Snoring (Adult)

Reassurance – Snoring is very common complaint and rarely represents a serious problem provided there are no red flag symptoms, though can be socially challenging. After consideration of the risks and benefits the ENT Scotland will no longer offer surgery for simple snoring.

Identify those with likely OSA (obstructive sleep apnoea) and perform an Epworth score as well as BMI and refer as below.

• Lifestyle changes
  • Weight loss if overweight (BMI over 28)
  • Stop smoking
  • Avoid alcohol in the evenings
  • Avoid sleeping on back
  • Ear plugs for partner
• Treatment
  • Mandibular advancement Device (refer to Dr Paul Sharma at NHS Fife; orthodontist)
  • Nasal dilation (strips/clips) ( available over the counter)
  • Nasal saline douches +/- steroid spray
  • Consider stopping sedative medication
  • CPAP – the recommended treatment for sleep apnoea, can also be effective for habitual snoring (not available on the NHS).

Patients with >11 Epworth sleepiness scale or witnessed apnoeas should be referred to respiratory sleep team for investigation of OSA.

Red flag symptoms requiring urgent assessment by ENT

• Sudden onset persistent snoring (No past history of any form of snoring at all)
• Associated SOBOE, Dysphagia, persistent hoarseness.

Management in secondary care

• As above currently we do not offer surgical intervention for simple snoring.
• There is a complex airway service established and surgical treatments maybe offered for the management of snoring in carefully selected cases.
  • Referral can be made to this via the sleep clinic.

NHS patient leaflet snoring

• Online Epworth scoring system
• British Thoracic Society sleep page
• Treatment options for snoring and sleep apnoea
• British snoring website