Snoring
INTRODUCTION 
WHY WE SNORE NASAL PROBLEMS TONSILS AND ADENOIDS
CAN BE SNORING SERIOUS? THE OFFICE EVALUATION TREATMENT REGIMEN
SNORING OBSTRUCTIVE SLEEP APNEA
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TAKE OUR SNORING QUIZ:
Do you snore and...
[. ] snore loud enough so that your partner has to leave the bedroom or has already left?
[. ] stop breathing during sleep?
[. ] wake up tired every day and stay that way?
[. ] wake up choking or gasping for air during the night?
[. ] get sleepy or fall asleep at the wrong time: during reading, watching TV?
[. ] have heart disease and high blood pressure?
If the answer is "yes" to two or more of the above questions, you owe it to yourself, your loved ones and friends to see one of our doctors for an evaluation. We have specialized in snoring and sleep apnea for over 30 years.
INTRODUCTION:
Snoring is a very common problem. Virtually all of us either snore, sleep with someone who snores or know someone who snores. Every family has a snorer who is often the object of many good-natured jokes. Yet, for many, snoring is a serious problem. It is not only embarrassing, but often keeps everyone in the house from getting a good night's sleep. Daytime problems such as fatigue, headache, and poor concentration can be attributed to poor sleep.
WHY WE SNORE:
When we breathe, air enters the nose and mouth on its way to the lungs. During the day, the tissues of the throat are held open by active muscle groups. When we sleep, our throat muscles relax, allowing the lining of the throat to move inward. Snoring is created by the tissues in the back of the throat vibrating against each other. The uvula and the soft palate are the main areas that are set into motion, thereby creating a snoring noise.
NASAL PROBLEMS:
If your nose is clogged, you have to breathe harder through the nose in order to get air into your lungs. The harder you breathe in, the more you will pull the relaxed tissues in the back of the throat against one another and the louder you will snore. Therefore, nasal congestion for any reason, will often make snoring worse.
TONSILS AND ADENOIDS:
Enlarged tonsils and adenoids can block the airway and cause severe snoring even in adults. This is the most common cause of snoring in infants and children.
CAN BE SNORING SERIOUS?
As there is increasing collapse of tissue, the snoring may indicate obstructive sleep apnea which indicates poor oxygenation of the blood along with other chemical changes. It can be a serious medical problem. People who are not getting enough oxygen while sleeping are prone to a variety of ailments, including: poor sleep, daytime fatigue, and poor concentration. Other serious health problems, such as heart disease, hypertension and stroke, can be caused by obstructive sleep apnea.
THE OFFICE EVALUATION:
A thorough history and physical exam will usually indicate whether or not there is part of the more serious medical problem. The exam allows us to determine the cause of snoring. We can tell what role nasal congestion, allergies, and sinusitis play in snoring. The questions that need to be answered at this visit include: Do you have nasal obstruction? Are your tonsils and adenoids causing blockage? Are your enlarged uvula and floppy soft palate the main issue?
TREATMENT REGIMEN:
We recommend that nasal obstruction, sinusitis, tonsil disease and allergies be treated before the laser operation for snoring (LAUP). If sleep apnea is an issue, a sleep study should be performed before the LAUP.
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 (see illustration) 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. 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.
Can Heavy Snoring be Cured?
Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer's health.
Snoring Treatment
Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids.
Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons:
* Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages.
* 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. Radiofrequency ablation—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).
* Genioglossus and hyod 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 unwanted, 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".
A chronically snoring child should be examined for problems with his or her tonsils and adenoids.
A tonsillectomy and adenoidectomy 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.
Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and not hopeless.
Snoring Is A Problem
Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers.Thirty percent of adults over age 30 are snorers. By middle age, that number reaches 40 percent. Clearly, snoring is a dilemma affecting spouses, family members and sometimes neighbors.
Snoring sounds are caused 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. When these structures strike each other and vibrate during breathing, snoring results.
Treatment For Snoring
Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea. Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of apnea (cessation of breath).Obstructive sleep apnea is a serious medical condition where individuals have frequent episodes of apnea during sleep, contributing to an overall lack of restful sleep and severe health risks including heart attack and stroke.
Various methods are used to alleviate primary snoring. They include behavior modification (such as weight loss), surgical and non-surgical treatments, and dental devices.
Surgical treatments for primary snoring include: laser assisted uvulopalatoplasty (LAUP), an outpatient treatment for primary snoring and mild OSA that involves use of a laser under local anesthesia to make vertical incisions in the upper palate, shortening the uvula and lessening airway obstruction; the Pillar Procedure involves placing small implants in the palate to reduce the vibrations that cause snoring.
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