Staying Motivated with SnoreGym

Staying Motivated With SnoreGym

Lifestyle, Mouth exercises | Nov 1, 2019
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If you have downloaded SnoreGym, congratulations! You have just unlocked a new exercise regime that could very well stop your snoring.

But …

We’ve all been there, starting out a new healthy habit with the best of intentions only for it to become neglected and eventually fizzle out into nothing. Whether it’s the gym in January or some other new-year-new-you resolution, new things are hard to stick to!

So what are the best ways to stay motivated with your new exercise regime?

1. Let SnoreGym remind you

Sometimes, despite our best intentions we simply forget. New routines are hard to establish so it is perfectly normal to forget to slot in those exercises when you meant to.

So, let us take care of that.

Helpfully, SnoreGym has a reminders feature. You can set as many reminders as you want and tailor them to repeat on certain days of the week at any time you please. SnoreGym will give you a little notification, letting you know that it’s time to exercise!

2. Set goals

New routines can be hard to maintain if you don’t know what you are aiming for.

With SnoreGym the ultimate goal is fairly obvious – to stop snoring. Whilst mouth exercises certainly have the capacity to do this, it could take a while. Therefore it is a good idea to set some intermediate goals to keep yourself motivated.

Intermediate goals are a great way of breaking up a big task into smaller, more manageable chunks. Firstly, set a goal for time spent exercising. We recommend doing at least 2 workouts or 10 minutes per day, but you can adapt this to suit you.

Being able to tick these boxes every day is a great motivator. SnoreGym will also let you know how long your daily streak is, and also if you are achieving your set goals.

Yes, our thumbs up, medals and trophies we present aren’t going to change your world, they’re a handy nudge to let you know that you’re well on track!

3. Routine and regularity

For a task to become habit, it needs to be regular and part of a daily routine. Exercises done religiously, every day at 8pm are far more likely to be stuck to than randomly exercising when you feel up to it or when you have a spare 5 minutes.

We believe a great technique to get SnoreGym to become part of your routine is to stick it on to another routine – toothbrushing! Most of us brush our teeth for a few minutes at least twice a day at pretty consistent times and for a set period of time. Simply extend it for another 5 minutes and mouth exercises will be as normal as brushing your teeth. The added benefit of a mirror to check you’re doing them right will ensure you get the most from your workout.

4. Involve others

We’re not going to sugar-coat it; you will probably look a bit silly when you do SnoreGym’s workouts. So why on Earth would you want to involve anyone else? With more conventional exercises it’s understandable; going for a run with someone else is arguably more enjoyable and motivating than doing it alone.

It’s not the most glamorous form of exercise, but the same applies for SnoreGym’s workouts. We share a lot with our nearest and dearest, so why not share these workouts? Especially given that they have the potential to greatly benefit each other’s sleep.

5. Track your progress

A single 5 minute workout isn’t going to change anything. However, 5 minute workouts, done twice a day, every day for several weeks could definitely. And it’s important to see that change if you are to stay motivated.

SnoreGym’s calendar view shows you the days you’ve exercised and how much of your target you are achieving. But those values are arbitrary and a bit abstract. We want to know if it’s improving your snoring. That’s where our sister app, SnoreLab, comes in!

SnoreLab records your snoring and gives you a Snore Score at the end of the night. This score is based on how often you were snoring and at what volumes. SnoreLab allows you to tag various remedies and factors to see how they influence your snoring. If you’ve achieved your SnoreGym goal for the day, be sure to tag it in SnoreLab.

Over time, SnoreLab should start to show a downward trend in your snoring – the best motivator possible.

6. Deal with excuses

Not only do you need to lose the excuses not to exercise, it’s important to create excuses to exercise.

Instead of focussing on the negatives that prevent you from exercising, try to think of the positives if you do exercise.

The sense of achievement, getting a step closer to your goal and even noticing changes in your snoring and sleep quality – these positive motivators should be enough to help you banish the negative excuses.

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Men vs. Women - Who Snores More?

Men vs. Women – Who Snores More?

About Snoring, Science | Oct 25, 2019
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Do men snore more than women? The short answer to this question is yes. There are sex differences when it comes to snoring. But there’s a little bit more to it than that.

Type “snoring” into a search engine and click on images. What do you see? Nine of the fifteen pictures on my screen showed men with mouths wide open whilst unfortunate women wrenched pillows over their ears to block out the sound. It’s a cliché, but one that is based on some truth.

Twice as many men snore than women, with roughly 40% of men reporting snoring versus 20% of women. That still means that 840 million women are regular snorers. Snoring is certainly not just a male problem, but there are differences. Let’s explore why and how.

Men’s airways are primed for snoring

The reason more men snore is partly down to their airway anatomy. Studies have found that there are crucial differences in the structure of men’s airways.

More soft tissue

Firstly, there’s more tissue in the noise makers themselves. Studies indicate that the male soft palate – a key player in generating snoring sounds – has a larger cross-sectional area. There’s basically more tissue available to flap around and make noise [1].

Male upper airway collapses more

Secondly, men’s upper airways are more prone to obstruction. The vulnerable area between the hard palate and epiglottis is larger in men. This means there is a greater amount of unsupported soft tissue that will relax whilst asleep [2].

Side note:

It is important to note that this has nothing to do with men having deeper voices. Whilst men’s vocal folds are indeed longer, they have more structural support and reside lower than the collapsible area associated with snoring. The area below the roof of your mouth and above the epiglottis is the soft, flappy area we are interested in.

Men gain fat on the neck

Finally, men put weight on the areas that can cause snoring. The chance of your airway collapsing is increased if there is more weight on your neck. An increased neck size and fat around the neck therefore puts you at greater risk of snoring.

We know that obesity is a great risk factor in snoring, but men and women distribute fat differently which influences snoring patterns. Men put on more weight around their neck and chest, whereas women tend to gain fat on their thighs, hips and buttocks.

Snoring is linked to male hormones

Testosterone is the main male sex hormone. Its primary duty is the maintenance and development of reproductive tissue, but it also plays a part in snoring.

Side note: what are hormones?

Hormones are produced in various glands and are the body’s chemical messengers. They travel in the blood and are a means of communication between different areas of the body, regulating the inner workings of cells.

Various studies have looked into the effects of testosterone on breathing during sleep, with a focus on sleep apnea. It has been linked to increased airway collapsibility and greater breathing instability, though the exact mechanism is still uncertain [3].

Indeed, raised testosterone in women is linked to disturbed breathing during sleep. Women with polycystic ovarian syndrome, a condition where testosterone levels are higher than they should be in women, have a greater risk of developing obstructive sleep apnea [4].

Female hormones protect from snoring

Whilst male sex hormones increase the chance of snoring, female sex hormones have a protective effect.

Steady ventilation

Progesterone, a hormone particularly high during pregnancy, promotes steady ventilation. This causes a less pronounced drop in airflow during sleep and makes the soft airway less prone to collapse [5].

