandibular splint devices which can be supplied by most General Dental Practitioners.  They are no longer supplied free by NHS Lothian.<\/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:\/\/apps.nhslothian.scot\/files\/sites\/2\/ENT-Snoring-Advice-for-Patients-v2.0-NHSL-Approved.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ENT – Snoring Advice for Patients v2.0 NHSL Approved<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ENT-Friedman-Tongue-Position.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ENT-Friedman-Tongue-Position.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ENT -Friedman Tongue Position<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This page was last reviewed 12-07-20 Snoring Snoring is rarely a symptom of significant diseaseDefinition – snoring 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).  OSAS occurs due to complete collapse of<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4183,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"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":"This page was last reviewed 12-07-20 Snoring Snoring is rarely a symptom of significant diseaseDefinition – snoring 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).  OSAS occurs due to complete collapse of","_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":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4435\/revisions"}],"predecessor-version":[{"id":14060,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4435\/revisions\/14060"}],"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}]}}