When I was just eight years old, my family relocated to a small town in North Dakota. The transition was jarring, especially as we were squeezed into a two-bedroom apartment while our new home was being constructed. My sisters and I grumbled about sharing a room, but that was not the most troubling aspect. Every night around 2 a.m., when my dad finally dozed off in front of the television, the entire apartment vibrated with his thunderous snores.

Initially, his snoring began softly, resembling a low rumble with each breath. But as he relaxed, the sound deepened, transforming into a powerful roar, coupled with sputtering and choking noises once he entered the REM stage. He would snore through the night, the rhythmic sound interspersed with alarming silences. On occasions when the silence extended beyond a few seconds, my older sister would hover over him, anxious he might stop breathing altogether. For six months, he was the sole occupant of the apartment enjoying any semblance of sleep, albeit not very restful.

Snoring is prevalent, yet it is not considered normal.

Most of us have encountered a snorer, and many of us have been one ourselves. Approximately half of the population snores at some point, with men (57%) being more frequent offenders than women (40%). Even children are affected, with 27% reported to snore. Snoring can be temporary, caused by colds or allergies, or it may occur in specific sleeping positions, such as lying on one’s back. Factors like excessive alcohol consumption or sedatives can also contribute. Weight gain is another common cause, along with various upper respiratory obstructions, including enlarged tonsils or adenoids and a deviated septum.

Snoring reaches its peak volume during the deepest sleep stages, when muscle tone is at its lowest. While the average snorer produces noise levels ranging from 60 decibels (similar to a normal conversation) to 80 decibels (akin to New York City traffic), the record for the loudest snorer belongs to a British grandmother, whose snores reached an astonishing 111.6 decibels—the equivalent of a jet engine.

Snoring serves as an annoying alert that something may be amiss.

Air should ideally flow in and out of the nose quietly. However, when the airway to the lungs is obstructed, the surrounding soft tissue vibrates. This obstruction can occur in various locations: the nose, back of the nose (nasopharynx), mouth (tongue), or throat/neck. The larger the blockage, the more effort required to breathe, resulting in louder snores. The vibrating tissues usually comprise the nasopharynx, soft palate, uvula (the small structure at the back of the throat), throat, or a combination of these. Identifying the exact source of the sound is often complicated, making effective treatment challenging.

While snoring alone does not indicate sleep apnea, it can signal potential issues. A sleep study is the most reliable method for diagnosis, with options ranging from at-home tests to more comprehensive evaluations in sleep labs. Neither method is flawless, but they can determine how frequently breathing stops and whether adequate oxygen levels are maintained. Sleep apnea can lead to serious health complications, including heart disease, hypertension, and diabetes.

From an evolutionary perspective, snoring appears counterintuitive. In the wild, the last thing one would want is to alert a nearby predator to their presence. However, humans often live in groups, theoretically providing mutual protection. One researcher suggested that snoring might keep others in the group in a state of readiness for potential threats. While this is an intriguing theory, my sleep-deprived sisters and I would likely disagree.

Snoring remedies: ranging from the desperate to the bizarre.

Ironically, unlike many medical conditions, those who snore are often unaware of their issue, as they are asleep. Typically, they find out through complaints from loved ones. Even then, many delay seeking help unless prompted (divorce was considered a viable solution as recently as the 1970s) due to the unappealing nature of treatments. Despite centuries of snoring issues, a straightforward solution remains elusive, yet that hasn't deterred attempts.

You might assume that the modern surge of devices indicates snoring is a contemporary problem. However, the Schnarchen Museum in Germany reveals that the earliest recorded snorer was Dionysus in 460 BC, likely a consequence of his drinking. His snoring was reportedly managed by being poked throughout the night with his thyrsus rod (most likely by a nymph). Even prior to Dionysus, ancient Egyptians utilized thyme as a remedy, a practice that continues in certain snoring oils today.

While surgical interventions are a more recent development in the U.S., they have been practiced in Morocco for centuries. Traditionally, infants had their uvulas removed to enhance speech and breastfeeding, simultaneously preventing the enlargement of tonsils and adenoids that could obstruct breathing. This method was also common among healers in various African tribes to ward off throat and lung infections.