Less relaxed tongue

Progesterone, alongside another key female hormone, estrogen, enhances the ability of a key muscle in the tongue to contract, reducing the likelihood of it falling back and causing a blockage [6].

Menopause increases the likelihood of snoring

As female sex hormones decline rapidly at the menopause, the likelihood of developing snoring or sleep apnea increases.

Incidence of snoring increases with age for both sexes, but in women, the onset of the menopause is a watershed moment when it comes to snoring and sleep apnea.

Artificially re-introducing female sex hormones via hormone replacement therapy (HRT) has been shown to reduce the occurrence of sleep apnea [4].

Obstructive Sleep Apnea is different between men and women

Sleep apnea is less common than habitual snoring but the relative proportions of men and women are roughly the same, with twice as many men suffering from the condition as women. However, eight times more men are diagnosed [7].

Some time ago, the sleep apnea ratio of men to women was thought to be as stark as 60:1. We are learning now that this is because of frequent misdiagnosis and the fact that women often exhibit an atypical form of the condition.

The severity of sleep apnea is measured by counting the number of instances where breathing stops (apnea) or is severely reduced (hypopnea). This measurement is called the apnea-hypopnea index (AHI). As women are less likely to experience complete airway collapse, they tend to have a lower AHI score.

Importantly, these women aren’t necessarily experiencing less obstruction. Women display more frequent episodes of longer, partial obstruction that still causes the fatigue, sleepiness and health issues associated with OSA.

Conclusion

With snoring, as with many dysfunctions in the body, there are things that are out of our control. Our sex is obviously the main one. Seeing where you fit into the profile of the 2 billion people worldwide who snore can help you understand your snoring better and be ready to take the next steps.

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References

  1. Lin CM, et al. Gender Differences in Obstructive Sleep Apnea and Treatment Implications. Sleep Medicine Reviews 2008; 12(6): 481-496. https://www.ncbi.nlm.nih.gov/pubmed/18951050
  2. Malhotra A, et al. The Male Predisposition to Pharyngeal Collapse: Importance of Airway Length. American Journal of Respiratory and Critical Care Medicine 2002; 155(10): 1388-1395. https://www.ncbi.nlm.nih.gov/pubmed/12421747
  3. Andersen ML & Tufik S. The effects of testosterone of sleep and sleep-disordered breathing in men: Its bidirectional interaction with erectile function. Sleep Medicine Reviews 2008; 12: 365-379. https://doi.org/10.1016/j.smrv.2007.12.003
  4. Bixler EO, et al. Prevalence of Sleep-disordered Breathing in Women: Effects of Gender. American Journal of Respiratory and Critical Care Medicine 2001; 163(3): 608-613. https://doi.org/10.1164/ajrccm.163.3.9911064
  5. Saaresranta T, et al. Sleep disordered breathing: is it different for females? European Respiratory Journal, Open Research 2015; 1(2): 00063-2015. https://dx.doi.org/10.1183%2F23120541.00063-2015
  6. Popovic RM & White DP. Upper airway muscle activity in normal women: influence of hormonal status. Journal of Applied Physiology 1998; 84: 1055-1062. https://doi.org/10.1152/jappl.1998.84.3.1055
  7. Hines J. 2018. Women with Sleep Apnea: Why Women are Less Often Diagnosed with OSA. [ONLINE] Available at: http://www.alaskasleep.com/blog/women-with-sleep-apnea-why-women-are-less-often-diagnosed-with-osa [Accessed 16 August 2018].


Is Snoring Genetic?

Is Snoring Genetic?

Science | 23 Oct, 2019
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Is snoring genetic? Questions in life rarely have a definitive answer, and this is no exception. Here, the answer is an unsatisfying “yes and no”. There is a genetic connection, but not a direct cause.

Your DNA can increase the risk of snoring but won’t condemn you to a certain life of nocturnal noises.

My family snores. Am I doomed?

Multiple studies have found that coming from a family of snorers confers a 3-fold increased risk of snoring yourself [1]. This is due to a number of different inherited features but there is no such thing as a “snoring gene”.

There is also some research to suggest that an increased risk of obstructive sleep apnea can be inherited [2].

But fear not – if your whole family snores, whilst you may have to work a little harder to make sure that you don’t, you are far from doomed!

What heritable traits can make you snore?

Cranio-facial features

A predisposition for snoring can come from certain structural features in your face and airways.

Physical characteristics like your eye colour, height and skin tone are inherited from your parents. The same is true of the features that can make you snore.

The usual anatomical culprits for snoring are:

  • Small nostrils
  • Receded chin (known as retrognathia)
  • Small jaw (known as micrognathia)
  • Narrow airway
  • Large tongue
  • Large soft palate

All of these factors decrease the size of your airway and disrupt airflow therefore making snoring more likely.

If your snoring can be attributed to a distinct anatomical feature, it can usually be helped with standard anti-snoring remedies. Sometimes, if the abnormality is particularly pronounced, corrective surgery could be a solution.

Weight

scales showing overweight

Obesity is a key risk factor in snoring and obstructive sleep apnea.

Basically, the heavier you are, the more likely you are to snore.

Less clear is how much your genes are to blame. In some cases, yes, being overweight does seem to run in families, but it is the subject of much debate as to whether this is the result of nature or nurture.

The likely answer is, again, probably somewhere in the middle …

Physiological factors that dictate weight can indeed be inherited genetically. Appetite is regulated by a system of hormones and signals in the body which are ultimately controlled by a series of underlying genes.

On the other hand, attitudes to food, diet and weight are learned from the behaviours and views of the people around us. This can include our family or simply the society and culture we live in.

Conclusion

There are lots of factors that influence snoring, and it would appear that your DNA is one of them. It’s important to remember that this is only an influence and not a sentence to an eternity of snoring.

So if your mum and dad compete for the best (or worst) Snore Score, you need not worry. You can’t control your genes, but you can control a lot of other factors that contribute to your snoring. Try to understand your triggers and the solutions that work for you.

If you don’t know where to start, have a look at SnoreLab’s 7 recommended lifestyle factors that can make huge differences to your snoring.

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References

  1. Jennum P, et al. Snoring, family history, and genetic markers in men. The Copenhagen Male Study. Chest 1995; 107(5): 1289-1293. https://www.ncbi.nlm.nih.gov/pubmed/7750320
  2. Cade BE, et al. Genetic associations with obstructive sleep apnea traits in Hispanic/Latino Americans. American Journal of Respiratory Critical Care Medicine 2016; 194: 886–897. PMC5074655


How to Cope with a Snoring Partner

How to Cope with a Snoring Partner

Lifestyle | 22 Oct, 2019
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Snoree, innocent by-snorer, passive snorer. There are many names, but to you, it really it doesn’t matter what you’re called when all you want is a bit of peace.

