What can we do for you today, asks the kind nurse at the sleep unit in a north London hospital. “Save my marriage, ideally,” I reply. I’m only exaggerating a little. My snoring means that my cat is more likely to sleep in the same bed as my wife than me. Even my teenage daughter and her teddy bear are more likely to sleep with my wife than me.
I am one of 15 million snorers in the UK – that’s 41.5% of the adult population. In fact, I’m one of the 25% of those 15 million who snore regularly and disturb their partners’ sleep. That is, if these snorers have partners, which seems a diminishing possibility given how much misery they cause to those on the receiving end.
Some nights in the past year or so, while wife, daughter, cat and teddy bear are upstairs in one bed giggling over something or other, I – having been banished from the master bedroom – trudge sadly downstairs to the living room where I can snore without disturbing anyone. Can I get a boo-hoo?
“There is nothing more disturbing than lying there trying to sleep and all you can do is tune into your partner snoring next to you,” says Dr Ellie Cannon, a GP and holder of my favourite job title, namely campaign ambassador for a leading anti-snoring nasal dilator.
I haven’t yet contacted all 3.75 million regular snorers to clinch this point, but it seems very unlikely that all are sleeping on sofa beds. Doubtless many don’t have that luxury. More likely, millions of non-snorers, most of them women, are suffering silently. There they lie, red‑eyed and resentful, while their snoring partners register themselves on the Richter scale.
The fact that I snore is made more likely because of my sex. “Men are more likely to snore or have sleep apnoea than women,” says Pavol Surda, a consultant ENT surgeon based at London Bridge hospital. “This is because men have a larger space at the back of their throats as they tend to have larger airways. When we relax, our tongue falls back and fills this space, but the bigger the gap, the more likely it is you will snore.
“Moreover, males tend to have a higher proportion of fat around the neck, in soft palate and the upper part of the tongue, whereas women tend to have greater fat deposition in the lower part of the airway. This is likely dictated by the levels of testosterone. Studies showed that females with overproduction of male hormones are four times more likely to snore.” Oestrogen and progesterone also provide protection against snoring and sleep apnoea. Male hormones not so much.
So, to review: men are more likely to snore than women because of their fatter necks and bigger holes at the back of their throats in which their tongues nocturnally loll with potentially disruptive effects for bed partners. Unless I’ve misconstrued the data, heterosexual prenuptial agreements should therefore include clauses about optimal neck fatness in men.
But it’s not just my sex that matters when it comes to snoring. My wife has noticed my snoring has got louder in recent years. Surda explains why: “As we age, our tongue and throat muscles begin to relax and weaken, which can limit our airflow, causing us to snore.” I’m now 59; in a few years my tongue and throat muscles will, you’d think, be as helpless as a kitten up a tree. Which is grounds for divorce in my book. There is another option: “You can practise mouth and throat exercises to strengthen these muscles, which may help to reduce your snoring.” Way ahead of you, doctor: I already play the clarinet, which makes me quite the formidable kisser.
I’ve assiduously performed some throat exercises I found online. I’ve said each vowel out loud for three minutes a few times a day as if in obeisance to some invisible Henry Higgins. I’ve placed the tip of my tongue behind my top front teeth and, for three minutes a day, slid the tongue backwards. I’ve closed my mouth and pursed my lips, holding the pose for 30 seconds.
I’ve even opened my mouth and moved my lower jaw to the right and held the pose for 30 seconds, and repeated the exercise on the left. I recommend you don’t do this on public transport. Again, with my mouth open, I’ve contracted the muscle at the back of my throat, all the while looking in a mirror to see my uvula bobbing up and down. Who needs Netflix? All very entertaining. But despite these exercises, I still snored. Could anything cure me?
My dad was a big snorer. This may not mean that my snoring is inherited. Once, he told me, he awoke on a train to find all the other passengers cowering at the other end of the compartment because of the incredible racket he was making. This, you may say, sounds fanciful, but you never heard him snore. One night, while he snored in an armchair, my mother – furious at the noise – crept behind him with a pair of scissors. She cut off his Bobby Charlton comb-over, a long thread of hair that measured more than 12 inches and, until it was (rightly) nipped, had been known to flap unbecomingly in the Midlands breeze. He was furious, like Black Country version of Samson to my mother’s Delilah. But, to be fair to my mother, you snooze, you lose. What’s more, when my dad snored in bed, it was my mother who would get up in the night and crash in the spare room. She self-banished, which seems unfair.
Both my parents are dead, so I will never know if my dad’s snoring was accompanied by twitching, but mine certainly is. It has lacerated sheets, creeped out my wife and makes me feel ashamed when in the morning I learn what I’ve been doing. What is going on? “Snoring and sleep apnoea can cause periodic limb movement during sleep (PLMS), which is involuntary twitching of the lower legs or ankles while you’re asleep,” Surda says. “This is because snoring can cause these movements as part of the arousal process, which is when there is a change in brainwave activity as we shift from a deep to light sleep stage.” How sad: I remember when a night-time arousal process meant something different.
