MINNEAPOLIS – Dave Barlow knew something about snoring. He worked as a physician assistant for a doctor who snored and whose patients had the same problem. And then, well, Barlow had an earful of noise most nights from his wife, Anne.

So when he heard about the Pillar System in 2005, he was intrigued. Three little polyester strands are injected into the soft palate to stop the vibration of soft tissue that may cause the distinctive buzz-saw sound familiar to bed partners everywhere. First, Barlow used the gun-like injection device to insert the three strands into his boss’s mouth, and then he did the same thing to his wife.

The doctor hasn’t had much of a problem since. But his wife? Still snoring.

“It’s a gamble,” Barlow said of the Pillar System, made by St. Paul, Minn.-based Restore Medical Inc., and which has now been used on some 23,000 snorers at a cost of $1,200 to $2,500 each. And that’s the same with most of the sleep-related snoring treatments – sometimes they work, sometimes they don’t.

Simple snoring, as opposed to sleep apnea, is considered a social problem, not a medical one, so health insurance generally doesn’t pay for treatments. But it affects half the adult population – and their bed partners – and the rate is rising as the baby-boom population ages. Often snoring can be an indication of apnea, which occurs when the tissues in the throat close completely many times in an hour, cutting off the flow of oxygen to the blood. It’s potentially serious because it increases the risk of heart disease, stroke and diabetes.

But snoring alone – when the soft tissues in the throat vibrate like a percussion instrument – is largely an affliction for bed partners that can drive couples apart. Consider that snoring rooms, adjacent second bedrooms to the master, are one of the latest hot trends in new housing construction because they offer an alternative to the couch.

No wonder people are willing pay out of pocket for everything from Breathe Right strips to open their nasal passages to the outpatient Pillar procedure to painful surgical treatments that can cost thousands of dollars.

“People will do about anything to make it go away,” said Barlow, who now teaches at the physician assistant training program at Augsburg College in Minneapolis.

But many doctors say that patients should steer clear of expensive or surgical treatments.

“Some will say the Pillar works, and some say surgery will work,” said Dr. Michel Bornemann, who treats apnea and snoring at the Minnesota Regional Sleep Disorders Clinic in Minneapolis. “But all of it is unpredictable because the airway is so complex.”

The upper airway is like a floppy bag attached to the top of the trachea. Inside are the tonsils, the tongue, the soft palate, the uvula, the walls of the throat and the epiglottis. And the vibration of tissue from constricted airflow can occur at any -or many – points along the way, Bornemann said.

Snoring treatments tend to fix one part of the anatomy, but not the others. The Pillar System, for example, stiffens the soft palate, but has no effect further down the airway. Bob Paulson, chief executive officer for Restore Medical, said it improves mild to moderate apnea 40 percent of the time, and snoring 60 percent of the time. But there is no way to predict who will benefit from it and who won’t, he said.

“That is the multibillion-dollar question,” Paulson said. “There is no diagnostic technique that can determine the site of obstruction.” Doctors, he added, have to use their best judgment, and that’s not foolproof.

“No matter how good the selection process is, we will get a percentage of patients who fail,” said Dr. Michael Friedman, a professor of head and neck surgery at the Rush University Medical Center in Chicago who has conducted research studies on the Pillar System. “I don’t use Pillar as a stand-alone.”

Other treatments are equally unpredictable. Breathe Right strips open up some of the nasal passageway, but do nothing for the throat. Aggressive surgeries that remove loose, excess tissue in the throat work about half the time. And snoring often recurs within five years, doctors said.

Where to start

So what’s a snorer to do? First, make sure you don’t have sleep apnea, experts say. That might require an overnight sleep study at a clinic, where you will be monitored for brain waves, oxygen levels and breathing patterns.

Research increasingly shows how important treating apnea can be. The first-line treatment is a CPAP machine that blows air into the nose or mouth, a device that many health plans will cover, but which many people find awkward and inconvenient to use.

Paulson said the Pillar System can sometimes be used for mild to moderate apnea, but Bornemann and other doctors say it’s a gamble. “If it worked, I would have no problem doing it,” Bornemann said.

If it’s snoring alone that’s driving your partner to another room at night, start small and work your way up the treatment ladder.

Dr. Joan Fox, a sleep specialist at the Sleep Disorder Center in Minneapolis, said her first priority is to find out “what’s going on with the nose.” If you can’t breathe through your nose, you’ll breathe through your mouth instead, and that’s a recipe for snoring, she said. So she makes sure to take care of allergies and other sinus problems first.

That did the trick for Bob Schmalz, 39, of Red Wing, Minn. He uses a CPAP machine even though he does not have apnea, because he has narrow air passages in his nose. He thought about having surgery to widen his nasal passages and to trim tissue from his throat, but chose not to because it often doesn’t work. Once he got used to it, the CPAP worked well, and he realized how badly he’d been sleeping.

“It does make the world of difference,” he said. In fact, studies are beginning to show that severe snoring can increase health risks as well.

Another option is a mandibular device, which looks a lot like a mouth guard that pulls the lower jaw and tongue forward, opening up the throat. Doctors say that they should be individually fitted by a dentist or oral surgeon who specializes in making them. Mass-produced, generic devices from online sites or drug stores are not likely to work well, they said.

Mandibular devices and other simple, noninvasive treatments are probably the most likely to help, doctors said. The CPAP is effective for severe snoring and apnea – but only for those willing to sleep with a tube trailing from their faces, Fox said. The mandibular device works up to 70 percent of the time if it’s properly made and fitted, she said.

The beauty of both options, doctors said, is that they can work no matter where the problem is in the airway.

“Whatever helps noise and does not harm the patient, that’s the goal of therapy to limit snoring,” Fox said.