If you’re losing sleep because of your partner’s snoring, there are some things you can do to help yourself and help them. Here, we look at the significance of sleeping with a snorer and explore the ways you can stop the snoring or at least cope better!

Jump to tactics to deal with a partner’s snoring

Sleeping with a snorer

The dangers of sleep deprivation

You probably don’t need to be told that sleeping with a snorer has massive implications for your sleep quality. Having disturbed sleep isn’t pleasant and isn’t very healthy.

The mental impairment from moderate sleep deprivation equates to the effects of mild alcohol intoxication.

Over a longer period, chronic sleep debt can do irreversible damage to the brain and the rest of the body. Multiple studies have shown that getting less than six hours of sleep per night significantly increases the chance of an early death. This is due to an increased likelihood of a host of maladies:

  • Stroke
  • Anxiety and depression
  • Dementia
  • Weight gain
  • Heart disease
  • Reduced immunity
  • Cancer

When you consider that sleep deprivation is closely linked to weight gain, and that weight gain facilitates snoring, one could even speculate that snoring is in-fact contagious!

The impact of snoring upon relationships

Living with snoring doesn’t just mean disrupted sleep but can entail a disrupted relationship too.

Conflicts can easily arise as a result of snoring, conjuring feelings of guilt and resentment, doing damage to your emotional and physical intimacy.

Some sources even cite snoring as the third leading cause of divorce in some countries [1]. One study in Australia reported that snoring was the sole cause of marriage breakdown in 50 of 300 women surveyed [2].

Tactics for partners of snorers – solving the problem

Snoring is not a life sentence for the snorer or the snoree. It has a cause and therefore has a solution too. Whilst the onus is mostly on the snorer, you already share the burden so why not share the solutions? These can often be approached as a couple …

Identify the problem

Make sure your partner knows that their snoring is a problem for you. If they are to stop snoring, they’re going to have to make some changes, but won’t do so if they don’t think their snoring is an issue.

Share lifestyle solutions

There are a number of lifestyle changes that can be adopted to help reduce snoring naturally. Engaging in these together can have benefits not only for the snoring, but for your relationship too.

If body weight is playing a part in your partner’s snoring, get involved in those things that can help them to lose weight. Show some solidarity with them by eating healthily, planning and cooking meals together, and by doing exercise you both enjoy.

Mouth exercises are another great way to tackle snoring for many people. It can sometimes feel a bit strange and silly doing them on your own, so why not make it more entertaining by doing them together?

Prop

Sleeping position is often factor in people’s snoring, as supine sleeping (on the back) massively increases the risk of snoring.

“Poke, nudge and roll” is a useful tactic in the short term, but soon enough, if it’s your partners preferred position, they will end up sleeping on their back again. And so the process repeats.

There are devices available for snorers to wear which look like a backpack to stop them rolling onto their backs, as well as some pillows to help keep them on their side.

Alternatively, you can instead address your shared sleeping position. Try sleeping back-to-back, propping each other onto your sides so that your partner can’t roll onto their back.

Observe

Two heads are better than one. Sometimes, the cause of snoring isn’t obvious and requires more investigation. With a fresh perspective as the snoree, you can help your partner to identify the cause of their snoring and find the things that really work.

Have you noticed a recent change in your partner’s snoring? Has this coincided with any behaviour or health changes? As the non-snorer, you are in the unique position of being able to see and hear the differences that the snorer may be oblivious to.

Tactics for partners of snorers – coping with the problem

If the solutions aren’t working and you just need some more sleep, there are ways to cope with the snoring without actually reducing the volume …

Get a head start

If you take a while to fall asleep, head to bed slightly earlier than your partner. Given that a snorer doesn’t wake themselves when they snore, then why should they wake you if you’re already fast asleep?

Unfortunately, this tactic is unlikely to work every time. The cyclical nature of sleep means you are still likely to catch the snoring sound during one of your lighter sleep phases. Nonetheless, it should at least prevent the “as soon as his head hits the pillow, he’s snoring” complaint.

Sleep separately

This is a solution that many couples cite as the saviour of their marriage. You’ll frequently hear accounts from couples who have slept separately for years due to someone’s snoring.
Whilst this solution is great for your health through banishing the snoring sound and getting some sleep, co-sleeping is still important for the health of a relationship.

In his book “Two in Bed: the Social System of Couple Bed Sharing”, sleep researcher Paul Rosenblatt examined how sharing a bed is important for couples. He described the importance of bed sharing for intimacy and comfort, as well as pre-sleep being a time that couples use to catch up, plan, make decisions and solve problems [3].

That said, and as many snoring couples will tell you, sleeping separately doesn’t necessarily mean the end of these benefits. Set aside that same time to enjoy each other’s company, before eventually doing the sleeping part in separate rooms.

Earplugs

Basic but effective, a good set of earplugs specifically designed for sleep can be indispensable for the partner of a snorer.

A simple multipack of foam earplugs will do the trick, but also shop around for ones that are sleep-specific: soft and comfortable when laid upon, and with properties that allow you to still hear your alarm in the morning.

White noise machines

Introducing more sound to a room plagued with snoring seems counter-intuitive, but there is some sense in using white noise to mask snoring.

White noise is a sound that contains all audible frequencies at the same intensity – similar to the notion of white light.

This doesn’t block the snoring sound, but instead masks it as the snoring frequencies blend in with the frequencies coming from the white noise machine. By playing this consistent sound before sleep, you are less likely to notice sudden changes to the sound profile of your room throughout the night.

Change how you perceive the snoring

“You can’t stop the waves, but you can learn to surf.”

In short, if you can’t stop the snoring, learn to cope with it. This quote comes from Jon Kabat Zinn, a medical professor who teaches mindfulness.

The mindfulness approach puts the onus on the snoree and is about changing the way you perceive your partner’s snoring. Try to emotionally detach from the snoring sound and instead treat it like your own personal soundscape.

There have been many accounts from frustrated partners who, instead of letting the snoring sounds irritate them, used it as a source of meditation and mindfulness. They objectively listened to the sounds, accepted them and lost no sleep as a result.

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References

  1. Wiseman R. Night School: The Life-Changing Science of Sleep. MacMillan, London 2014. p144
  2. Dilkes M and Adams A. Stop snoring the easy way and the real reasons you need to. Hachette UK 2017.
  3. Rosenblatt PC. Two in Bed: the Social System of Couple Bed Sharing. State University of New York Press: Albany, NY, 2006.


What is Sleep Apnea?

What is Sleep Apnea?

Sleep Apnea | Oct 19, 2019
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Apnea simply means “no breathing”. Sleep apnea is a serious condition where your airway repeatedly closes during sleep, depriving you of oxygen until you gasp awake. It is normal for a snorer to wonder what sleep apnea is and if they are at risk.