Less invasive methods were employed during the U.S. Revolutionary War, where cannonballs were sewn into the uniforms of noisy sleepers to discourage them from rolling onto their backs. By 1900, this was replaced with a star-shaped metal object strapped to the snorer's back. More subtly, marbles were sewn into the backs of nightshirts to remind wearers to avoid sleeping on their backs, and one physician even suggested a soft collar to maintain neck extension during sleep. If only it were that straightforward.

By the late 1800s, inventors turned their focus to the source. The first oral device was created by Otto Frank, leading to various models made of metal or stiff leather designed to pull the tongue forward. These contraptions resembled props from a Ryan Murphy production more than medical devices and were equally ineffective. Subsequently, chin straps were introduced, wrapping around the head to keep the mouth closed.

By the 1950s, surgical solutions gained traction. Early operations aimed at removing soft palate tissue to tighten it and reduce its tendency to vibrate. The 1960s saw surgeons adopting Moroccan techniques, excising the uvula, which merely altered the snore's pitch without addressing the issue.

In 1970, physicians recognized that some snorers exhibited more severe symptoms, including excessive daytime sleepiness and hypertension. They determined that effective treatment required a more drastic approach, involving a tracheotomy to create a direct airway in the neck. Understandably, this was not well-received by patients. In some instances, removing tonsils and/or adenoids or performing turbinate reduction was sufficient.

Around the same period, Japanese surgeons pioneered a surgery known as uvulopalatopharyngoplasty (UPPP), which involved removing the tonsils and uvula while stitching the soft palate together. While this procedure is still performed today, it comes with a painful recovery and does not always prevent snoring.

Once sleep apnea was diagnosed in the 1980s, treatment evolved beyond merely silencing the disruptive noise. Procedures like UPPP and other aggressive surgeries that aimed to prevent tissue collapse in the throat gained popularity in the U.S. One such operation involves cutting and repositioning a segment of the chin bone to prevent the tongue from falling back during sleep (mandibular osteotomy with genioglossal advancement). Some surgeons resort to burning the base of the tongue to create scar tissue (radiofrequency ablation). The list of surgical interventions is extensive and quite graphic.

Less invasive yet equally extreme techniques have also been explored, such as implanting "pillars" in the soft palate, using radiofrequency to burn the palate, or injecting a scar-inducing agent to tighten it.

In 1975, Continuous Positive Airway Pressure (CPAP) was adapted for treating snorers with sleep apnea. These machines force air into the nose and/or mouth with enough pressure to overcome any obstructions. Early CPAP machines were bulky and noisy, but advancements have led to quieter, more portable versions. The initial masks were cumbersome; a plaster mold of the snorer's face was used to create a fiberglass mask with tubes protruding from it. Before bed, the user had to affix the mask to their entire face with silicone adhesive. Today, masks have become more streamlined, available in three types: for the nose, mouth, or both. However, they remain challenging to wear.

For those unwilling to endure the "horrible machine," a plethora of alternative options exists.

Dentists have developed oral appliances designed to slightly advance the jaw, preventing the tongue from falling back into the throat. Over 500 types of custom appliances are available. For those unable to afford the pricier options, numerous over-the-counter alternatives exist, though they may cause jaw discomfort and misalign teeth if improperly fitted.

Disposable options include Breathe Right strips to widen the nostrils externally, silicone inserts that prop the nostrils open internally, and nasal vents that create pressure to keep the airway open. The comfort level of these devices is questionable.

Wedge pillows can elevate the head during sleep, while the Hypoglossal nerve stimulator, a small device implanted under the clavicle, stimulates the tongue and chest muscles.

Among the more unconventional remedies are Snore Stop Spray and antisnoring chin straps. A recent popular product, Sleep Strips, essentially tape that keeps the mouth shut, has received positive feedback online. However, as an ENT specialist, I find the idea of sealing the mouth alarming. Ideally, we should breathe through our noses; mouth-breathing occurs only when nasal passages are blocked. Taping the mouth shut is akin to disabling a smoke alarm instead of extinguishing a fire—it may reduce the noise but could worsen breathing difficulties.

I am certain there are numerous other devices I have overlooked, but one thing is clear: the search for a definitive snoring cure is far from over.