Snoring and Sleep Disorders

Snoring: Not Funny, Not Hopeless
Diet and Exercise Tips
Continuous Positive Airway Pressure (CPAP)
Laser Assisted Uvula Palatoplasty (LAUP)

Snoring: Not Funny, Not Hopeless

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. 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.

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.
• 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. 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.

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Diet and Exercise Tips

Excessive body weight contributes to snoring and obstructive sleep apnea, inaddition to being a major influence on general health and well-being. Obstructive sleep apnea occurs in about 50-60% of those who are obese.

A recent report from the National Center for Health Statistics concludes that seven of 10 adults don’t regularly exercise, and nearly four in 10 aren’t physically active. Lack of exercise can increase the risk of diabetes, heart disease, and stroke. About 300,000 people in the U.S. die each year from diseases related to inactivity.

Proper diet and exercise are the mainstays for a healthy lifestyle, although many Americans turn to costly fad diets and exercise programs that fail to provide weight loss and a healthy lifestyle. The basic tenets to gradual weight loss and good health include developing healthy eating habits and increasing daily physical activity.

Self-help guidelines for healthy activity:

• Consult a physician – men over age 40; women over 50; people with (or at risk for) chronic health problems such as heart disease, diabetes, or obesity.
• Start out slowly and build up activity gradually over a period of months. This will help avoid soreness and injury.
• Try to accumulate 30 minutes or more of moderate-intensity cardiovascular activity each day. You can do all 30 minutes together or through short bouts of intermittent activity (e.g. 10 minutes at a time).
• Add strength-developing exercises at least twice per week.
• Incorporate physical activity into your day (walk to the office or store, take the stairs instead of the elevator, walk or jog at lunch time, etc.).
• Make leisure time active – garden, walk, ride a bike with family and friends, participate in an exercise class, join in a sports activity.
• Select activities you enjoy, find satisfying, and give you a feeling of accomplishment. Success leads to increased motivation to be physically active.
• Be sure your activities are compatible with your age and physical condition.
• Make it convenient to be active. Choose activities that are readily accessible (right outside your door) like gardening, walking, or jogging.
• Try “active commuting.” Cycle, walk or in-line skate to work or to the store.
• Make your activity enjoyable – listen to music, include family and friends, etc.

For those who are already regularly moderately active, increase the duration and intensity for additional benefits.

Weight loss tips:

• Take in fewer calories than you expend. Few people understand this basic, simple concept.
• Eat smaller meals 3-5 times per day.
• Eat nutrient dense foods such as whole grains, lean proteins, fruits, and vegetables.
• Eat slowly, and wait 10-15 minutes before taking second helpings.
• Don’t eliminate everything you like from your diet. Eat those things in small amounts (pizza, candy, cookies, etc.)
• Prepare healthy snacks that are easily available (cut carrots, apples, etc.)
• Avoid buffets.
• Drink plenty of water, especially immediately prior to meals.

The healthy weight approach to dieting:

• Enjoy a variety of foods that will provide essential nutrients.
• Three-quarters of your lunch and dinner should be vegetables, fruits, cereals, breads, and other grain products. Snack on fruits and vegetables. Eat lots of dark green and orange vegetables. Choose whole-grain and enriched products more often.
• Choose lower fat dairy products, leaner meats and alternatives, and foods prepared with little or no fat. Shop for low fat (2% or less) or fat-free products such as milk, yogurt, and cottage cheese. Eat smaller portions of leaner meats, poultry, and fish; remove visible fat from meat and the skin from poultry. Limit the use of extra fat like butter, margarine, and oil. Choose more peas, beans, and lentils
• Limit salt, caffeine, and alcohol. Minimize the consumption of salt. Cut down on added sugar such as jams, etc. Limit beverages with a high caffeine content (tea, sodas, chocolate drinks) and caffeinated coffee to two cups per day. Minimize alcohol to 1-2 drinks per day.
• Limit consumption of snack foods such as cookies, donuts, pies, cakes, potato chips, etc. They are high in salt, sugar, fat, and calories, and low in nutritional value.
• Eat in moderation. If you are not hungry, don’t eat.

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Continuous Positive Airway Pressure (CPAP)

The Problem

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. 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.

