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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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
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.
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.
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