Snoring treatment has been a major part of my clinical practice, as it can be an important social nuisance as well as a key reason people seek treatment for obstructive sleep apnea. Unfortunately, there has only been a limited amount of scientific research on snoring treatment. This has been due mainly to the difficulties of obtaining objective measurements of snoring, for two reasons:
- Sleep studies were not specifically designed for snoring assessment
- It is not practical (or covered by insurance) to get numerous sleep studies over time just to assess snoring (especially in patients without obstructive sleep apnea)
For decades, the typical approach was to ask patients to have others rate their snoring on a 0-10 scale before and then after treatments. I always laughed with patients that patients are sleeping and may not have someone else to provide feedback information, but this was all we had to judge results. Unfortunately, a few studies have shown that these ratings do not match up with objective measurement of snoring, raising the possibility of a placebo effect and, more importantly, making the subjective reports unreliable.
The emergence of smartphone apps designed to measure snoring, such as SnoreLab.I recommend this app often to my patients and use others to determine a baseline level of snoring and then monitor the response to various interventions, ranging from conservative measures like weight loss or sleeping on one’s side to procedures. For some patients who have snoring without obstructive sleep apnea or, in some cases, mild obstructive sleep apnea, an office procedure like palate radiofrequency (I use the Coblation technology) can produce results.
“Snoring Is in the Ear of the Beholder”
My experience with all treatment for snoring is that we often do not eliminate all snoring but can substantially improve loud snoring (called “Loud” or “Epic” snoring in the SnoreLab app). Whether that is enough benefit for a patient (and their bed partner) depends on many factors. What I will do before treatment is get a sense of the intensity and pattern of a patient’s snoring to determine, for example, if it is just these louder snoring sounds that disturb someone else. I heard a speaker make this statement, and so many of us in the audience could not agree more. In fact, it summarized my approach to the treatment of snoring, and I just wish I were clever enough to have come up with the statement.
Recent Research Makes Things a Little More Complicated
I was intrigued by an article published this month in the Journal of Clinical Sleep Medicine, the official publication of the American Academy of Sleep Medicine. A Spanish examined the SnoreLab results for a 30-day period of the first author (who did snore, it turned out) with simultaneous measurement using 3 different smartphones (Samsung Galaxy Alpha, BQ Aquaris V, and Xiami MI 8 Pro) that used different versions of the Android operating system. Interestingly, they showed substantial differences measured by the different smartphones in the “Snore Score”, amount of snoring, and proportions of different snoring loudness categories (including “Loud” and “Epic”). While there was a correlation between the scores and fairly-consistent results for the same smartphone over time, the differences between results from different smartphones were meaningful from the standpoint of treating patients, meaning that:
- If a patient changes their smartphone, it may not be possible to compare results from one smartphone with another (for example, to monitor treatment results)
- Research must consider these differences in examining outcomes, including the fact that we cannot simply add results together for different patients
Similar variability has been shown with other apps and with smartphones using Apple’s iOS operating system, so I do not mean to criticize a specific app or software package. My goal is really to highlight some of the challenges of objective measurement of snoring and of conducting research related to snoring. In the meantime, I will continue offering a wide range of snoring treatment options and performing procedures only in those patients where the available research and my own experience indicate that they are specifically good candidates.