OHSU

Snoring and Sleep Disorders

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.

Snoring

WHAT CAUSES SNORING?

Snoring is most commonly caused by vibrations of the soft palate and uvula, parts of the mouth and upper throat area. These structures become soft and floppy 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 positional. 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. The focus on treatment is to make these sections of the body more stiff and firm to prevent the “flutter”that happens when a patient breathes in and out.

Uvulopalatopharyngoplasty (UPPP) is a procedure where the soft palate and tissues of the throat are tightened. If tonsils are present, they are 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.

Snoroplasty is a new procedure that involves injection of a special chemical, called a sclerosing agent, into the palate, which induces soft tissue scarring. It is also relatively painless.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.

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.

The procedure of choice depends on the evaluation of your condition, and the condition of the throat and uvula areas. Typically, all procedures performed in the outpatient (you would usually go home the same day) setting have reported similar results. The simplicity, expense, and lack of pain are starting to make snoroplasty the procedure of choice for certain patients.

How to Make an Appointment

If you are interested in being evaluated in the Snoring and Sleep Disorders Clinic, please give us a call at 503 494-5355. Dr. Mark Wax leads this clinic, and will be able to evaluate your condition to determine if a treatment or therapy option is available.