You're lying in bed, waiting. Here it comes - the same familiar sound. It's the low growl of a bear. Pause. There it is again. You look up at the clock. It's 4am. You calculate: how much longer will you have to sleep before you have to get out of bed?

Sure, people tease and joke about snoring. But it's a very serious matter that can cause problems for the snorer and family members. Fortunately, doctors have a number of cutting-edge answers for snorers, including many outpatient treatments.

"Snoring is not a cosmetic problem. It not only disrupts the snorer's sleep, but their partner's sleep. The partner of a snorer can get one to two less hours of sleep a night so everyone is tired the next morning. Snoring is also one of the main warning signs of a more significant problem, sleep apnoea," says Dr Nicole Maronian, assistant professor of otolaryngology at the University of Washington School of Medicine.

Sleep apnoea occurs when a person stops breathing during sleep. This can occur many times during the night and, if undetected, will affect the person's health.

One of the first things a doctor will do is examine someone for sleep apnoea. The doctor will review the results of an examination, a medical history and a sleep questionnaire. If what the person has is plain ol' snoring, many treatments are available.

A doctor may first recommend lifestyle changes. Since flabby tissues pressing on the airway can cause snoring, doctors recommend weight loss, healthy eating habits, and general body toning. They also recommend people avoid alcohol four hours before bed and heavy meals or snacks for three hours before bed.

Snorers should also sleep on their side rather than their back, to improve the airway flow, and can try tilting the head of their bed upwards by about four inches.

If these don't work, there are many kinds of surgery available. Procedures seek to open up the airway by reducing obstruction in whatever area is causing problems for a particular snorer. Some people have a floppy uvula - that thing that looks like a teardrop hanging from the back of your mouth. Other people have swollen tissues in their nose. Other people may have a tongue that's moving too far back during sleep. And still other folks have a combination of two or all of these.

It wasn't that long ago that people had to stay in the hospital to have a piece of uvula or something else removed. Today, most surgeries are done during outpatient visits. One surgery is laser-assisted uvulopalatoplasty known by a slightly catchier name, LAUP - that can be completed with a local anaesthetic in three or four short clinic sessions. The doctor uses the laser to shorten the uvula and tighten floppy tissue by making small cuts.

You can get similar results through a newer kind of outpatient surgery, with another eye-popping name: radiofrequency tissue reduction (RFTR), or Somnoplasty.

The machine uses a tiny needle electrode placed in the uvula, nose tissues or tongue, to emit small, very concentrated bursts of radiofrequency current. This creates a burn pocket, roughly the size of a little fingernail. As the tissue scars, it contracts. This shrinks the tissue that's been obstructing the airway. No obstruction no snoring.

Because doctors do only a small area at a time, it often takes two or three treatments - roughly eight weeks apart - before someone feels cured.

RFTR is a low-key procedure: after the treatment involving a local anaesthetic, patients can go back to whatever they were doing before their office visit. They need take only over-the-counter painkillers.

To get more information about the various alternatives for snorers, check with an otolaryngologist. "Snoring that disrupts your sleep or your partner's sleep may be very amenable to office-based treatment options," says Dr Maronian.

Health Beat, University of Washington

Date reviewed: 13 March 2000