Breathe easier: the new treatments to help stop snoring

Office worker Gerard Cowie’s snoring was so bad his former landlady swore she could hear him through two walls.

Like many loud snorers, however, his problem turned out to be more than just noisy nights: it was caused by obstructive sleep apnoea (OSA), a shortage of oxygen caused by blockage of the upper airway.

Now, 13 years after being diagnosed, Gerard has become one of the first patients in the UK to undergo a new operation called hypoglossal nerve stimulation. It involves implanting a small pacemaker-like device under the skin of the chest.

Sufferers turn it on via a remote control before sleep and, once activated, it stimulates the hypoglossal nerve that controls the tongue muscles, preventing the tongue from blocking the airway.

Guy’s and St Thomas’ NHS Foundation Trust in London is the first in the UK to adopt the procedure – also called Inspire – although it’s been used for longer elsewhere in the world.

The first patients have experienced great improvement, according to consultant ENT surgeon and laryngologist Yakubu Karagama.

“It’s not for everyone but, for carefully selected patients with moderate to severe sleep apnoea, it can be a game changer,” he says. “It involves making two five-centimetre cuts – one in the right of the chest and one under the chin – and takes around an hour.

“While it’s done as a day case elsewhere, because it’s new here and it involves a general anaesthetic, we keep patients in for 24 hours.”

An alternative treatment

Gerard, from south London, is delighted with the results, after years spent battling with the gold-standard treatment for sleep apnoea, a mask worn during sleep which pumps pressurised air into the airway (called continuous positive airway pressure, or CPAP for short).

“I struggled with the mask, so when I heard about the new procedure, I jumped at it. The first step was an examination to check that my sleep apnoea was due to my tongue blocking my airway,” he says.

“It can feel strange when your tongue shoots forward, however it’s not cumbersome like CPAP. I’m so relieved not to have to wear a mask any more nor plug my machine into a socket at bedtime.”

Surgeons throughout the country are being trained in the procedure, which has the seal of approval from NICE (the official body that makes recommendations on medicines and treatments), though it’s not yet widely available.

At around £20,000 it doesn’t come cheap, and not everyone is convinced. But what isn’t in doubt is that sleep apnoea is a growing problem, as obesity rises and we become an increasingly older population.

“Both snoring and sleep apnoea become more common as we get older, due to loss of muscle tone in the neck and throat, which causes them to relax and the upper airway to narrow,” says Dr Annabel Nickol, at the Oxford Centre for Respiratory Medicine and one of the experts behind the latest NICE guidelines on OSA.

“Snoring is the result of vibration of these relaxed tissues as you breathe.”

Not everyone who snores has sleep apnoea, but many people with sleep apnoea snore.

It’s thought at least 2.5 million people in the UK with sleep apnoea have not been diagnosed, which is worrying given the slump in blood oxygen caused by the repeated breathing interruptions that can lead to high blood pressure.

Sleep apnoea is also linked to a slew of other problems from heart attack and stroke to type 2 diabetes, cognitive impairment, depression, and, according to recent research, glaucoma. Plus there’s a higher risk of accidents and diminished quality of life.

How do you know you’re affected?

As well as deafening snores and pauses in breathing, you may surface with a cough, snort or gasp.

Waking unrefreshed, dozing off in front of the TV or while driving or operating machinery are other tell-tale signs, as can be a headache on waking, irritability and forgetfulness.

CPAP can dramatically improve matters, but many people dislike it. One sobering review concludes that most users abandon CPAP after a while or don’t use it often enough to reap the benefits. Most difficulties can be ironed out, insists Dr Nickol.

More concerning is the lack of CPAP equipment, which began during the pandemic and has been exacerbated by an ongoing global shortage of microchips due to supply chain hold-ups in China.

New innovative solutions

CPAP has been around since the 1980s, and while it’s still the gold-standard treatment for sleep apnoea, increased understanding has led to the development of newer, less invasive interventions.

One of the newest for people with mild OSA is eXciteOSA, a tongue exercise device for the mouth, used during the day.

Wearing a mask to bed is hardly sexy, so this is a big plus point. According to the company’s research, nine in ten users snore less, while almost four in five achieve a reduction in OSA after using it for 20 minutes a day for six weeks.

At more than £500, it’s not cheap, but for Richard Ballatine, 61, a precision engineer from Bournemouth who was first diagnosed with sleep apnoea in 1996, it’s been worth it.

Richard was due to have CPAP in 2020 when the pandemic struck, so it didn’t happen. He started using eXciteOSA last year.

“It’s really turned things around,” he says. “Before, I’d have days when I couldn’t think straight and would sometimes begin to fall asleep at work. These days I’m much more alert and responsive.

“Combined with lifestyle measures such as yoga, it’s had a tremendous impact on my quality of life and my partner doesn’t notice me stopping breathing any more.”

Apart from these innovations, other sleep apnoea treatments include mouthguards, called mandibular advancement devices, which pull the jaw forwards and can work for people with mild to moderate sleep apnoea.

The best are bespoke and prescribed by a dentist. Then there’s surgery – around 40 different operations in all – but according to ENT surgeon Vik Veer, from the Royal National ENT and Eastman Dental Hospitals, that’s strictly a last resort.

“Most patients think of success as a complete resolution of all symptoms,” he says. “But, for example, if they have surgery and their Apnoea Hypopnea Index – a measure of the number of times they stop breathing or oxygen level falls – drops from 90 to 35, that might be deemed successful as severity has been reduced by more than 50%.

“However, they still have severe sleep apnoea at the end of it. It’s important to recognise the limitations.”

Do sleep gadgets really work?

There are also ways to help yourself, including a variety of sleep gadgets that claim to help with snoring – although many ‘treatments’ on offer simply don’t work.

A new campaign, #SnoreYawnWarn, from the British Society of Pharmacy Sleep Services, aims to raise awareness of OSA and its dangers – and to establish a network of sleep-trained community pharmacists. Its CEO, Adrian Zacher, adds:

“We want people to consult a community pharmacist who can point them towards help rather than self-diagnosing – or buying useless over-the-counter aids.”