Why, my wife wonders, don’t snorers wake themselves up? Why do they wake everybody else up nearby but not themselves? Is it because they’re selfish? It is, isn’t it? “When we sleep, we can still hear, but our decision-making processes are different from when we are awake and our brain filters out sounds that aren’t important, letting us sleep through background noise,” Surda explains. “People do wake up from particularly loud snores, but this will only be for a brief moment before going back to a deep sleep.” Put that way, I sound quite the selfish clod.
The number of snoring victims – most, I suspect, women – has risen considerably since 1975 because, Surda points out, since that year the worldwide level of obesity has nearly tripled. “Generally speaking, it might be said that our stressful, busy lifestyles, which can have a negative on the quality of sleep, have made snoring more and more common. Stressed people often rely on unhealthy lifestyles to cope, such as overeating. Obesity can mean that we hold an increased level of fat in our neck, which restricts our airways and can lead to snoring.”
For a long time, I’ve struggled to sort out my snoring problem. Like millions of others, I’m not sure what to do. I’m not especially overweight, not unusually stressed and I have no problem sleeping – I’m not sure what’s wrong with me but I really want to overcome the problem. That said, I’ve balked at some remedies. My brother-in-law wears a continuous positive airway pressure (Cpap) machine at night to reduce the impact of his sleep apnoea. But I am not at all convinced I have sleep apnoea (a disorder in which breathing repeatedly stops and starts at night and whose symptoms include feeling tired after a good night’s sleep). Moreover, the Cpap machine costs nearly £500 and the acronym worries me. It’s one diagonal line from being a Crap machine, and nobody wants that. Plus, even though it supplies much-needed nocturnal oxygen, it looks ridiculous.
Instead, I’ve experimented with lots of other remedies. The first involved sleeping on my side. “Sleeping on your back can cause you to snore, and so laying on your side is always advised for a better night’s sleep,” counsels Surda. “Laying a pillow or wedge behind you can be a good prompt for your body to remain in that position, if you tend to move or roll over a lot in your sleep.” Easier said than done: I would start sleeping on my side, but within a few hours be on my back again, pillows notwithstanding, snoring loudly until my wife shook me awake. Also, the sleeping-on-the-side remedy became untenable when I had another problem associated with getting older: last year, I had an eye operation for a detached retina that required I sleep face down. As a result I spent several nights snoring loudly into the mattress. Not a good look. Or indeed a good sound. On the plus side, my eyesight recovered even if my snoring, if anything, got worse.
On YouTube, there is a channel called Asian Zen Lullabies that promises not just to solve sleep problems but also to stop those who fall asleep to its soothing sounds from snoring. It didn’t work for me. But then again, I have no trouble falling asleep, be it to a soundtrack of Napalm Death or Radio 3’s Night Tracks. I’ve even recorded myself snoring and played that back at bedtime. It put me right to sleep, but did it stop me snoring? Have a guess.
I also tried menthol strips that you place on the roof of your mouth before you fall asleep. The idea is they dissolve as you doze, open up the air passageways and stop one snoring. But for the minty fresh breath, I might just as well have poured the money down the toilet.
I tried £18.50 plastic nostril inserts, carefully adjusting them in my nose last thing at night, and washing the mucus from them each morning. These nasal dilators are hailed by Cannon for reducing the incidence of snoring by 75%. Sadly, I’m in the incorrigible 25% and my wife is very much not among the 73% of users’ partners who reported a reduction in snoring severity. Nor did the £19.95 Rhynil anti-snoring throat spray work for me, despite boasting astringent properties from some rare leaves that purportedly help reduce palatal flutter.
I even filled in a questionnaire by the British Snoring and Sleep Apnoea Association. No, I don’t smoke. Yes, my BMI is higher post-lockdown, but whose isn’t? I scarcely drink alcohol. I exercise regularly. Yes, I do have a beard. Hold on. What has a beard got to do with it? The only answer I’ve been able to find is that some snoring men grow beards to conceal weak or double chins. Both of these anatomical variants increases the odds of having sleep apnoea. My beard, more like George Michael stubble than Darwin’s, was not grown to hide these shortcomings.
The findings of this questionnaire? I don’t have nasal abnormalities, I don’t grind my teeth and I sometimes sleep with my mouth slightly open. I should lose a little weight. Plus, finally, a diagnosis. “Your snoring is most likely caused by a vibration at the base of the tongue and mouth breathing during sleep.” The solution? Purchasing a Tomed SomnoGuard 3 for £47.99. “This new version of the simple one-piece boil and bite Mandibular Advancement Device (MAD) … ” goes the blurb. What now?
And yet I bought one, put it in boiled water like a sachet of cod and parsley sauce from the 1970s, then placed it in my mouth, like a boxer before the bell rings. Then I moved my lower jaw 5mm forwards as instructed, bit down hard and pressed the plastic firmly against my teeth to create a custom-moulded fit. The aim? To move the jaw forward to open up partially closed airways and stop me snoring. The result? In the mirror, I looked more neanderthal than ever. Oh yes, and I still snore.
