Snoring & Sleep Disorders

Snoring & Sleep Disorders - About

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 people and usually worsens with age. Snoring occurs when your breathing is partially obstructed in some way while you're sleeping. As you breathe, air travels through passages in your nose and throat. When these air passages are wide enough to allow air to flow freely, you breathe quietly. However, if the passages become too narrow, the tissues of the throat may start to vibrate, leading to snoring. An otolaryngologist (ENT Specialist) can help you to determine the cause, or causes, of your snoring and offer solutions. It is common for snorers to have multiple factors that contribute to their snoring problem, as opposed to just a single factor.

Problems in the structure of the nose may obstruct breathing. A crooked, or deviated, septum or swollen turbinates can lead to nasal obstruction. Nasal polyps, allergies, and chronic sinusitis can also cause nasal obstruction. These problems, in turn, can lead to mouth breathing and contribute to snoring. Large tonsils, a floppy soft palate or an elongated uvula are common findings with snorers because they can decrease movement of air through the mouth. A receding jaw or enlarged tongue may also obstruct oral breathing, by allowing the tongue to come into contact with the back of the throat. Weight gain increases the thickness of the tissues of the neck and throat, compromising the diameter of the airway.

In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, who may recommend a tonsillectomy and adenoidectomy to return the child to full health.

Obstructive Sleep Apnea - About

Light snoring may not disrupt your overall sleep quality. Heavy snoring may be associated with obstructive sleep apnea, which can be a serious sleep disorder.

Obstructive sleep apnea is a reduction in breathing or temporary stop of breathing during sleep due to blockage of the nose and/or throat. Besides snoring, gasp or snort in your sleep, Sleep apnea can decrease the level of oxygen in the blood and it can also disrupt sleep as your body attempts to restart breathing.

People with sleep apnea can feel tired even after a full night's sleep, may have morning headaches, have problems with memory or concentration, and feel irritable. Sleep apnea also makes you more likely to develop certain other problems such as high blood pressure, diabetes, coronary artery disease, and stroke.

Snoring & Sleep Disorders - Diagnosis

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Sleep specialists are doctors who diagnose and treat people who have sleep problems. Some ear, nose, and throat (ENT) doctors specialize in snoring and sleep disorders. Medical and Family Histories

Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them. Many people aren't aware of their symptoms and aren't diagnosed.

Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.

You may also need to keep a sleep diary for two weeks. This includes information about what time you went to bed each night, when you woke up in the morning and how many times you woke up each night. This will help the doctor see your sleep patterns, which could contain clues about how to diagnose and correct your sleep problem.

If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.

Physical Exam

Your doctor will check your mouth, nose, and throat for extra or large tissues. Children who have sleep apnea might have enlarged tonsils. Doctors may need only a physical exam and medical history to diagnose sleep apnea in children.

Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.

Sleep Studies
If sleep apnea is suspected, an overnight sleep study called a polysomnogram (poly-SOM-no-gram; also called a PSG) may be recommended.

A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure.

A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe.

PSGs often are done at sleep centers or sleep labs. The test is painless. You'll go to sleep as usual, except you'll have sensors attached to your scalp, face, chest, limbs, and a finger. The staff at the sleep center will use the sensors to check on you throughout the night.

Your doctor also may use a PSG to find the best setting for you on a CPAP (continuous positive airway pressure) machine. CPAP is the most common treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your airway open while you sleep.

Home-Based Portable Monitor

Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG. For example, it may record:

The amount of oxygen in your blood Air movement through your nose while you breathe Your heart rate Chest movements that show whether you're making an effort to breathe A sleep specialist may use the results from a home-based sleep test to help diagnose sleep apnea. He or she also may use the results to decide whether you need a full PSG study in a sleep center.

Snoring & Sleep Disorders - Treatment

Treatment depends on the diagnosis and level(s) of upper airway narrowing. In some cases, more than one area may be involved.

Snoring or Obstructive Sleep Apnea (OSA) may respond to various treatments offered by many otolaryngologist—head and neck surgeons.

Conservative treatments—In mild cases of obstructive sleep apnea, conservative therapy may be all that is needed. Overweight persons can benefit from losing weight. Losing weight can be difficult with untreated obstructive sleep apnea due to increased appetite and metabolism changes that can occur with obstructive sleep apnea. Individuals with obstructive sleep apnea should avoid the use of alcohol and certain sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. People with sinus problems or nasal congestion should use nasal sprays or breathing strips to reduce snoring and improve airflow for more comfortable nighttime breathing.

Mechanical therapy—Positive Airway Pressure (PAP) therapy is the preferred initial treatment for most people with obstructive sleep apnea. With PAP therapy, patients wear a mask over their nose and/or mouth. An air blower gently forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. PAP therapy prevents airway closure while in use, but apnea episodes return when PAP is stopped or if it is used improperly. There are several styles, and types of positive airway pressure devices depending on specific needs of patients. For example CPAP (Continuous Positive Airway Pressure) is the most widely used of the PAP devices. The machine is set at one single pressure. Auto CPAP or Auto Bi-Level PAP uses a range of pressures that self-regulates during use depending on pressure requirements detected by the machine.

A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA. This should be fitted by an otolaryngologist, dentist, or oral surgeon with expertise in sleep dentistry.

Surgery—Surgical procedures may help people with obstructive sleep apnea and others who snore but do not have sleep apnea. There are many types of surgical procedures, some of which are performed as outpatient procedures. Surgery is reserved for people who have excessive or malformed tissue obstructing airflow through the nose or throat, such as a deviated nasal septum, markedly enlarged tonsils, or small lower jaw with an overbite that causes the throat to be abnormally narrow. These procedures are typically performed after sleep apnea has failed to respond to conservative measures and a trial of CPAP. Types of surgery include:

• Hypoglossal nerve stimulation (Inspire) represents the newest form of sleep apnea surgery. A nerve stimulator is implanted which stimulates the nerve that moves the tongue (hypoglossal nerve). This directs the tongue forward to open the back of the throat. It is only active during sleep.
• Uvulopalatopharyngoplasty (UPPP) removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration and collapse. This is typically performed with a tonsillectomy if tonsils are still present.
• Tonsillectomy is a procedure that removes the tonsillar tissue in the back of the throat which is a common cause of obstruction in children with sleep apnea.
• Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base, and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser, and radiofrequency. These procedures may be done in the operating room or during an office visit. Several treatments may be required.
• Genioglossus and hyoid 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.

Nasal surgery includes correction of nasal obstructions, such as a deviated septum.

New (investigational) procedures:
Trans-oral Robotic Base of Tongue Resection: In this procedure a surgical robot is used to resect (remove) a large section of the backend of the tongue. This procedure is available in select academic centers.

Tongue Pacemaker: A pacemaker (similar to a cardiac pacemaker) is inserted in the chest. This activates the nerve that controls the tongue, pulling it forward as one breathes in. This procedure has recently received conditional approval by the FDA.

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