Snoring & Sleep Apnea

Sleep apnea and snoring are part of a spectrum of diseases that can be described as Upper Airway Resistance Syndrome diseases.

Mild increased upper airway resistance while sleeping results in snoring. Mild snoring is probably not harmful. As Upper Airway Resistance increases during sleep from a variety of factors, initially snoring becomes much lighter and eventually results in complete obstruction of the airway, which is known as sleep apnea. Upper Airway Resistance Syndromes are usually due to multiple underlying problems. These include relaxation of the muscles of the throat during sleep, which tends to progress with age. An enlarged set of palatine tonsils and an elongated soft palate and uvula, as well as anything which contributes to nasal obstruction such as septal deformities, nasal fractures, nasal septal deviations or turbinate hypertrophy are all additional factors which can result in increased upper airway resistance and resistance during sleep. Heavyset patients, many times, will fall asleep spontaneously many times during the day; this is known as narcolepsy. However, even mild weight gain in the order of 10-20 pounds can result in a significant increase in airway obstruction, snoring and/or sleep apnea during sleep. Sedative medications such as alcohol, antihistamines and tranquilizers can also aggravate the condition.

Treatment for snoring is important because of the possible risks that it presents to a person’s health, short-term and long-term. At this point in time it is not accepted, at least by insurance companies, that snoring, however loud, in the absence of apnea indicates a health risk. If a patient has problems with sleep apnea they are at risk from injury during periods of narcolepsy, especially if operating heavy machinery or driving. Additionally, more severe forms of sleep apnea have been shown to cause heart failure, decreased levels of oxygen in the blood during sleep, and are thought to contribute to hypertension and chronic pulmonary disease, and even sudden death while sleeping. Therefore, treatment of Upper Airway Resistance Syndrome is indicated and the urgency of treatment is, in general, proportion to the severity of the syndrome.

There are effective surgical and nonsurgical treatments for snoring and sleep apnea. One of the nonsurgical treatments for sleep apnea is a dental device which is similar to a large orthodontic retainer or a bite block used by athletes participating in contact sports. This device positions the jaw forward and improves airway during sleep. Some patients have had good results with these devices, however, many patients find them out of their mouths and in the bed by morning. Another nonsurgical device, which is very effective in treating snoring and sleep apnea, is the CPAP machine. This machine delivers continuous positive airway pressure during inspiration which helps maintain the patency of the airway and has been very effective in treating patients with snoring and sleep apnea. It’s side effects include soreness of the mouth, dryness of the mouth, dryness of the nose, and the disadvantage of having a machine with a face mask on in the bedroom at nighttime. Recent improvements in the masks and apparatus have resulted in increased patient satisfaction. However, long-term continuation of patients’ use with these devices, in some studies, is less than 50%. Some patients with severe sleep apnea find that after they have undergone a surgical procedure they require less pressure with their CPAP machine and are much better able to tolerate it than prior to surgery.

The Pillar Procedure is the first and only FDA cleared implant system to treat the soft palate component of snoring and mid to moderate snoring. The Pillar Procedure typically takes 20 minutes and is performed in Dr. Gilmore's office. It is not covered by insurance.

Surgical procedures for nasal obstruction, including septoplasty and turbinate reductions, have been performed, at least for decades, and the benefits and risks are well established. Many times these are used as adjuncts to surgeries on the airway to improve snoring and sleep apnea if nasal obstruction is a significant part of the problem.

The uvulopalatopharyngoplasty (UVP) is a surgical procedure during which the palate and uvula are shortened in the operating room. This has been demonstrated to be 80% or more effective for patients with snoring. Sleep documented “cure” of patients with severe sleep apnea with this surgical procedure has been shown to be somewhat less than 50%, however, patients subjective improvement rates are better. If the tonsils are present and/or enlarged, they are usually removed at the same setting. Risks of the surgery include post-operative bleeding anywhere up to two weeks after the surgery which occasionally can require a return trip to the operating room. Changes in speech with increased leakage of the air through
the nose known as “velopharyngeal insufficiency” have been reported long-term, but usually resolve within the first two weeks after surgery. Additionally some fluids can regurgitate through the nose if too much of the soft palate is removed. However, again, this is usually a self limited condition which resolves within the first two weeks after surgery.

The LAUP procedure (Laser uvulopalatopharyngoplasty) was developed for patients with snoring but without sleep apnea, and whom insurance benefits were not available for paying for treatment. The procedure is performed in the office with the patient awake and soft palate anesthetized in a similar fashion used for dental procedures in a dental office. During this procedure the patient is awake at all times. The risks are the same as the risks for a uvulopalatopharyngoplasty. The advantages are the absence of the charges for the hospital and for the anesthesiologist. The disadvantages are that occasionally more than one session, and occasionally up to three or more sessions, are required to achieve the desired result.

Upper Airway Resistance Syndromes are increasingly becoming recognized as a threat to a patient’s health and wellbeing, however, effective surgical and nonsurgical treatments are readily available to help patients deal with these conditions successfully.

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