It is a common misconception that all loud snorers have sleep apnea, but if you think you do, ask yourself or your partner if you have any of the following:

  • Loud snoring with periodic silence and choking/gasping
  • Sore throat or headaches in the morning
  • Excessive sleepiness in the daytime
  • Lack of concentration
  • Behavioural changes and mood swings

Snoring, especially loud snoring, puts you at risk of developing sleep apnea later on – as good a reason as any to address your snoring now.

Side note: obstructive vs. central sleep apnea

Sleep apnea comes in two forms; the obstructive condition is linked to snoring as there is an airway blockage. The other type, central sleep apnea, is due to a fault in the brain’s regulation of breathing – this type is not linked to snoring. All subsequent references to sleep apnea refer to the obstructive form.

How does sleep apnea differ from normal snoring?

The key difference between snoring and sleep apnea is whether or not you are breathing.

When you produce a snoring sound, you are breathing; air must be travelling through your airways and into your lungs, albeit a bit bumpily. Noise from snoring is bothersome but the more worrying event is when the sound suddenly stops – now you aren’t breathing.

Here, snoring has made the serious transition to obstructive sleep apnea.

“Is it snoring or sleep apnea?” – Read the full article

Thankfully your body has a mechanism to kick-start breathing again. When it stops for too long, the amount of oxygen in the blood drops and carbon dioxide rises; your brain recognizes this dangerous situation. A fizz of brain activity briefly wakes your body up, often with a gasp or snort. Muscles in your neck open the airways so air can get back into the lungs.

Sadly, when you go back to sleep, this process of obstruction, low oxygen and awakening repeats itself again and again.

Why is sleep apnea dangerous?

Sleep apnea is harmful because repeated oxygen debt and fitful sleep every night takes its toll on your body [1]. During the low oxygen events, your heart is having to work harder. This increases blood pressure which damages your arteries, thickening their walls and increasing the likelihood of:

  • Heart problems including angina, heart failure and heart attacks
  • Stroke
  • Diabetes
  • Impotence

These physical problems are only made worse by disturbed sleep. A lack of sleep also has detrimental effects on your day-to-day mental functioning. Many people experience:

  • Low energy
  • Daytime sleepiness
  • Worsened reaction times
  • Poor memory

Beyond the sufferer, sleep apnea impacts upon society too. At work, persistent tiredness shrinks productivity and means more days taken off sick [2].

On the road, studies have found that people with sleep apnea are twelve times more likely to be involved in road traffic accidents. Some countries now make it mandatory to inform the driver registration authorities if you are diagnosed with sleep apnea [3].

What can put you at risk of sleep apnea?

Snorers are not necessarily suffering from sleep apnea, but the risks associated with each are closely aligned. The things that make you more likely to develop sleep apnea mirror the risk factors for snoring:

Identifying potential sleep apnea

There are some important things to watch out for if you suspect you have sleep apnea:

  • Very loud snoring, with periodic silence and gasping
  • Headaches or a sore throat in the morning
  • Being excessively sleepy in the day
  • Lack of concentration
  • Mood swings and behavioral changes

Despite continuously waking during the night, sufferers don’t usually realize it themselves. Many people assume that the fatigue they are experiencing is a symptom of age so fail to seek help. Instead, partners of those with the condition are more likely to spot their sleep apnea.

How does sleep apnea severity vary?

The severity of your condition can be assessed by counting how many times you experience low-oxygen events. This helps to generate an AHI score, the apnea-hypopnea index. This measures the apnea or hypopnea episodes per hour of sleep:

  • Apnea episode – complete airflow blockage for at least ten seconds
  • Hypopnea episode – at least 50% reduction in airflow for at least ten seconds

Your AHI score relates to the severity of sleep apnea:

  • 0-5 events per hour – normal
  • 5-15 events per hour – mild sleep apnea
  • 15-30 events per hour – moderate sleep apnea
  • 30+ events per hour – severe sleep apnea

Your score is very important when deciding on the best way to treat your sleep apnea. Mild to moderate cases can be addressed with normal snoring reduction techniques and consumer remedies. If you have a severe case, continuous positive airway pressure devices (CPAP) are the most effective form of treatment.

Conclusion

It is important to know that relatively benign snoring can make a dangerous transition to obstructive sleep apnea. This is a serious condition where your airway repeatedly closes during sleep, briefly depriving you of oxygen until you gasp awake.

Low oxygen events and continuous poor sleep can have serious repercussions on both your physical and mental wellbeing.

The same things that cause snoring put you at risk of sleep apnea. Some people even consider loud snoring to be the first stage of “sub-clinical” sleep apnea. Importantly, up to 95% of people with sleep apnea snore [4], but not everyone who snores has the condition. Understand your risk and know how to spot the signs so you don’t make the switch.

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References

  1. Dempsey JA et al. Pathophysiology of Sleep Apnea. American Physiological Society 2010; 90(1): 47-112. https://doi.org/10.1152/physrev.00043.2008
  2. Dilkes M and Adams A. Stop snoring the easy way and the real reasons you need to. Hachette UK 2017.
  3. Wiseman R. Night School: The Life-Changing Science of Sleep. MacMillan London 2014. P144
  4. Nimrod M and Hanly PJ. Does snoring intensity correlate with the severity of obstructive sleep apnea? Journal of Clinical Sleep Medicine 2010; 6(5): 475-478. https://www.ncbi.nlm.nih.gov/pubmed/20957849


The Science Behind SnoreGym

The Science Behind SnoreGym

Mouth Exercises, Science | Oct 20, 2019
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Researchers have found evidence to show that performing mouth exercises can reduce snoring and sleep apnea, improve deep sleep and give more rest to bed partners. SnoreGym’s exercises are based upon the routines detailed in a number of scientific papers. This post is a summary of those papers.  

Introduction

Snoring occurs when the muscles in your upper airway relax, restricting airflow which in turn causes these tissues to vibrate and make sound.

Conventional snoring remedies treat the symptom, not the cause. Whilst they may stop the sound in the short term, they don’t address the root of the problem – weak muscles in the airway.

Increasing volumes of research are highlighting that snorers don’t need to be committed to a snoring remedy that they switch on or wear for the rest of their lives, but rather, they can incorporate inexpensive and effective techniques into their daily lives to stop snoring without artificial assistance.

Using techniques adapted from speech and language therapy, various research groups have employed the use of a set of oropharyngeal exercises which address weaknesses and develop muscular tone in the tongue, soft palate, throat, cheeks and jaw. This is with a view to reducing snoring, decreasing the severity of sleep apnea, mitigating disturbance of bed partners and producing better sleep and quality of life [1].

In this article, we summarise their findings.

Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome – Guimaraes et al, 2009 [2]

Overview of study

Kátia Guimaraes is a speech and language therapist from Brazil and is one of the first people to propose that oropharyngeal exercises can produce positive outcomes for obstructive sleep apnea [3].

This study uses an exercise regime that has become the basis for many subsequent experiments (though now, usually somewhat redacted). It is the first of its kind, has a robust design and is the most extensive.

