Sleep Apnea and Snoring

Sleep Apnea and Snoring: What is sleep apnea?

Obstructive sleep apnea syndrome is a medical condition which requires careful diagnosis and treatment. This medical condition can be life threatening. It involves recurrent collapsing of the breathing passage during sleep, causing partial or complete blockage. Symptoms include excessive daytime sleepiness, morning headaches, high blood pressure and depression.

This condition is caused by obstruction of the airway from the lips or opening of the nose to the voice box; thus it is within the ear, nose and throat specialist’s field. Treatment can involve weight loss, treatment of nasal obstruction, surgery in the throat, or use of a breathing machine called CPAP. This condition does have a definite health risk and should be investigated and treated.

Sleep Apnea and Snoring: Excessive daytime sleepiness

Sleep Apnea and Snoring: What can I do about my snoring?

Many people have loud snoring which interferes with both their own sleep and their bed partner’s sleep. In the past, nothing could be done about this problem. Fortunately, through advances in medical science, we have a much clearer understanding as to what causes this problem and how to treat it.

There are three main causes of snoring that can be treated surgically:

To investigate this problem, you will need a thorough examination of the nose, throat, palate and neck. You may also need a sleep study to determine if you have sleep apnea. Fortunately, through a combination of technologies, snoring no longer needs to be endured.

SIMPLE TIPS FOR THE LIGHT SNORER:
1. Avoid sleeping pills and alcohol before bed rest.
2. Exercise regularly, improve muscle tone and lose weight.
3. Sleep on your side rather than on your back.
4. Use a nasal decongestant at bedtime.

Snoring can now be treated with in-office laser surgery, which is safe, affordable, and effective. Call for an appointment if you need help.

Options in treating sleep apnea

When a patient has obstructive sleep apnea, the airway between the lips or nostrils and the voice box intermittently closes during sleep. There are several methods for treating this problem which are described below.

Non-Surgical Treatment

Our first approach is to use conservative, non-surgical treatment.

1. Weight Loss
Weight loss can be effective in eliminating the problem for some people and is the first recommended course of action, especially if the sleep apnea has developed in association with a recent weight gain.

2. CPAP - a Breathing Machine
If weight is not the problem or a patient cannot lose weight, or if weight loss alone is not effective, a mechanical breathing device called CPAP can be used at night to open the throat, which may correct the problem (see below: "What is Nasal CPAP?"). As long as the patient has sleep apnea, he must either use the machine or undergo surgery to treat the problem.

Surgical Treatment

If a patient is not successful with weight loss and cannot tolerate CPAP or chooses to not use it for the rest of his life, we recommend considering a more permanent surgical solution to the problem. The first step is to evaluate the upper airway through a detailed assessment of nasal, oral and pharyngeal anatomy to determine all sources of obstruction. The appropriate surgery is then determined based on the obstruction site, the patient's general health, and the ability to stage the treatment to reduce the degree of risk and pain.

1. Septoplasty and Turbinate Reduction for nasal obstruction
For significant nasal obstruction, treatment involves a septoplasty and/or turbinate reduction. These are relatively pain-ftee, safe procedures performed in an ambulatory care (outpatient) setting. It is sometimes necessary to perform this surgery to allow CPAP to function.

Obstruction at the back of the mouth is corrected by a tonsillectomy and a UPPP. A UPPP involves trimming some muscles at the back of the throat, removing some of the uvula, and rotating part of the uvula forward onto the soft palate. This not only improves the airway but also reduces most snoring, and that in itself can improve sleep. These procedures may require one overnight hospital stay.

Obstruction further down the throat, behind the tongue, is treated with two simultaneous operations.

a) In the genioglossus advancement with segmental mandibular osteotomies, a window is cut in the jaw bone and the tongue muscle pulled about 1/2 inch forward. This repositioning keeps the tongue permanently more forward when the patient is asleep. This procedure, which requires hospitalization for about two days, is painful and has a risk of temporary aspiration (choking when drinking liquids).

b) For hyoid myotomy and anterior suspension, a small bone in the neck is pulled forward and down. This repositioning also pulls the lower part of the tongue more forward during sleep.

Sleep Apnea and Snoring: My child has sleep apnea

Some children suffer obstructive sleep apnea due to excessively swollen tonsils and adenoids. The combination of enlarged adenoids blocking the back of the nose and large tonsils blocking the back of the throat results in obstruction of the airway while the child is asleep. Usually these children snore extremely loudly and have a restless sleep, tossing and turning throughout the night. They will not be well rested in the morning and may continue to need an afternoon nap.

Sleep apnea can be diagnosed by the parents when they hear two missed breaths due to the throat obstructing the airway. Often the child will snore loudly; there will be a pause for 8-10 seconds, and then a very loud resuscitative snort. If this only occurs when the child is having an infection, then treatment is usually not necessary. If this pattern is chronic, then a tonsillectomy and adenoidectomy may be required to return the child to full health.

Sleep Apnea and Snoring: What is nasal CPAP?

Nasal CPAP is a breathing system, which uses room air to pump this into the nose and pharynx through a mask over the nose. The positive pressure prevents the tissues from collapsing during inhalation. Nasal CPAP may be based on the results of a sleep study and a complete evaluation of the nose, mouth, and pharynx.