New Treatments for Snoring and Sleep Apnea

Husbands , wives and lovers all over the world have common discussions and arguments with each other over one topic……Snoring. Some complain that their spouse snores so loudly that it will raise the roof, wake the children, disturb the neighbors, or perhaps wake the dead. Others merely leave the bedchamber and seek a more quiet location for sleep. Some report that they lie awake guarding their spouse to be able to provide the ….'poke in the ribs ' to stimulate resumption of rhythmic breathing, fearing that sleep apnea might truly be a last gasp.

Snoring , loud sonorous vibratory noise from the nose and mouth with respiration during sleep is a very common problem. Sleep Apnea, the breathless interruptions in sleep lasting from seconds to sometimes minutes, is usually associated with snoring ….and interruptions in snoring….but is a much more serious problem.

Snoring is usually caused by soft tissue vibrations in the nose and throat during sleeping inspiration. The airway size and the speed of airflow both affect the vibratory tendencies of the soft tissue. Snoring is more common in individuals who are overweight. It is thought that the palatal and pharyngeal tissues are thickened and enlarged in obese people, thereby encroaching on the available airflow space. This creates a relative narrowing of the airflow column moving through the affected respiratory cavities, and thus increases the speed of flow for a given volume of air in a single inspiratory effort. Generally, deep, rapid inspirations will create louder vibratory noises in such a setting.

Snoring is noted in thin people as well. Obesity may be a factor but some who still have dramatic somnolent noise are not overweight at all. Snoring can be highly variable. Position, amount of nasal obstruction or congestion, and other associated factors such as fatigue and use of alcohol causing additional tissue relaxation, may contribute to this variability.

Elimination of snoring is widely sought and is extremely important to spouses throughout the world. The techniques used to deal with this problem are sometimes innovative. While the use of decongestants, whether in medications, herbal preparations, or in teas, is most common, efficacy is widely variable here. In some cases , mechanical devices such as the BREATHRITE nasal strip device may open the air passage and allow slower, less noisy airflow. There are other types of nasal prosthetic devices to accomplish a similar effect in existence though not commonly available without the help of a physician trained in nasal surgery and medicine.

Simple methods can help. Sewing a small bean bag or a rubber ball into the back of a pajama top may discourage sleeping on the back by the discomfort it creates. Many snorers are more offensive in their sound production when they are reclining supine. These methods merely encourage a change of position which may result in a different position of the head and chin and thus a different airflow pattern. For some this dramatically reduces the noise of snoring.

There are some who have a jaw and tongue position that falls backward into the airway during sleep. In these sufferers, the use of a special mouthpiece to pull the teeth and lower jaw forward may result in the opening of the airway and the reduction of snoring. - For some, a simple mouthpiece to keep the teeth apart and the lips open may suffice.

A new method of opening the airway was introduced in the early 1990's. This method , called LAUP, requires the use of the CO2 laser to evaporate some of the soft tissue in the palate and throat. This removes much of the vibratory tissue and has been found in many cases to dramatically reduce snoring, if not eliminate it completely. Some Snoring sufferers who have sleep apnea may find that the symptoms of their apnea, fatigue and daytime somnolence, may be significantly improved with this procedure as well. Other apnea sufferers who are able to tolerate the tight fit of a facial mask during sleep time, may benefit from the use of an air pump device which delivers air pressure to the nasal airway. This is usually called CPAP for Continuous Positive Airway Pressure. These machines can have their pressure adjusted up or down to overcome the resistance in the airway passages at a selected level.

Those individuals who do not tolerate CPAP in treatment for apnea may benefit from LAUP or from another procedure developed a few years earlier called Uvulopalatopharyngoplasy or UP3. This procedure allows the surgeon to create a "face lift" in the throat. This removes much of the vibratory tissue and rebuilds the back of the throat. The reduction of vibratory tissue may improve the airway immensely. Often the result is elimination of snoring and significant improvement in sleep apnea.

Although it is not commonly considered a type of sleep disorder by the lay public doctors know that children with large tonsils and adenoids may suffer from sleep apnea too. Snoring in children may be only one of the signs and symptoms. Daytime sleepiness, irritability, poor schoolwork and noisy breathing and snoring during sleep are but a few of the items sometimes noted. These children may benefit from simply removing the tonsils and adenoids. On rare occasions that may be all that is required for adults with similar problems due to the enlargement of these tissues in the throat. Such surgery may be done as an outpatient in many cases.

Recently, a new type of treatment has been recommended for snoring and now for sleep apnea. This treatment has been reported to be a painless office procedure. It requires a special radiofrequency machine and creates a subsurface scarring lesion in the soft tissue. The tissue presumably contracts when it is healing from the microwave type injury and this contraction tightens and opens the airway tissues. It has been helpful for snoring sufferers but is still being evaluated for individuals with sleep apnea. Some snorers experience improvement with just one treatment. Others may need repeat treatments. This type of palatal and nasal surgery is called Somnoplasty by the firm marketing the technique and the specialized equipment designed to perform the procedures. The equipment is expensive, and many third party payors will not cover the fees for these procedures. Fees ranging from several hundred to nearly two thousand dollars are common for these procedures. Payment is often required in advance of such a procedure, and the treatment is not always completely successful.

A most difficult problem for people with snoring and for those who have sleep apnea is the variability in insurance policy coverage for testing and for treatment. Many insurance plans have position statements on snoring and on sleep apnea. Most will refuse coverage for treatment for snoring. Some will refuse to pay for polysomnography studies, i.e. the sleep lab sleep study.

New equipment allows some individuals to be tested in their own bed at home. The computer interface equipment can download the information to the special program on the PC at the doctors office and the details collected during the sleep period studied can be reviewed looking for clues about the sleep pattern problems. Some insurance carriers are covering these types of studies while others refuse in the name of certification and quality assurance. Innovation and convenience to the patient are rarely viewed as valuable by third party payors.

In some instances snorers may be successful with nasal surgery alone. Others will benefit from the use of medications and perhaps nasal sprays. Some physicians have returned to the use of injections of medicines, usually medicinal steroids, directly into the soft tissue inside the nose. These techniques may help open the nasal passage. In rare instances, facial realignment surgery using rhinoplasty and in some cases orthognathic maxillofacial realignment or mandibular advancement may be recommended. Neck surgery is occasionally recommended. Also, reduction of the size of the back of the tongue may sometimes be recommended. In refractory cases, placement of a tracheotomy tube or a tracheal t- tube may be considered. These tubes bypass the obstructing areas completely and thereby eliminate apnea, which is caused from obstruction, and bypass snoring as well.

The problem with snoring is obviously disturbing. Choosing the best treatment for maximum success and minimum risk and discomfort is sometimes difficult and can be expensive. Consultation with your Family Physician or with an Otorhinolaryngologist who treats sleep disturbances is wise. In some areas the Pulmonologist or lung specialist may be the practicing sleep disorders specialist. In other areas your family doctor may refer you to a Neurologist. Referral to a sleep clinic for a formal Sleep Study may be recommended, and in many cases the team of physicians and technicians who review the sleep data may develop a treatment plan as a group.

If you have questions regarding the treatment of snoring or sleep apnea please feel free to call our office and speak to a member of the nursing staff.

For further recommendations regarding a sleep disturbance specialist in your area you may wish to contact one of the following sites:

American Academy of Otorhinolaryngology Head and Neck, and Facial Plastic Surgery http://www.entnet.org/
American Sleep Disorders Association http://www.asda.org/
American Academy of Neurology http://www.aan.com/reguser.html
National Institute of Health NIH http://www.nhlbi.nih.gov/
Sleepnet http://www.sleepnet.com/

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