Snoring is a symptom that typically bothers the spouse or companion much more than the patient who is asleep. It is very common in adults with perhaps 40% of the males having this symptom and 25% of females. When young children snore it usually indicates enlarged tonsils and adenoids. The adults snore when the soft palate and uvula vibrate excessively when the throat relaxes in sleep. The back of the tongue may play a role in a small percentage of people. Nasal blockage will make snoring worse. Snoring can be a sign of a more serious condition, sleep apnea.
Conservative measures for snoring such as weight loss, avoiding alcohol before bedtime, avoiding sleeping on the back and relieving nasal obstruction are helpful. Treatment for snoring is directed at the back of the throat where the palate and uvula are vibrating. An older treatment procedure involved removing parts of these structures with the laser. We now have methods that are much less painful and very effective. Radiofrequency techniques (somnoplasty) are directed at shrinking and stiffening the uvula and soft palate by gently heating the tissues under the mucous membrane surface. This is performed as an office procedure, usually involving three treatments. There are also procedures to implant Dacron battens (Pillar procedure) within the soft palate to reduce vibration. Snoreplasty involves an injection of medication in the palate to induce deliberate scarring and stiffness. There are dental devices which reposition the jaw forward to reduce collapse in the back of the throat. Each of these procedures can be reviewed with an ear, nose, and throat specialist. The over-the-counter sprays for snoring are unproven and typically not effective.
When a sleeping individual is observed to be struggling for air for 10 seconds or more before taking a breath, this indicates apnea. The brain becomes aroused as the body struggles to breathe and this leads to poor sleep. In adults, excessive weight, shape of the chin nasal obstruction, and narrowing of the posterior throat all play a role in sleep apnea. The patient will often have daytime fatigue, high blood pressure, and even cardiac arrhythmia. Whenever this condition is suspected, a sleep study is indicated. This test involves taking measurements while a patient is asleep. It will determine whether there is apnea, the frequency and the level of hypoxia (lack of oxygen). There may be association with restless leg syndrome and other sleep disorders.
For those patients who test positive, treatment involves the use of a nasal mask and a small quiet air pump to push past the obstruction in the throat. It is quite effective in relieving apnea. Dr. Feld is now recommending APAP over the older CPAP device. APAP automatically adjusts the air pressure depending on on the patient’s sleep position and is usually much more comfortable to wear. Not everyone can tolerate the use of a mask. Alternate treatments can include the use of a dental device. Surgical treatment has become the last option. The surgery involves the removal of tissue and remodeling of the soft palate as well as removal of the tonsils when present. Reduction of the tongue base may be necessary.