A study published in Sleep, “Heavy snoring as a cause of carotid artery atherosclerosis” should alert all health professionals and concerned family members about the dangers of snoring. Snoring has always been a major warning sign of sleep apnea that can result in six-fold increases in heart attacks and stokes and in one eight year study patients with untreated sleep apnea had a 36 % decrease in survival. Disturbed sleep is also a problem because of increases in motor vehicle accidents, declining cognitive function and short term memory loss. This study was done using 110 snorers and non-snorers with non-hypoxic snoring. The excellent study showed significant increases in carotid atherosclerosis even after adjusting for age, sex, smoking history, and hypertension. The study concludes that ” Considering the high prevalence of snoring in the community, these findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.” This study makes it imperative for medical evaluation of all heavy snorers and insurance companies should reevaluate the parameters for coverage of sleep disorders when mild or no apnea is found.

Dr Shapira has opened a new office serving Chicago, Highland Park, Deerfield and Lake Forest. Visit his new website @

Additional information on the dangers of sleep apnea and snoring can be found at Oral appliances can be used to treat sleep apnea and snoring and are overwhelmingly referred over CPAP. Recently CPAP manufacturers have been creating a line of oral appliances or buying oral appliance companies recognizing the in the future the majority of patients will not be using CPAP. For many years this has been the dirty little secret of sleep medicine. Studies have shown that only 23-42% of patients tolerate CPAP. The most recent study showed 65% of patients abandoning CPAP.
Compliance has always been a major issue for CPAP. Compliance is occasionally a problem with oral appliance therapy offered by Dental Sleep Medicine but studies have shown that the majority of patients chose oral appliances when offered a choice between oral appliances and CPAP. Many sleep physicians have been resistant to Dental Sleep Medicine.

Oral appliances have been shown to be more effective than surgery and are considered a first line of treatment along with CPAP. The parameters of care of the American Academy of Sleep Medicine consiers oral appliances a first line treatment along with CPAP for mild to moderate sleep apnea and an alternative to CPAP for severe apnea when patients do not tolerate CPAP. Recent studies are showing oral appliances successfully treating severe sleep apnea. When CPAP is required combination therapy with custom CPAP masks retained by oral appliances allow patients to access the best of both treatments. The oral appliance opens the airway thereby reducing the CPAP pressure required and holing the mask firmly in place without straps eliminating leaks and facial irritation. Many problems associated with CPAP worsen when pressure is increased especially sinus pain and infections, bronchitis, eye irritation, nasal irritation and throat pain. Combination with appliances reduce pressure and reduces or eliminates these problems.

CPAP is still considered the Gold Standard of treatment and about 23% of patients love their CPAP from the first day they recieve it and are very successful with CPAP treatment on long-term basis.

I HATE CPAP LLC was developed by Dr Ira Shapira a Diplomate of the American Board of Dental Sleep Medicine to bring this information directly to the public. Examples of many oral appliances are available at: and other types of treatment are discussed at

Sleep. 2008 Oct 1;31(10):1335; discussion 1337.
Sleep. 2008 Sep 1;31(9):1204-5.
STUDY OBJECTIVES: Previous studies have suggested that snoring and obstructive sleep apnea hypopnea syndrome may be important risk factors for the development of carotid atherosclerosis and stroke. However, it is not clear if snoring per se is independently related to the risk of developing carotid atherosclerotic plaque. DESIGN: Observational cohort study. SETTING: Volunteer sample examined in a sleep laboratory. PARTICIPANTS: One hundred ten volunteers (snorers and nonsnorers with only mild, nonhypoxic obstructive sleep apnea hypopnea syndrome) underwent polysomnography with quantification of snoring, bilateral carotid and femoral artery ultrasound with quantification of atherosclerosis, and cardiovascular risk factor assessment. Subjects were categorized into 3 snoring groups: mild (0%-25% night snoring), moderate (> 25%-50% night snoring), and heavy (> 50% night snoring). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The prevalence of carotid atherosclerosis was 20% with mild snoring, 32% with moderate snoring, and 64% with heavy snoring (P < 0.04, X2). Logistic regression analysis was used to determine the independent effect of snoring on the prevalence of carotid and femoral atherosclerosis. After adjustment for age, sex, smoking history, and hypertension, heavy snoring was significantly associated with carotid atherosclerosis (odds ratio 10.5; 95% confidence interval 2.1-51.8; P = 0.004) but not with femoral atherosclerosis. CONCLUSIONS: Heavy snoring significantly increases the risk of carotid atherosclerosis, and the increase is independent of other risk factors, including measures of nocturnal hypoxia and obstructive sleep apnea severity. Considering the high prevalence of snoring in the community, these findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.