Is a cure for snoring finally getting closer?

The Schnarchmuseums unusual collection traces humankinds millennia-long struggle to cure snoring a problem that still affects millions. But is science getting closer to solving it?

A steel cannonball sits on a shelf above a mannequin head whose mouth is covered in a thick leather muzzle-like mask. Although they resemble medieval torture devices, they were both once used to prevent snoring.

The mask and cannonball are part of the collection of the Schnarchmuseum in Alfeld, Germany, founded 17 years ago by sleep researcher and therapist Josef Wirth. He started collecting items brought to him by his clients. “They would say, ‘this has not worked for me’. I stored them and the collection grew. We are looking for new items all the time,” Wirth says.

Today, about 1,500 people come from around the world each year to see the museum. Wirth explains that the cannonball was used during the War of Independence in the US: soldiers who snored had it sewn into their uniforms to stop them sleeping on their backs. The 100-year-old mask next to it is designed to keep a snorer’s mouth shut while they sleep – which is no help if they snore through their nose.

The interest in Wirth’s project is unsurprising when you consider just how many people are affected by snoring, a phenomenon created by obstructed airflow during breathing, which causes parts of the respiratory system to vibrate. It can also be a sign of obstructive sleep apnea, which occurs when the throat muscles intermittently relax and block the airway during sleep.

A
A 100-year-old leather mask, designed to keep a snorer’s mouth shut. Photograph: Sarah Marsh

But despite the fact snoring has persisted for millennia, scientists have still not found a simple solution for the problem, which affects hundreds of millions of people. The British Snoring and Sleep Apnoea Association (BSSAA) estimates that about 41.5% of the population snores, while in the US recent data puts the figure at 44% of men and 28% of women.

“There will never be a quick-fix cure as there are so many reasons somebody would snore,” says Marianne Davey, director of the BSSAA. “Your snoring will not [have] the same cause as your next door neighbour, so we have to tailor treatment to each individual. Even then, the patient will have to work with the treatment in order to attain success in managing the snoring.”

Nowadays, the main treatments for snoring involve lifestyle changes, such as losing weight and avoiding alcohol, which is thought to narrow the airways. Decongestants and allergy medication can help if the cause of their problem is medical, while surgery is an option for those with a deviated septum, for example. Oral devices that can also sometimes be used, such as one that moves the jaw forward to help the flow of air.

Modern
Modern sleep masks, this time a variety of continuous positive airway pressure (CPAP) ventilators. Photograph: Sarah Marsh

Ideas about how to cure snoring were not all that different in ancient times. The Greeks and Romans knew over-eating and drinking meant you were more likely to snore; Dionysus, the Greek god of wine, was a well-documented perpetrator.

The Ebers Papyrus, an Egyptian medical papyrus of herbal knowledge dating to circa 1550 BC, recommended using thyme to reduce snoring. Indeed, snoring oils made from thyme and other herbs are still available today.

In modern history, technological advancements have meant that devices have gone from cumbersome to sleek. “Over time treatments for snoring have evolved and changed, but the principles have stayed the same,” says Rafael Pelayo, clinical professor at the Stanford Center for Sleep Science and Medicine.

One such device is an appliance that holds the tongue forward while the snorer sleeps. A comparable oral device has been around since 1953 but was made from metal rather than the more comfortable plastic now used.

Jaw-advancing devices have also benefited from technology, and are now normally made using a mould formed to each patient’s teeth and mouth shape. The oldest example in Wirth’s museum is 25 years old.

“They are very effective,” he says. “In recent years it got much more comfortable and you can change the [width]; it is not fixed like the older ones.”

Surgery for snoring has also improved, according to Pelayo. “It used to be that they would crush the bone out, but now they use radio waves to do it and it heals faster. Also allergy medication has got much better.”

Jaw-advancing
Jaw-advancing devices, which hold the tongue forward during sleep. These are usually made using a mould of the snorer’s mouth and teeth. Photograph: Sarah Marsh

The first surgery for snoring became widely available to the public in the UK in 1999, and snoring specialist Prof Bhik Kotecha says robotic surgery is increasingly used for sleep apnoea.

“This form of therapy is more aggressive; robotics lets you perform surgery more accurately and in regions more difficult to get to,” he says. “In the last half-decade we have also introduced upper airway stimulation, so if the tongue is trying to obstruct the windpipe we will stimulate a nerve that moves the tongue. It stops people holding their breath during sleep.”

Another device, the continuous positive airway pressure (CPAP) ventilator, has also evolved. Colin Sullivan, an Australian physician, invented the CPAP flow machine and nasal mask in 1980. The snoring museum has a kit from 1985, which looks more like an effort to create Frankenstein’s monster. Wirth explains that in 1985 CPAP kits weighed 35kg but now tip the scales at as little as 400g, making them portable and easy to use at home.

But the evolution of snoring treatments does not stop here, according to to Lawrence Epstein, former president of the American Academy of Sleep Medicine. “A device that stimulates the nerves that coordinate the muscles in the airways was recently approved. It is primarily used for obstructive sleep apnoea, as it requires surgical implantation similar to the one required for a pacemaker, but as this technology gets better it could be applied to snoring.”

Patient
Patient Michael English trying out some then revolutionary snoring equipment in 1986. Photograph: David Mansell/Getty Images

“The other major area that is being looked at is targeting specific factors that contribute to snoring. For instance, one might try to strengthen muscle stimulation when reduced neurological control leads to airway narrowing … So lots of work is being done to find individual solutions for the different contributors to the problem and when you isolate these issues you can tweak the different parts resulting in much more targeted therapy.”

Wirth, too, is optimistic about the future: “I believe that maybe 30 years from now more work will be done to look at snoring as a genetic problem. From my experience, if you have a parent who snores then the child tends to snore. So perhaps snoring will be solved if you can work out the genetic cause.”

He adds: “The main thing to take on is that now we are taking snoring much more seriously. 30 years ago no-one talked about it and now you hear about it in newspapers and on TV. There is more awareness of sleep apnoea, although more work must be done. But now we recognise that snoring may also be the beginning of a disease and so it is taken seriously, with more effort in finding solutions to it. I am optimistic that there will be innovation over the years – and maybe one day a cure.”

Read more: www.theguardian.com

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