Snoring and Sleep Disorders
Snoring: Not Funny, Not Hopeless
Diet and Exercise Tips
Fact Sheet: Injection Snoreplasty
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.
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Diet and Exercise Tips
Excessive body weight contributes to snoring and obstructive
sleep apnea, in 
addition
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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Fact Sheet: Injection Snoreplasty
What Is It?
Injection snoreplasty is a nonsurgical treatment
for snoring that involves the injection of a hardening agent
into the upper palate. Army researchers from Walter Reed Army
Medical Center introduced this procedure at the 2000 Annual
Meeting of the American Academy of Otolaryngology - Head and
Neck Surgery Foundation. Their early findings indicate that
this treatment may reduce the loudness and incidence of primary
snoring (snoring without apnea, or cessation of breath). The
Academy neither endorses nor discourages the use of injection
snoreplasty for the treatment of snoring.
Download this Injection Snoreplasty fact sheet
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Those seeking injection snoreplasty to reduce
snoring should first be screened for obstructive sleep apnea
or OSA (frequent cessation of breathing due to upper airway
obstruction) by undergoing a sleep test. If sleep apnea is confirmed,
other treatment may be recommended.
Treatment
Injection snoreplasty is performed on an outpatient
basis under local anesthesia. After numbing the upper palate
with topical anesthetic, a hardening agent is injected just
under the skin on the top of the mouth in front of the uvula
(upper palate), creating a small blister. Within a couple of
days the blister hardens, forms scar tissue, and pulls the floppy
uvula forward to eliminate or reduce the palatal flutter that
causes snoring.
In some patients, the treatment needs to be
repeated for optimum benefits. If snoring occurs from vibrations
beyond the palate and uvula and/or obstructive sleep apnea is
suspected, further testing and alternative treatment options
may be advised. A thorough examination by an ear, nose and throat
specialist is recommended to diagnose the source and type of
snoring, and determine whether injection snoreplasty may be
helpful.
Post-Treatment Follow-Up
After injection of the hardening agent, patients
are observed in the otolaryngologist's office and then sent
home. Tylenolâ and throat lozenges or spray are suggested for
pain management. Patients can return to work the next day. Though
snoring may continue for a few days, it should eventually lessen.
A post-procedure sleep test may be administered to fully evaluate
the effects of the procedure.
Possible Side Effects
A residual sore throat or feeling that something
is "stuck" in the back of the mouth may occur. Suggestions
for treatment of sore throat include Tylenolâ and/or throat
lozenges or spray.
Statement on the Use of Sotradecol®
Sotradecolâ, a trade name for sodium tetradecyl
sulfate, is the most common hardening agent used in injection
snoreplasty. This agent is indicated by the Food and Drug Administration
(FDA) for "intravenous use only" and "for small
uncomplicated varicose veins of the lower extremities that show
simple dilation with competent valves." Warnings include:
1) "severe adverse local effects including tissue necrosis,"
and 2) "allergic reactions, including anaphylaxis, have
been reported that led to death."
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.
How Is Snoring Treated?
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;
and radiofrequency volumetric reduction of the palate, a relatively
new procedure performed in an otolaryngologist's office that
utilizes targeted radio waves to heat and shrink tissue in the
upper palate.
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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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