Study design

Patients selected for the study met the following criteria:

  • Aged 25-65
  • BMI under 40
  • Previous diagnosis of moderate obstructive sleep apnea (AHI 15-30) via a sleep study

Guimaraes and colleagues designed a randomised-controlled trial. This means that as well as getting some patients to perform the prescribed exercises under scrutiny, another group of patients were given “sham therapy” and nasal irrigation as a control. The sham therapy consisted of simple deep breathing exercises and had to be performed with the same frequency as the study group’s exercises. This is a similar concept to a placebo in a drug trial.

The study group

The study group of sixteen patients were given a set of exercises designed to work out a variety of muscles. These exercises included:

  • Tongue brushing
  • Sliding tip of the tongue back along hard palate
  • Sucking tongue against roof of the mouth
  • Forcing tongue down into the floor of the mouth whilst the tip stays in contact with the lower front teeth
  • Pursing lips
  • Sucking movements with the cheek
  • Using cheek muscles to pull against a finger
  • Elevation of soft palate

These exercises were repeated daily including a once weekly supervised session with a speech pathologist. The duration of the study was three months.

In addition to the exercises themselves, patients also supplemented their therapy with bilateral chewing (using both sides of the mouth to chew) with a focus on correct tongue, teeth and lip positioning.

Patients in both groups underwent a sleep study before starting their treatment and again after the three months. Polysomnography was conducted by professionals blind to the group allocation of the patients.

The patients in both groups also used the Epworth Sleepiness Scale (0-24) and answered questions about perceived snoring frequency and intensity (0-4).

Results

The findings from PSG comparisons before and after are as follows:

  • There were significant decreases in the severity of sleep apnea in the study group.
  • Average AHI in the study group significantly decreased from 22.4 to 13.7 – a 39% reduction.
  • Average AHI in the control group showed a non-significant increase from 22.4 to 25.9.
  • 62.5% of study group patients shifted their severity classification from moderate obstructive sleep apnea to mild or none.
  • The lowest recorded oxygen saturations improved for the study group: 83% at baseline, 85% after 3 months.
  • The lowest recorded oxygen saturations worsened for the control group: 82% at baseline, 80% after 3 months.

In addition to the objective, quantifiable findings from PSG analysis, patients and their partners also answered a series of questionnaires about snoring frequency and intensity, and sleepiness:

  • In the study group, snoring frequency and intensity significantly decreased from 4 to 3 and 3 to 1 respectively (in the control group, there was no change in snoring frequency and intensity).
  • In the study group, the Epworth Sleepiness Scale score significantly decreased from 14±5 to 8±6 (in the control group, there was no change in sleepiness).

Effects of Oropharyngeal Exercises on Snoring – Ieto et al, 2015 [4]

Overview of study

This study looked at the influence of exercises on primary snoring as opposed to obstructive sleep apnea. The subjects were described as being “a population poorly evaluated by the scientific community […] composed of middle-aged and overweight patients who were disturbed by snoring, were on average not sleepy and did not present severe OSA”. In short, unlike much of the research into sleep-disordered breathing, this research assesses the “normal snorers”.

There are fewer exercises in this study than used by Guimaraes et al [2], and the 5 exercises used in this study form the basis of subsequent work. Importantly, this study shows that big workout sessions weren’t necessary to have a positive effect. 3 short sets of exercises every day for 3 months was shown to reduce snoring.

Study design

Patients selected for the study met the following criteria:

  • Aged 33-59
  • BMI under 40
  • Complaints of primary snoring with recent diagnosis confirming such, or of mild-moderate obstructive sleep apnea (AHI 5-30)

Ieto and her team used a control group (20 subjects) as well as a therapy group (19 subjects). Each group was randomly allocated. The study duration was 3 months.

The patients underwent polysomnography at baseline and after the 3 months to objectively measure snoring. This was done by creating a “snore index” which assessed the number of times per hour the patient broke a threshold of 38 db.

Subjects also answered questions on sleepiness using the Epworth Sleepiness Scale and sleep quality using the Pittsburgh Sleep Quality Index before and after the study.

A set of 5 exercises were performed three times a day, each session taking roughly 8 minutes):

  • Push the tip of the tongue against the hard palate and slide backwards – repeat 20 times.
  • Suck the tongue upward against the hard palate and press – repeat 20 times.
  • Force the bottom of the tongue against the floor of the mouth whilst the tip maintains contact with the lower incisors – repeat 20 times.
  • Elevate soft palate and uvula whilst saying “ah” – repeat 20 times.
  • Use cheek muscles to pull against finger – repeat 10 times on each side.

In addition to these exercises, when eating, subjects were told to alternate bilateral chewing and swallowing pushing the tongue into the hard palate.

The control group performed a “sham therapy” of deep-breathing exercises as well as wearing nasal strips during sleep and performing nasal irrigation 3 times per day.

Results

Objectively measured snoring using the snoring index did not change for the control group but showed a significant decrease in the treatment group:

  • Frequency of snoring reduced by 36%
  • Total power of snoring reduced by 59%
  • The objective snoring reduction was corroborated by a significant subjective decrease in the perception of snoring by bed partners.

Whilst not the primary focus of this study, a decrease in average AHI was also observed for the small subset of snorers (8 subjects) recently diagnosed with moderate OSA from an average AHI of 25.4 to 18.1 (a reduction of 29%).


Oropharyngeal exercises in the treatment of obstructive sleep apnoea – Verma et al, 2016 [5]

Overview of study

Another study with its primary focus on obstructive sleep apnea, this study stands out due to the findings beyond snoring, particularly on sleepiness and sleep quality.

The types of exercise in this study are more extensive and require a greater investment of time and effort.

Study design

As a case report, this study has a less robust design as it is missing a control group who don’t receive the intervention under investigation.

20 patients with mild to moderate obstructive sleep apnea (AHI 5-30) were given a rigorous set of oropharyngeal exercises. These exercises were split into 3 grades of difficulty, with patients stepping up a grade for every month of the 3 month study. Each exercise had to be repeated for 10 reps, 5 times per day.

The Epworth Sleepiness Scale, subjective snoring questionnaires and full PSG were performed at baseline and after 3 months.

Results

After the three month trial, the researchers found the following:

  • 85% of patients in the study showed a significant reduction in sleepiness.
  • Patients spent on 1.6 hours in deep sleep, compared to 0.97 at baseline – a 65% increase.
  • The average snoring as measured on the snoring intensity scale (0-4, lowest to highest) decreased significantly from 2.8 to 1.7.
  • Significantly less time was spent at oxygen saturations below 90%.

The effects of oropharyngeal-lingual exercises in patients with primary snoring – Nemati et al, 2015 [6]

Overview of study

Similar to the study conducted by Ieto et al, this study addressed the effect of exercises on primary snoring – not obstructive sleep apnea.

In addition to their explorations of the impact on snoring intensity and frequency, Nemati and colleagues also took the interesting step to look at the psychological and emotional impacts of snoring – assessing the relationship between changes in snoring intensities and conflicts had with roommates.

