Snoring

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a sock that holds a tennis ball on the pajama back to force the snorer to sleep on his side. (Snoring is often worse when a person sleeps on his back). Some devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. But, if you snore, the truth is that it is not under your control whatsoever. If anti-snoring devices work, it is probably because they keep you awake.

What Causes Snoring?

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

People who snore may suffer from:

· Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep.

· Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare.

· Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse.

· Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection.

Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction. More commonly, chronic swelling of the tissues on the nose (turbinates) seems to progress with age and worsen the problem.

Is Snoring Serious?

Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness. Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.

Obstructive Sleep Apnea

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder. The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur. This in turn leads to an earlier incidence of heart disease.

How should I proceed?

A sleep study is necessary to make the diagnosis of Obstructive Sleep Apnea versus just benign snoring. This should be the first priority as no treatments can be offered for either snoring or sleep apnea until the diagnosis is made. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. This will allow accurate evaluation of the level of obstruction and the possibilities of future surgical treatments to these areas. Fortunately, the physicians at Midwest Ear, Nose & Throat are trained in all aspects of sleep medicine and surgery.

Treatment

Treatment depends on the diagnosis. A thorough history and physical examination will reveal if allergies, nasal deformities, or enlarged tonsils play a role. Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons:

· Home Remedies seem to help some patients but largely remain unproven.

· Weight Loss and Aerobic exercise can often mean the difference between failure and success.

· Allergy evaluation and treatment to lessen congestion. (see our information on allergies)

· Dental Splints can be helpful to some, but can also cause future joint and occlusion problems in others. Chin straps have proven helpful to some as well (www.mysnoringsolutions.com).

· Nasal Surgery, as previously mentioned, may be all that is required to better open up the airway. This must address all areas of nasal surgery, as the nasal valve can often be the culprit to obstruction. (see our information on nasal obstruction)

· Palate Procedures: Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages. It often is performed in conjunction with a tonsillectomy, which greatly enhances the results. This is the classic and most successful treatment of the palate. It is done in the operating room with the patient under general anesthesia. Some palate procedures can be performed in the clinic.Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures in a doctor’s office under local anesthesia. Injection snoreplasty involves injecting a sclerosing agent into the palate to stiffen it. Radiofrequency ablation—“Somnoplasty”(www.somnoplasty.com) some with temperature control approved by the FDA—utilizes a needle electrode to emit energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction). Palatal implants with stiffening material has been helpful to some. This is termed the “Pillar” procedure and more information can be found at www.restoremedical.comRegardless of what you call these techniques, they are all surgeries on the palate. They all hurt a bit and the goal is to stiffen the palate to eliminate the snoring. They do work but they do cause a significant sore throat. Also, insurance generally does not cover these procedures if they are just done for snoring.

· Base of Tongue procedures such as radiofrequency ablation or Repose suture fixation have proven beneficial. Suture fixation is relatively new and can be a longer recovery (www.influ-ent.com) .

There is a new base of tongue procedure utilizing the coblator (arthrocare). This is really exciting and addresses the most difficult area to fix without unreasonable morbidity.

· Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.

If surgery is too risky or unwarranted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or “CPAP”. Somnoplasty of the turbinates can greatly facilitate the efficacy of CPAP. A trial of CPAP is usually instituted prior to any surgical consideration.

A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A tonsillectomy, adenoidectomy, and turbinoplasty may be required to return the child to full health.

Self-Help for the Light Snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

· Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.

· Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.

· Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.

· Establish regular sleeping patterns.

· Sleep on your side rather than your back.

· Tilt the head of your bed upwards four inches. (This may also help with your reflux)

· Maximize your nasal airway with allergy evaluation, saline rinses, and nasal steroid sprays.