By this point I was imagining that I would spend the rest of my life alone on the sofa bed when, after a nearly two-year wait, I was finally given an appointment at the hospital’s sleep clinic where they promised to do what they could to save my marriage. To that end, a nurse gave me a monitoring device rather like a wrist-based fitness tracker to sleep with overnight. While I slept it measured brainwaves, as well as muscle and breathing activity.
Twelve weeks after wearing this device for one night and returning it to hospital, a letter arrived. It informed me that: my AHI was 0.6 per hour, ODI 0.9 per hour, RDI 5.7 per hour, snore index 1.7%, mean SpO2 97% and my Epworth score 9/24. I obviously had no idea what any of this meant and so went online to find out.
AHI, which stands for apnoea-hypopnoea index, shows how often my breathing stops and starts while asleep for 10 seconds or longer (apnoeas); a hypopnoea is a partial loss of breath for 10 seconds or longer). RDI stands for respiratory disturbance index, which, like the AHI, measures apnoeas and hypopnoea, but in addition, measures lower-level breathing disruptions in sleep called respiratory-effort related arousals, which aren’t as sexy as they sound. ODI means oxygen desaturation index and measures how many times an hour oxygen levels fall below a baseline, while SpO2 also measures how much oxygen there is in your blood. Oxygen levels fall during sleep because of interrupted breathing. The snore index is the number of snore events per hour. At 1.7% that doesn’t sound as though I snore very often, but, of course, as I sleep blissfully through these snore events and am completely unaware of how the racket is giving my wife and anyone else in earshot the nocturnal pip, I’m not fit to judge on the intensity of those events. One paper I read tells me the snoring can reach 100 decibels and prolonged exposure can damage hearing.
When I finally get an appointment with a respiratory consultant to explain all this data, Dr Nikesh Devani says that the snore index measures volume rather than intensity of snoring, adding that it wouldn’t surprise him if it were 45 decibels, which is roughly the volume of traffic. “That’s very loud and very disturbing for anybody nearby,” he says. He tells me I do not suffer from sleep apnoea, nor was there evidence of sleep-disordered breathing. The Epworth score, he explains, is based on a questionnaire I filled in asking in which situations I might nod off (watching telly, reading, at the wheel of a car stuck in traffic, etc). The ranking of 9 suggests I have an average amount of sleepiness. If it were above 16, I should seek medical attention (though, you’d think, I should probably get someone else to drive me to hospital).
This is all good news but what would you recommend I do to remedy the problem, I ask Dr Devani. “A mandibular splint,” he replies. And what’s that? “It’s a bit like a gum shield that you attach to your teeth after boiling it .” I tell him I’ve tried it and it didn’t work. “Well, it’s really worth persevering for more than one or two nights,” he says. “They really do work because they push your lower jaw forward and stop your windpipe collapsing and causing obstructed breathing. Wearing something at night to achieve that is really key. ”
There’s also a new device on the market that intrigues Devani and his colleagues. The eXciteOSA is unusual in that it’s a device you wear during the day to stop snoring at night. It electronically stimulates your lolling tongue and collapsing windpipe, ostensibly to retrain you physiologically not to snore at night. Test data done by the manufacturers looks promising, Devani says, but so far there’s not enough for the NHS to warrant recommending it.
I check out eXciteOSA’s website, already predisposed against it because of the otiose capitalised X. It looks rather like an electronic version of those throat exercises that had me pronouncing vowels like a latter-day Eliza Doolittle. “Tired of sleeping alone?” asks the website. You’d better believe I am. There’s a picture of a distinguished grey-haired man reading Wallpaper* magazine while a gizmo that looks like a cat’s extended tongue dangles goofily from his mouth. Behind him in a living room devoted to what looks like minimalist Danish design is a glamorous woman, presumably his life partner. She is smiling, presumably not just because she’s married to a silver fox but for the first time in years is getting eight hours’ uninterrupted sleep a night.
This, Wallpaper* notwithstanding, is very much the image of domestic felicity I’m looking forward to enjoying. I am tempted into ordering an eXciteOSA – until I discover it retails at £540.
Instead, I dust off the SomnoGuard 3 for another try. After five nights of wearing it, I wake myself up snoring. Clearly it doesn’t work for me.
In despair, I order another device from a website Devani mentioned. I opt for another mandibular splint; the Stop Snoring Mouthpiece, at £44.99, costs less than a 10th of the price of the eXciteORA. Perhaps it was the series of Zzzzs spiralling from the company logo that tempted me. More likely it was the 30-day money back guarantee if the device doesn’t stop my snoring.
When this mouthguard arrives, it looks and feels in the mouth exactly the same as the SomnoGuard 3, but instead of boiling it to fit my mouth, I just pop it in at night. I’ve absolutely no idea why it works better than the SomnoGuard 3, but, for two weeks now, it has. I’m back sleeping with my wife in the proper bed, and no longer disrupting her sleeping with my snoring, though the device hardly makes me look like love’s young dream. It makes all but rudimentary kissing tricky. While my wife slept the other night, I lay awake wondering if this is how it is going to be for the rest of our marriage. Perhaps. The prospect is not so appalling.
And it sure beats the sofa bed.
July 16, 2022 at 02:56PM Stuart Jeffries