Study design

Interestingly, all measurements from this study were obtained from roommates of the snorer. 53 snorers were assessed before and after 3 months of soft palate, tongue and facial exercises totalling 30 minutes per day, at least 5 times per week. This was done by asking their roommates to report on the severity their snoring using a sliding scale of 0 (no snoring) to 10 (unbearable snoring).

In part due to the lack of a control group, this study describes itself as “semi-experimental”. That said, a sample size of 53 is good.

Results

Before versus after the exercise intervention:

  • Average snoring severity significantly decreased from 7.01 to 3.09 – a 56% reduction.
  • This reduction in the severity of snoring had a significant relationship the number of conflicts with roommates.

The role of oral myofunctional therapy in managing patients with mild to moderate obstructive sleep apnea – Baz et al, 2012 [7]

This prospective study evaluated the effect of oropharyngeal exercises on 30 patients with mild to moderate obstructive sleep apnea.

The exercises – similar to those outlined by Guimaraes et al [2] – were conducted in twice weekly supervised sessions plus at home for 3-5 times a day for at least 10 minutes at a time.

After the three months of therapy, patients showed some very positive, statistically significant changes:

  • 47% of patients reported not snoring any more.
  • Only 40% (compared to 100% at baseline) reported still experiencing excessive daytime sleepiness. This was reflected on the Epworth Sleepiness Scale with an average decrease from 16.4 to 9.27.
  • Average AHI reduced from 22.27 to 11.53.
  • Time spent at an oxygen saturation below 90% was halved.

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea – Diaferia et al, 2013 [8]

Speech and language therapy techniques underpin anti-snoring exercises. This study looked at the effectiveness of speech therapy in addition to the more conventional treatment of CPAP for obstructive sleep apnea.

In a nicely robust study design, there were four groups of similar sample sizes:

  • Speech therapy alone (n = 27)
  • Sham therapy alone (n = 24)
  • CPAP alone (n = 27)
  • Combination of CPAP with speech therapy (n = 22).

Speech therapy alone was shown to drastically reduce the average AHI for these patients (28.0 to 13.9). When supplemented with CPAP, the average reduction was even more marked, dropping from 30.4 (just over the “severe” threshold) to 3.4 (below the “mild” threshold).

In terms of sleepiness, speech therapy alone showed comparable results to using CPAP alone. The sham therapy control showed no difference in either sleepiness or AHI.


Other studies

The aforementioned studies have shown that a clearly defined set of exercises, repeated over time can produce very positive outcomes in terms of snoring reduction and reduction of sleep apnea severity amongst other facets like sleep quality and partner disturbance.

We believe this structured approach is ideal for working into your daily routine. However, the evidence extends beyond these sets of exercises.

Research groups have shown that you can work out your snoring muscles via other means. It could even be said that these earlier studies inspired the research into oropharyngeal exercises fo snoring. These techniques combat snoring via the same mechanisms as the prescribed exercises, so their findings are certainly worth a mention.

Can Singing Exercises Reduce Snoring? – Ojay and Ernst, 2000 [9]

Alise Ojay, a choir director, singer, composer and research fellow at the University of Exeter in the UK developed a series of singing exercises for a group of 20 snorers.

The group sung these songs for 20 minutes a day for three months. These songs weren’t the typical tunes you might hum to yourself, but were instead focussed on projecting strong vowel sounds with exaggerated mouth movements.

Ojay’s team saw significant improvements in the snoring of those who consistently sung. More in-depth studies have since confirmed Ojay’s findings, showing improvements in sleepiness, frequency and volume of snoring for a larger group of 93 patients in a recent randomised controlled trial [10].

Ojay continues to advocate singing as a therapy for snoring with her “Singing for Snorers” CDs.


Didgeridoo playing as an alternative treatment for obstructive sleep apnea syndrome – Puhan et al, 2006 [11]

In this small but well-known study, 25 patients with moderate obstructive sleep apnea (AHI 15-30) were randomised to 2 groups. The study group of 14 patients were given didgeridoo lessons for four months and told to practice regularly at home. The remaining 11 were left on a waiting list as a control.

Playing the didgeridoo is hard and requires strong mouth, tongue and throat muscles. A different and fun activity, adherence to the “treatment” was high, patients averaging 5.9 days a week of practice for 25.3 minutes per day.

Compared to the control group, the didgeridoo group showed on average less sleepiness (3 points less on the Epworth Sleepiness Scale), reduced OSA severity (reduced AHI score by 6.2) and disturbed the sleep of partners less.


Conclusion

The studies mentioned are the best examples of using oropharyngeal exercises to combat snoring and sleep apnea, but are non-exhaustive. There have been plenty of other case reports that have produced positive outcomes [1].

The studies in this article used the same time span of three months, and subtly varied the types of exercise and the time spent doing them. Despite this heterogeneity, the results are consistent and can be summarised as follows:

  • Oropharyngeal exercises reduce snoring both objectively and subjectively.
  • Exercises reduce the severity of obstructive sleep apnea, often changing the classification from moderate to mild or even none.
  • Subjective feelings of tiredness significantly reduce after consistently performing these exercises, with some studies objectively measuring greater time spent in deep sleep.
  • Partners report feeling less disturbed and conflicts arising from snoring reduce.

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References

  1. Macario C, et al. Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. Sleep 2015; 38(5): 669-675. https://www.ncbi.nlm.nih.gov/pubmed/25348130
  2. Guimaraes KC, et al. Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome. American Journal of Respiratory and Critical Care Medicine 2009; 179(10): 962-966. https://doi.org/10.1164/rccm.200806-981OC
  3. Guimaraes KC. Soft tissue changes of the oropharynx in patients with obstructive sleep apnea. J Bras Fonoaudiol 1999; 1: 69-75.
  4. Ieto V, et al. Effects of Oropharyngeal Exercises on Snoring. Chest 2015; 148(3): 683-691. https://pdfs.semanticscholar.org/36a8/e559e74d123e9f1087538ab1731f00a1ea84.pdf
  5. Verma RK, et al. Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience. Sleep & Breathing 2016; 20(4); 1193-1201. https://doi.org/10.1007/s11325-016-1332-1
  6. Nemati S, et al. The effects of oropharyngeal-lingual exercises in patients with primary snoring. European Archives of Oto-Rhino-Laryngology 2015; 272(4): 1027-1031. https://doi.org/10.1007/s00405-014-3382-y
  7. Baz H, et al. The role of oral myofunctional therapy in managing patients with mild to moderate obstructive sleep apnea. PAN Arab Journal of Rhinology 2012; 2(1): 17-22. http://www.academia.edu/12781370/The_role_of_oral_myofunctional_therapy_in_managing_patients_with_mild_to_moderate_obstructive_sleep_apnea
  8. Diaferia G, et al. Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea. Sleep Med 2013; 14: 628–35. http://www.sleepclinic.be/wp-content/uploads/Effect-of-speech-therapy-as-adjunct-treatment-to-continuous-positive-airway-pressure-on-the-quality-of-life-of-patients-with-obstructive-sleep-apnea.pdf
  9. Ojay A and Ernst E. Can Singing Exercises Reduce Snoring? A Pilot Study. Complementary Therapy Medicine 2000; 8: 151-156. https://doi.org/10.1054/ctim.2000.0376
  10. Hilton MP, et al. Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers – A Randomised Controlled Trial. International Journal of Otolaryngology and Head & Neck Surgery 2013; 2: 97-102. https://www.creativenz.govt.nz/assets/ckeditor/attachments/1086/singing_reduces_snoring_by_o_jay_and_ernst.pdf?1413517377
  11. Puhan MA, et al. Didgeridoo playing as an alternative treatment for obstructive sleep apnea syndrome: randomized controlled trial. British Medical Journal 2006; 332(7536): 266-270. https://www.ncbi.nlm.nih.gov/pubmed/16377643


