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Dental India

When the snoring has to stop.....

Dentists may have the answer to the nightmare of noisy sleepers, says Christine Doyle

HELP is at hand for those who snore with the force of a revving motorcycle -
and for their distracted bedfellows and flatmates who try to blot out the din
with earplugs

Dentists are being trained to fit mouth guards, which are said to eliminate or
significantly reduce the explosive noises in up to 80 per cent of snorers.
Recently, the British Dental Association held its first anti-snoring workshop
to teach dentists more about the causes and treatment of snoring and how to
select the right guard for each patient.

Dr Jacinta Yeo, the London dentist who ran the workshop, says: "For several years,
a few dentists have been trying out the mouth guards with their patients, but most
dentists do not know how to fit them or get the best out of the laboratory
technicians who custom-make the devices.

"We felt it was time to make a simple solution to snoring more widely known.
Mouth guards are comfortable to wear and can help many heavy snorers.
They are very popular in America."

Karen Roth, 28, a dental nurse, heard about the mouth guard two years ago.
"I thought I might as well try it, and have worn one called Silensor every night
since. It has certainly done the trick. I am not a thunderous snorer -
I don't think I could be, as I am quite tiny - but my boyfriend used to make
pointed remarks in the morning and he worried about not getting a good night's sleep.

"I don't know why I snore, but it runs in my family. My mother and grandmother are
both lifelong snorers."

Snoring is caused by air travelling rapidly through an obstructed airway, setting
up vibrations in the soft palate, tonsils and uvula - the dangly bit at the back of
the throat. The mouth guard, which Roth puts into her mouth before falling asleep,
is designed to pull and hold the lower jaw forward. This creates space in the throat
and prevents the back of the tongue and soft throat tissue collapsing and blocking
the airway.

At between 500 and 800, the anti-snoring guards are no giveaway, but their
introduction could transform lives, says Dr Yeo. Around 30 per cent of women and
40 per cent of men snore. One professional woman, whose high-decibel roars were
beginning to threaten her marriage, realised just how loud they were only when
she heard fellow delegates at an overnight work conference complain they had been
kept awake all night by snoring. She was mortified.

John Bennett, 36, a senior marketing director, says he was once woken by a stewardess
on a night flight because he was keeping everyone else awake. The woman with whom
he lives has found it difficult to be tolerant.

"John sent off for every gadget you can think of," says Angela Harvey. "He's tried
nose-clips and pillows and I even sewed a tennis ball into his pyjamas to stop him
rolling on to his back. Ear plugs did not blot out the noise and often I felt forced
to sleep downstairs."

After being fitted with a mouth guard called the Thornton Adjustible Positioner,
or Tap, Bennett was astonished by the difference. "From the first night, I no longer
felt sleepy during the day." The change was so instant, says Harvey, and the silence
so eerie, that she used to check that he was still breathing.

Bennett also has sleep apnoea, a condition in which the airway is so obstructed that
the sufferer intermittently stops breathing. This can happen regularly during the night
for around 10 seconds at a time and, in very severe cases, last up to 40 seconds,
many times an hour. Sufferers jerk awake with unnerving grunts and gasps when oxygen
in the brain dips to a low level.

Frank Govan, chairman of the British Sleep Apnoea Trust and a sufferer himself, says
the condition affects about four in every 1,000 people and can be life-threatening.
In extreme cases, the dips in oxygen lead to irregular heart beat, high blood pressure
and as much as 20 times the average risk of a heart attack.

The BDA points out that most people with sleep apnoea snore, but not all snorers have
sleep apnoea. "It is important for dentists to make the distinction and to work in
conjuction with a sleep clinic where specialists can identify the anatomical cause
and degree of blockage."

People with severe sleep apnoea sometimes wear a mask which pushes oxygen into the
lungs under slightly raised pressure. This works, but there are people who find the
masks cumbersome and claustrophobic and who are converting to mouth guards.
A study being carried out at the Churchill Hospital, Oxford, suggests the mouth guard
will be helpful for heavy snorers and people with light to moderate apnoea, but less
so for those with severe sleep apnoea.

Mouth guards have three basic designs. One lifts the soft palate up, but some people
find this makes them gag. Another holds the tongue forward, which is useful if you
have no natural teeth. Most common are those, like the Silensor, that pull the lower
jaw forward, and these have a high success rate.

Maria Sergides, a dentist in Carshalton Beeches, says her patients get used to these
quickly. She began to recommend them after trying one out on her father. "He kept us
all awake, but now the household is peaceful."

Roth says: "Your mouth feels a little strange, a bit stretched for a minute or so in
the morning, but this soon wears off."

They are definitely not romantic: "It's best not to make a big deal out of it. Not
everyone likes wearing one, but I think they work well."

Some snorers may also be able to help themselves by trying to cut out some
pre-disposing factors - being overweight, eating large meals late at night,
drinking too much beer and using sleeping pills. But for some people,
none of these are influences. "Look at me," Roth says. "Who would expect a size
eight to snore?"