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SLEEP DISORDERS CLINIC AT OHSU Treating snoring and sleep apnea
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SNORING
Approximately 45% of normal adults snore at least occasionally, and 25% are habitual snorers. It is estimated that up to 40% of males over the age of 40 snore consistently. Women tend to snore less, but a significant population of women over the age of 40 will also consistently snore quite loudly. Snoring can be an indicator of a more serious disease and is known to wreak havoc on relationships. Social stigmata and the accompanying ostracism may prevent individuals from enjoying social activities such as camping, staying in hotel rooms, etc.
Snoring is no laughing matter. It may be an indication of a more serious medical problem, such as sleep apnea. Visit Snoring and Sleep Disorders (American Academy of Otolaryngology/Head and Neck Surgery).
SLEEP APNEA
Sleep apnea is a well-defined medical condition that occurs when individuals cease to breathe for periods of greater than ten seconds. Episodes where the oxygen levels in the blood decreases or an irregular heartbeat occurs are also considered as significant events. Sleep apnea is a potentially life-threatening disease that may not only diminish life span but may also be an early symptom of hypertension, heart trouble or stroke. The best way to diagnose sleep apnea is a formal sleep study that is performed in a certified sleep center. The Epworth sleepiness scale is the only clinically recognized way to determine if you are predisposed to sleep apnea. Only an assessment by a physician and a properly performed sleep study can actually determine the severity or degree of sleep apnea.
Treatment options for sleep apnea and snoring differ. Sleep apnea is best treated by continuous positive airway pressure (CPAP) under the direction of a professional sleep physician. For further information, contact your family physician.
WHAT CAUSES SNORING?
Snoring is most commonly caused by vibrations of the soft palate and uvula. These structures become flaccid during sleep. If they are “floppy” then they will flutter and cause noise on breathing. The “flutter” can be loud and disruptive or minimal. It may also be posoitional. In some patients, the pharyngeal walls or tongue base are the source of the flutter and noise on respiration. Treatment of snoring in this circumstance is very difficult and not very successful.
HOW IS SNORING TREATED?
Many treatment options for snoring are available. All of them address the soft palate and uvula. Stiffening of these structures to prevent the “flutter” during inspiration is the end point of all treatments.
Uvulopalatopharyngoplasty (UPPP) is a procedure where the soft palate and tissues of the throat are tightened. If tonsils are present, they are also removed at the same time. This procedure requires general anesthetic and usually a two-week recovery period.
Laser-assisted uvulopalatoplasty (LAUP) is a procedure where a laser is used to vaporize the uvula and a portion of the palate. The heat induces a burn, which causes scarring and stiffening of the soft palate. See also Laser Assisted Uvula Palatoplasty (American Academy of Otolaryngology/Head and Neck Surgery).
Snoroplasty is a new procedure that involves injection of a sclerosing agent into the palate, which induces soft tissue scarring. It is also relatively painless.
The procedure of choice depends on the anatomical findings in the individual’s throat or oropharyngeal inlet. Typically, all procedures performed in the outpatient setting have reported similar results. The simplicity, expense, and lack of pain are starting to make snoroplasty the procedure of choice for certain patients.
WHAT IS SNOROPLASTY?
This procedure was introduced to U.S. physicians
in 1995. It involves an injection of Sotradecol into the soft palate. Sotradecol
is a sclerosing or scarring agent. It has been most commonly used for the
treatment of varicose veins over the last 30 years. Typically, the palate
is frozen with local anesthetic, and a small amount of the material is injected
directly above the uvula. There is an immediate swelling. Patients remain
in the physician’s office for 15-45 minutes to ensure that no untoward effects
or adverse reactions to the chemical occur. The procedure has been described
as painless, although we recommend that Motrin or Tylenol be taken beforehand
and continued for 24 hours. Patients who undergo this procedure are given
a prescription for a narcotic and an anti-inflammatory. These medications
are usually required for 3-4 days following the procedure. Patients are
advised to take at least 1-2 days off work before returning. Those that
require lots of verbal interaction with other people are suggested to take
4-5 days off.
This procedure has been in use for almost a decade. Short-term results
are as good as all of the other procedures that have been used purely
for snoring in an outpatient setting. Long-term effects over 2-5 years
have faded by 10-20%. Patients are eligible to be retreated.
Among the more common aftereffects of the injection are a minor swelling
and a feeling of fullness in the soft palate. After a 4-6-week period,
the chemical reaction induces a stiffening of the soft palate and the
local tissue. This in turn decreases the fluttering of the palate and
has a beneficial effect on the snoring.
See also Injection
Snoreplasty (American Academy of Otolaryngology/Head and Neck Surgery).
Pillar Implants - Recently, a new
form of treatment for snoring has been introduced. This involves the implantation
of three non-absorbable, nonreactive implants into the palate. This procedure
is done under topical/local anesthetic in the physician's office. These
implants serve to stiffen and dampen the vibration of the palate and thus
relieve snoring. Patients are able to return to work within a day or two.
There is minimal pain that requires non-narcotic analgesia as the usual
course. For more information, please see www.pillarprocedure.com
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