What is Snoring?

What is Snoring?

About Snoring | Oct 21, 2019
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Snoring is the sound of partial airway obstruction which causes soft tissue to vibrate and make noise.

Nearly everyone snores at some point. Snoring can affect young and old, men and women, and people of all shapes and sizes. Roughly 40% of men and 20% of women snore – that’s over 2 billion inhabitants of planet Earth.

This habit is often shrugged off as annoying and embarrassing but otherwise nothing to be worried about. In reality, snoring can affect so much of life, having physical, mental and social repercussions.

But what is a snore?

Q. What is a snoring sound?

A. Vibrating soft tissue

Snoring is the sound of the soft palate and other soft tissue in the upper airway vibrating. This can include the uvula, tonsils, adenoids, nasal turbinates and other surrounding tissue.

These vibrations happen when air can’t move freely through your airway which causes the floppy soft tissue to flap and make noise.

Q. Why does snoring only happen during sleep?

A. Relaxation

When we fall asleep, many muscles in our body relax. This is true of the muscles in our airway.

Being still in our sleep prevents us from doing damage to ourselves and others by acting out our dreams or walking around when not fully conscious. Therefore our muscles – including those in our upper airway – are paralysed when we sleep.

Because we are lying down while we sleep, gravity compounds this relaxation to set up snoring – whether it’s your jaw falling open, your tongue falling back or your throat giving way to the weight around it.

All of us relax when we sleep – so why doesn’t everyone snore? Snoring occurs when this normal relaxation is added to abnormal airway obstruction.

Q. Why doesn’t air flow freely?

A. Obstruction at various places in the airway

Airflow becomes turbulent when there is an obstruction in the airway causing a partial blockage.

The obstruction can be in several areas in the upper airway, sometimes concurrently [1]:

Tongue. When this falls back, it can block your airway.

Soft palate. This is the soft tissue behind the harder roof of your mouth. Excess floppy tissue here stops air flowing freely.

Nose. The nose is the more efficient way of breathing, and when dysfunctional, mouth breathing ensues and heightens the risk of snoring. Breathing through a partially blocked nose can also create whistling and popping sounds, or even cause suction that collapses your airway.

Knowing your obstruction is the starting point in identifying what causes your snoring.

If you are lucky, there is one cause for your snoring. You can tackle this and sleep quietly. More often than not, multiple factors accumulate to cause your obstruction.

Q. What causes airway obstruction?

A. Many different factors can influence snoring

Understanding what causes your airway obstruction is vital for matching snoring solutions to you. This is what we strive to help with at SnoreLab.

The reasons for snoring are made of lifestyle factors that you can control PLUS physical traits that are beyond your influence.

Factors that you CAN control

Many lifestyle factors need scrutinising if you want to identify the causes of your snoring:

Bodyweight. The heavier you are, the more likely you are to snore as excess weight compresses your airway.

Sleeping position. Sleeping on your back is a big risk factor for snoring. This position allows gravity to compress your airway more than when you sleep on your side.

Allergies. Allergic reactions cause nasal blockage and airway inflammation. Allergy sufferers have trouble breathing through their nose and therefore have to switch to noisier mouth-breathing.

Alcohol. Depressant drugs like alcohol make muscles relax. Relaxed airway muscles are more prone to disrupting airflow.

Smoking. Cigarette smoke irritates the airways, causing inflammation which can lead to obstruction.

Common cold. Similar to allergies, colds mean stuffy noses and mouth-breathing.

Medication. Certain drugs used to control blood pressure, sleeping pills and even some medicated nasal sprays can increase nasal congestion and relax airway muscles.

Factors that you CAN’T control

Unfortunately, in some cases, the obstruction is simply a part of your anatomy and genes.

Certain face shapes predispose people to snoring. For example, those with a pronounced overbite have a recessed jaw which pushes the tongue further back into the airway, making it more prone to falling back and causing a blockage.

Age. Older people are more at risk of snoring. This is because as we age we lose muscle tone in much of our body – this includes the muscles of the airway.

Sex. Men are more likely to snore than women. This is due to several reasons including how fat is differently distributed, contrasts in male and female airway anatomy and hormones.

Hormonal balance. Some hormones are protective against snoring, whereas others confer heightened risk. Menopause is a time in many women’s lives where snoring starts for the first time. This is because of a decrease in hormones that help to prevent snoring.

Thankfully, these uncontrollable elements are usually associated with heightened risk but not a direct cause.

Conclusion

By understanding the basis of snoring you can gain better insight into what makes you snore. Just as snoring impacts upon your life, your lifestyle impacts upon your snoring.

There are many snoring remedies and solutions available, including products that enthusiastically tell you that this will stop you snoring. Many of them do work very effectively, but only if they are well matched to you and your snoring.

Understanding how your snoring works and finding your specific causes is the first step towards healthier, quieter nights.

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References

  1. Chokroverty S. 100 Questions & Answers About Sleep and Sleep Disorders. Jones & Barlett, Burlington 2007. p124


What are Mouth Exercises?

What are Mouth Exercises for Snoring?

Mouth Exercises | Oct 18, 2019
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Unlike conventional snoring remedies, mouth exercises treat the root cause of snoring – a weak upper airway. Anti-snoring mouth exercises can be of massive benefit to almost all snorers.

We know that getting some exercise can help us lose weight which is a great way to tackle snoring. Increasingly, we are seeing that exercise to help snoring needn’t involve running, cycling or swimming, or even breaking a sweat.

More people are turning to mouth, tongue and throat exercises to take control of their snoring and are seeing amazing results.

Jump to: five anti-snoring exercises that really work

How do these exercises work?

Snoring is caused by slack tissue in your airway increasing resistance to air passing through [1]. Anti-snoring exercises aim to tone up this slackened tissue, treating the root cause of snoring.

