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Snoring and Sleep Apnea

Snoring interferes with the lives of many people, both men and women. It often interferes with the sleep of the bed partner and sometimes the whole household. Snoring is often associated with sleep apnea and sleep apnea can be life-threatening. Snoring has bothered people throughout the ages. Ancient legend defined snoring as "terrifying noises made by man at night to protect women by frightening away the beasts of prey.

Snoring is a noise made as air passes through the collapsible part of the upper airway-- the soft palate, the uvula, the tonsils, the tonsillar pillars, the soft tissue at the base of the tongue, the throat muscles and lining membranes, and tumors or anything protruding into these spaces. Snoring is three times as common in obese people as thin ones. It occurs in 60% of men and 40% of women by age 60. It can drive sleeping partners from the bedroom. It can awaken people sleeping in other parts of the house. It can disrupt business trips, camping/hunting trips, and family vacations. It can destroy marriages. It is embarrassing when it occurs at church or at the movies.

Nonsurgical management of snoring:

Avoid sleeping on ones back. Sleeping on one's side often helps.

Bite blocks have been made to hold the jaw forward so the tongue doesn't fall against the back of the throat.

Loose weight and works out regularly.

Avoid alcoholic beverages within 4 hours of retiring

Avoid tranquilizers, sleeping pills, and antihistamines

Keeping the neck extended and letting one's sleeping partner fall asleep first

Surgical procedures have been used to decrease the amount of floppy tissue in the back of the throat, decreasing the snoring. The procedure LAUP, laser assisted uvulopalatoplasty is one of the most common procedures done for snoring. The throat is treated with a local anesthetic in the office and the palate is trimmed. This is often done in increments, with 1-5 treatment sessions. Other treatments include cauterization or radiofrequency treatment of the palate or base of the tongue. Injection of the palate with stiffening agents has also been performed. Ask your otolaryngologist about the different procedures and the results obtained in his/her practice. These proceduresmay not eliminate snoring completely and are usually not covered by the patients insurance.

Sleep Apnea

It is important to differentiate simple snoring from snoring with sleep apnea because sleep apnea carries major, life-threatening risks. The biggest risk is the risk of having a heart attack after the age of 50. There is a higher risk of getting into an automobile accident because of the daytime sleepiness associated with sleep apnea. It is defined as cessation of airflow through the nose and mouth lasting 10 seconds or more. Just before breathing resumes, there is a brief microarousal. Obstrictive sleep apnea occurs when there are repetetive obstructive or mixed apneas associated with repetitive microarousals.

Symptoms:

Loud snoring

Hypersomnolence-- extreme sleepiness or falling asleep often during the day

Obesity

Morning headaches

Impaired intellectual performance

Personality changes or depression

Hypertension and cardiac arrythmias

Sexual impotence

Hyperactivity in children

The original treatment of obstructive sleep apnea (OSA) was a tracheostomy. This reduced the risk of death from sleep apnea to zero but has social and medical risks and problems of its own. CPAP was designed to push air through the obstructing parts of the airway and this generally works quite well. It does require an open nasal airway. A septal deviation, chronic allergies, nasal polyps, or enlarged nasal turbinates or tonsils can cause a patient to wake up suddenly unable to breathe. CPAP is generally pitched off the bed at that point and the patieht will say they don't "tolerate" CPAP. These are reasons a good otolaryngology exam is indicated in most patients with OSA.

Auto CPAP, BIPAP, and auto BIPAP are modifications and refinements of the original CPAP.

A sleep study defines the patients problems during sleep and allows titration of CPAP or BIPAP. Important information recorded during a sleep study during each portion includes the positions of the patient, the levels of sleep, the length of time spent in each level of sleep, the presence of REM sleep and non-REM sleep, vaariations in oxygen saturations, leg movements, the numbers and lengths of the apneas and hypopneas.

 

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