Only recently have the adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) been recognized. Various methods are used to alleviate snoring and/or OSA. They include behavior modification, sleep positioning, Continuous Positive Airway Pressure (CPAP), Uvulopalatopharyngoplasty (UPPP), and Laser Assisted Uvula Palatoplasty (LAUP), and jaw adjustment techniques.

What is Continuous Positive Airway Pressure (CPAP)?

Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea.

If your otolaryngologist determines that the CPAP treatment is right for you, you will be required to wear the nasal mask every night. During this treatment, you may have to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen.

Before the invention of the nasal CPAP, a recommended course of action for a patient with sleep apnea or habitual snoring was a tracheostomy, or creating a temporary opening in the windpipe. The CPAP treatment has been found to be nearly 100 percent effective in eliminating sleep apnea and snoring when used correctly and will eliminate the necessity of a surgical procedure.

So, if I use a nasal CPAP I will never need surgery?

With the exception of some patients with severe nasal obstruction, CPAP has been found to be nearly 100 percent effective, although it does not cure the problem. However, studies have shown that long­term compliance in wearing the nasal CPAP is about 70 percent. Some people have found the device to be claustrophobic or have difficulty using it when traveling. If you find that you cannot wear a nasal CPAP each night, a surgical solution might be necessary. Your otolaryngologist will advise you of the best course of action.

Should you consider CPAP?

If you have significant sleep apnea, you may be a prime for CPAP. Your otolaryngologist will evaluate you and ask the following questions:

• Do you snore loudly and disturb your family and friends?
• Do you have daytime sleepiness?
• Do you wake up frequently in the middle of the night?
• Do you have frequent episodes of obstructed breathing during sleep?
• Do you have morning headaches or tiredness?

Suitability for CPAP use is determined after a review of your medical history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications. You will also receive a physical and otorhinolaryngological (ear, nose, and throat) examination to evaluate your airway.

Before receiving the nasal mask, you would need to have the proper CPAP pressure set during a “sleep study.” This will complete the evaluation necessary for prescribing the appropriate treatment for your needs.

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Laser Assisted Uvula Palatoplasty (LAUP)

The Problem:

Some 45 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. Snoring sounds are caused by an obstruction to the free flow of air through the passages at the back of the mouth and nose.

Only recently have the adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) been recognized. Various methods are used to alleviate snoring and/or OSA. They include behavior modification, sleep positioning, Continuous Positive Airway Pressure (CPAP), jaw adjustment techniques, Uvulopalatopharyngoplasty (UPPP), and Laser Assisted Uvula Palatoplasty (LAUP).

What is Laser Assisted Uvula Palatoplasty (LAUP)?

LAUP allows treatment of snoring and mild OSA by removing the obstruction in your airway in an outpatient setting under local anesthesia. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures. LAUP is performed while you are positioned in an upright sitting position in an examination chair.

Before administration of anesthesia, you are informed that the back of your throat will become numb and that you will lose the sensation of swallowing and breathing. A local anesthesia is sprayed over the back oral cavity, soft palate, tonsils, and uvula followed by an injection of additional anesthesia in the muscle layer of the uvula. After several minutes, a CO2 laser is used to make both, vertical incisions in the palate on both sides of the uvula. The uvula is shortened, eliminating the obstruction that has contributed to the snoring.

LAUP requires up to five treatments spaced four to eight weeks apart (although one to three are usual).

How long will it take to recover?

If you undergo the LAUP procedure you can expect to return to a normal routine almost immediately. For the majority of those undergoing this procedure there will be swallowing pain similar to a severe sore throat. This discomfort lasts for approximately ten days and can be relieved by oral analgesic and anti­inflammatory medicines.

Improvement is noted by the reduction in or disappearance of your snoring.

Should you consider LAUP?

If your snoring is habitual and disruptive to others, you may be a prime candidate for LAUP. Your otolaryngologist will evaluate you and ask the following questions:

• Do you snore loudly and disturb your family and friends?
• Do you have daytime sleepiness?
• Do you wake up frequently in the middle of the night?
• Do you have frequent episodes of obstructed breathing during sleep?
• Do you have morning headaches or tiredness?

Suitability for LAUP is determined after a review your health history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications in use. You will also receive a physical and otolaryngological (ear, nose, and throat) examination to evaluate the cause of the snoring.

Before the laser procedure is conducted, you will participate in a “sleep study,” which will grade the level of actual snoring and sleep apnea. This will complete the evaluation necessary for prescribing the appropriate treatment for your needs.

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