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Snoring and Sleep Apnea
Snoring may result in nightly jabs in the ribs and grumblings from your bed partner, or complaints and uncomplimentary remarks from your friends and family members. The noise you make can disrupt their sleep more than your own. However, snoring can also be the first sign of sleep apnea, a significant health problem for you.
What Causes Snoring?
What is Obstructive Sleep Apnea?
How is Snoring Treated?
How is Sleep Apnea Treated?
What Causes Snoring?
As you breathe, air travels through passages in your nose and throat. When these air passages are wide enough to allow air to flow freely, you breathe quietly. However, if the passages become too narrow, the tissues of the throat may start to vibrate, leading to snoring.
Obstruction to normal airflow may occur at multiple levels. Problems in the structure of the nose may obstruct breathing. A crooked, or deviated, septum or swollen turbinates can lead to nasal obstruction. Nasal polyps, allergies, and chronic sinusitis can also cause nasal obstruction. These problems, in turn, can lead to mouth breathing and contribute to snoring.
Large tonsils, a floppy soft palate or an elongated uvula are common findings with snorers. These anatomic abnormalities lead to decreased movement of air through the mouth. A receding jaw or enlarged tongue may also obstruct oral breathing, by allowing the tongue to come into contact with the back of the throat.
Finally, weight gain increases the thickness of the tissues of the neck and throat, compromising the diameter of the airway.
It is common for snorers to have multiple anatomic factors that contribute to their snoring problem, as opposed to just a single factor.
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What is Obstructive Sleep Apnea?
Obstructive sleep apnea is defined as a reduction or cessation of breathing during sleep due to blockage of the nose and/or throat. This can result in a decrease in oxygen in the blood and disruptions in sleep in which the body attempts to restart breathing.
What are the symptoms of sleep apnea?
Besides snoring, you may stop breathing, gasp or snort in your sleep, wake up tired after a full night’s sleep, experience morning headaches, feel sleepy during the day, have problems with memory or concentration, and feel irritable. Sleep apnea also makes you more likely to develop certain other problems such as high blood pressure, diabetes, coronary artery disease, and stroke.
How do you evaluate snoring and apnea?
To learn more about your snoring and possible sleep apnea, you need a thorough evaluation by an otolaryngologist. Your doctor will take a health history that includes detailed questions about your chief complaint, other symptoms, and any treatment you may have already had. A physical examination is performed in the office to evaluate the air passages. This may include a fiberoptic endoscopy in which a flexible telescope is placed through the nose and down into the throat. This is done with topical anesthesia and with minimal discomfort.
An overnight sleep study (polysomnogram) is the diagnostic test for sleep apnea. The sleep study involves spending a night at a sleep clinic where your breathing, heart rate, oxygen level, and other physiologic functions are measured and recorded. The findings help determine whether you have sleep apnea and which treatments will best help you.
How is Snoring Treated?
If your physician determines that you do not have a significant degree of sleep apnea, a variety of treatment options for snoring may be discussed. Non-surgical methods of treating snoring include weight loss, elimination of alcohol and sedatives before bedtime and treatment of nasal congestion. In some cases, an oral appliance designed by a dental sleep specialist may be effective.
Surgical treatment of snoring can take many forms, and is aimed at reducing airway obstruction. Traditional surgeries such as a septoplasty for a deviated septum, or a tonsillectomy for enlarged tonsils may be recommended. Most other procedures specifically designed to treat snoring are designed to reduce vibration of the palate and uvula. These include injection snoreplasty, and the pillar implant procedure, among others.
Injection snoreplasty
Injection snoreplasty is a procedure performed in the physician’s office under topical anesthetic. It consists of injecting a chemical into the tissue of the palate just above the uvula and takes about 5-10 minutes to complete. The chemical causes a breakdown in the tissue in this area, which is followed by scarring. The scarring increases the firmness of the soft palate, which leads to decreased vibration and decreased noise of snoring. The site of injection typically feels irregular for about two weeks. It may hurt, as well, but this will generally respond to over-the-counter pain medication. In properly selected individuals, the likelihood of improving snoring is approximately 85%.
Pillar implant procedure
The pillar implant procedure is performed in the physician’s office under local anesthetic. It consists of inserting three to five small Dacron struts under the skin of the soft palate. These struts provide stiffness to the soft palate, reducing vibration. This procedure typically takes about 15 minutes to complete. Pain and discomfort are relatively minimal and can be treated with over-the-counter pain medication. In properly selected individuals, the likelihood of improving snoring is approximately 85%.
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How is Sleep Apnea Treated?
Treatments for sleep apnea include non-surgical approaches -- such as lifestyle changes, oral appliances, and Continuous Positive Airway Pressure (CPAP) treatment -- and surgical approaches.
What are the non-surgical approaches to treating sleep apnea?
Changing a few habits may be all that is needed to stop snoring and prevent mild sleep apnea. Even if you need further treatment, these changes are a good place to start. Sleeping on your side may reduce the blockage caused by gravity pulling relaxed throat tissue down. Losing weight also helps as excess fat deposits in the neck make the structures in your throat more bulky and floppy. Avoid alcohol and sedating medications at night, as these may relax your throat muscles more than usual. A blocked up nose makes snoring and sleep apnea worse. Treatment of allergies and sinus problems may improve this problem. Nasal strips may make breathing easier. Stopping smoking can also improve a stuffy nose.
Oral appliances may also be a part of the treatment options. A dental specialist can build and fit an oral appliance that can move the jaw and tongue forward while you sleep, thus preventing blockage.
Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for obstructive sleep apnea. The CPAP machine uses a mask and air pressure to hold the airway open. The machine is used at night and is generally the most effective treatment for sleep apnea. You will require a CPAP titration study performed in a sleep laboratory to arrive at the proper CPAP settings. A variety of masks and machines are available. Any CPAP setup must be tailored to meet your needs and preferences, so expect several adjustment before the setup suits you.
How can surgery help sleep apnea?
The goal of surgery is to widen the air passages in the nose and the throat. Although non-surgical options of treatment are generally encouraged, surgical treatment can be useful if a patient is unable or unwilling to comply with non-surgical treatment, or if readily identifiable anatomic abnormalities are found where correction is likely to result in improvement.
Nasal surgery may involve reducing the turbinates, straightening a deviated septum, or endoscopic sinus surgery to remove nasal polyps or treat sinusitis. Problems in the nose can make snoring or sleep apnea worse and make CPAP harder to use. Surgery to open the nasal passages tends to help snoring and apnea problems and can help patients become more compliant with CPAP.
Palate surgery may be required if excess tissue of the soft palate is blocking the airway. The most common surgical procedure for sleep apnea is a Uvulopalatopharyngoplasty, or UPPP. This involves trimming the soft palate and uvula and removing any tonsillar tissue. This procedure is done under general anesthesia, may be combined with nasal or tongue surgery, may require overnight hospitalization, and takes a minimum of one week for recovery.
Tongue surgery may be needed if the base of tongue is found to be too large or too posterior. Tongue advancement procedures include hyoid myotomy and suspension, radiofrequency ablation of the tongue base, genioglossal advancement, and mandibular advancement. These surgeries attempt to move the tongue forward, so that it does not collapse against the back wall of the throat during sleep.
Conclusion:
There are many options in treating snoring and sleep apnea. You should work with your doctor to formulate the best plan for you. Treatment can help you and your partner enjoy quiet, restful sleep and can prevent the development of serious health problems.