Low muscle tone causes snoring

Our tongues and muscles in the thoat naturally relax when we sleep. Snoring happens when this relaxation becomes too much and the tissues start to flap, or when the tongue falls back and its base obstructs airflow.

When these muscles are weak, the chance of snoring is much higher. Muscle tone diminishes with age which explains why older people are more likely to snore.

Exercises vs. snoring aids

Wearing various remedies can tighten this tissue or hold things in place. But to keep snoring away, you’ll always rely on these appliances.

Anti-snoring exercises tone these tissues, stop them collapsing and prevent them from flapping.

You can train yourself into sleeping more quietly without having to wear an anti-snoring appliance ever again!

There are snoring aids on the market with very little science to back them up. The same is not true for anti-snoring exercises. There’s plenty of evidence and it all looks rather encouraging [2].

The evidence – music lessons

In 2000, researchers investigated whether you could reduce snoring with singing. A drama therapist from the University of Exeter in the UK developed a series of singing exercises for a group of twenty snorers [3].

The group sung these songs for twenty minutes a day for three months. The singing they did wasn’t your typical tune you might hum to yourself, but focused more on projecting strong vowel sounds with big exaggerated mouth movements.

It sounds more like yodeling, is rather bizarre, but it works. Comparing the participants’ snoring recordings before and after the study, the researchers saw a big drop in snoring.

In a different study six years later, twenty-five patients with moderate obstructive sleep apnea were signed up for didgeridoo lessons. Fourteen received tuition and did practice at home every day for four months. The other eleven – the control group – were put on a waiting list and carried on as normal.

Playing the didgeridoo is hard and requires strong mouth, tongue and throat muscles. At the end of the four months, the group who played the instrument showed some promising results improvements to their snoring [4]:

  • They were less sleepy throughout the day.
  • Their sleep apnea episodes reduced. Patients had a lower apnea/hypopnea index, 6.2 points fewer than the control group.
  • Their partners reported feeling less disturbed at night.

The evidence – targeted exercises

Didgeridoos and didgeridoo teachers are not easy to come by, and not everybody wants to walk around yodeling. Researchers took the concepts of these practices and created a series of exercises that target the snoring muscles of the tongue, soft palate and throat.

Guimaraes et al

In 2009, a group of scientists in Brazil performed the largest snoring exercise study to date [5]. The study design was robust, randomizing thirty-one different patients with moderate obstructive sleep apnea into two groups.

Each group was under the impression that they were receiving an amazing new anti-snoring therapy (important to ensure that any improvements are not due to the “placebo effect”), but only 16 were given the anti-snoring exercises. The other fifteen were a control group, given “sham therapy” which entailed a series of breathing exercises.

Each group attended supervised sessions for thirty minutes once a week and were told to do their exercises every day at home too.

Whilst the control group did ineffectual deep breathing, the test group followed an exercise regime involving the tongue, soft palate and walls of the throat. Exercises involved sucking, swallowing, chewing, breathing and speaking.

After three months, those doing the exercises had markedly improved their sleep apnea. They:

  • Reduced the severity of their sleep apnea. AHI on average dropped by 39% compared to no change in the control group.
  • Snored less frequently and less loudly
  • Had better sleep quality
  • Experienced less sleepiness during the daytime
  • Had improved oxygen saturation during sleep apnea episodes

Other studies

Further studies highlighted that thirty minute sessions are long and realistically people were unlikely to do this under their own steam. Merely brushing our teeth twice a day for two minutes is something that one in four of us struggle with [6]!

Researchers started to focus on shorter regimes, using similar exercises but done in short sessions several times per day. These patients still significantly decreased their snoring volume by 60%, improved their sleep quality and made their partners feel less disturbed [7].

Overall, the studies have strongly shown that [2]:

  • Anti-snoring exercise therapy reduces sleep apnea severity by 50%.
  • Exercises also reduce normal snoring, both objectively and subjectively. Snorers’ partners feel less disturbed and both the frequency and volume of snoring is decreased.
  • Sleepiness improves with consistent anti-snoring exercises.
  • Exercise regimes needn’t be long. As little as forty minutes per week can have a positive impact.

Read our detailed summary of the research into oropharyngeal exercises for snoring

Five anti-snoring exercises that really work

One doctor, a massive advocate of anti-snoring exercises and the professed “patron saint of snorers” describes these exercises as yoga for your mouth with a focus on stretching and positional training [1].

The exercises favor quicker, sharp repetitions as opposed to long holds, which can instead add muscular bulk and make matters worse.

Different studies have used different techniques, but here are five of the key exercises that appear in most experiments and can really make a difference:

  1. Tongue curlers. With your mouth open, slide the tip of your tongue backwards along your hard palate as far back as it will go. Repeat 20 times.
  2. With an open mouth, press your tongue flat against the roof of your mouth and suck it upwards. Hold for 2 seconds and repeat 20 times.
  3. Force the back of your tongue against the floor of your mouth whilst the tip remains in contact with your lower front teeth. Again, you should do this with an open mouth.
  4. Pull your cheek out with your finger, use your cheek/mouth muscles to pull the finger back in.
  5. Elevate the back of your throat by sounding “aahh”. Once you get better at this exercise, you should be able to raise your uvula (the dangling part in the back of your throat) without making a sound.

You are unlikely to see instant results. These exercises are most effective when performed daily and stuck to over a period of time. Remember, you don’t need to spend ages on your routine, as little as eight minutes has shown to still be very effective [7].

To give yourself the best chance of success, set aside a time in the day to do these exercises. Also try to do them in private as you may look and feel a little strange. With some practice you will get better at the exercises and will start to notice the difference.

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References

  1. Dilkes M and Adams A. Stop snoring the easy way and the real reasons you need to. Hachette UK 2017.
  2. Macario C, et al. Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. Sleep 2015; 38(5): 669-675. https://doi.org/10.1007/s00405-017-4848-5
  3. Ojay A and Ernst E. Can Singing Exercises Reduce Snoring? A Pilot Study. Complementary Therapy Medicine 2000; 8: 151-156. https://doi.org/10.1054/ctim.2000.0376
  4. Puhan MA, et al. Didgeridoo playing as an alternative treatment for obstructive sleep apnea syndrome: randomized controlled trial. British Medical Journal 2006; 332(7536): 266-270. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/
  5. Guimaraes KC, et al. Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome. American Journal of Respiratory and Critical Care Medicine 2009; 179(10): 962-966. https://doi.org/10.1164/rccm.200806-981OC
  6. YouGov (2016). Consumer Oral Health Survey 2016. [online] Available at: http://www.denplan.co.uk/~/media/Denplan/files/pdfs/companies/2016/cam1788-consumer-oral-health-survey-2016_low-res.pdf [Accessed 23 Oct, 2018]
  7. Ieto V, et al. Effects of Oropharyngeal Exercises on Snoring. Chest 2015; 148(3): 683-691. https://doi.org/10.1378/chest.14-2953