Dr. Hazenfield -- Ear, Nose, and Throat Doctor in Hawaii

Sleep Disorders -- Snoring and Sleep Apnea

Hugh N. Hazenfield, M.D., F.A.C.S.

Snoring:

• Background

   

  • 45% of normal adults snore at least occasionally

  • 25% snore habitually

  • Snoring is more frequent in males and overweight persons, and it usually grows worse with age.

  • At least 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. 

    • Variations on the old idea of sewing a sock with a tennis ball inside it on the back of the pajama top to force the person to sleep on his side. 

    • Some devices reposition the lower jaw forward; some open nasal air passages; others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs.

    • If you snore, it is not under your control whatsoever.

    • If anti-snoring devices work, it is probably because they keep you awake.

• Causes of Snoring

   

  • Snoring occurs 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 picture below) where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

   

   

  

   

  • 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 and throat tissue.  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 and acts as a noisy flutter valve during relaxed breathing.  A long or swollen uvula makes it 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, with resultant snoring.  Snoring may occur only with allergies or with a cold or sinus infection.

  • Deformities of the nose or nasal septum, such as a deviated septum (the middle of the inside of the nose) can cause an obstruction.

   

• Is snoring serious?

   

  • Socially, snoring subjects the person to ridicule and joking and disrupts others' sleep.  It has been known to cause marital discord and even divorce.

  • Medically, it can disturb sleeping patterns and deprive the person of necessary rest.  When snoring is severe, it can be associated with serious, long-term health problems, including obstructive sleep apnea.

Obstructive Sleep Apnea:

• Background

   

  • Obstructive sleep apnea occurs when breathing stops completely due to an obstructed airway.  When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea.

  • Obstructive sleep apnea is serious if the episodes last more than ten seconds each and occur more than seven times per hour.  Apnea patients may have 30 to 300 such events per night.  Blood oxygen levels may fall, causing the heart to pump harder.  A myocardial infarction (heart attack) is possible.

  • Not all individuals who snore have sleep apnea.

  • Not all individuals with sleep apnea snore.

  • Effects on the patient:

    • The patient sleeps lightly with tensed muscles.

    • The patient may have morning headaches.

    • The patient is fatigued and may even fall asleep during the day.  This is especially dangerous while driving or if working around machinery.

    • The patient may develop hypertension (high blood pressure) or heart problems.

• Seeking help:

   

  • People who snore loudly, snore in any position, snore loudly enough to disrupt others' sound sleep, or stop breathing in sleep should seek medical advice to ensure that sleep apnea is not a problem.

  • An otolaryngologist (ENT doctor) will perform a thorough evaluation of the patient's history and a thorough examination of the nose, mouth, throat, palate, larynx, and neck.

  • A sleep study in a sleep laboratory may be required for complete evaluation and is usually necessary prior to treatment for sleep apnea.

Treatment:

• Treatment depends on what is causing the obstruction such as allergy, infection, deviated nasal septum, enlarged tonsils, adenoids, uvula, or tongue, or fat beneath the lining of the throat.

• Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons:

   

  • Nasal CPAP (continuous positive airway pressure) is applied with a mask over the nose or inserts in the nostrils.  Some patients (or their bed partners) are unable to tolerate it or do not wish to use it and seek a surgical treatment.

  • Diathermy Palatoplasty is a procedure for treating both snoring and sleep apnea.  This may be used to decrease the bulk of the palate, uvula, base of the tongue, or turbinates (bony structures in the nose).  It is usually a relatively simple procedure in the office under local anesthesia.  Post-operative main is usually minimal.

  • Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages.  It is performed under general anesthesia and requires a hospital stay for one or two nights. Post-operative pain is moderate to severe.

  • 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.  It is usually done at the same time as a UPPP.

• A child who snores loudly, frequently, or who stops breathing during sleep should be examined by an otolaryngologist for possible enlargement of the tonsils and adenoids or other causes of airway obstruction.  Allergy treatment and/or a tonsillectomy and adenoidectomy may be required.

• Adults who suffer from mild or occasional snoring can try the following remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone.

  • If obese, lose weight now.  I will not perform surgery for sleep apnea unless you weigh less than 260 pounds.

  • 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 for the night.

  • Establish regular sleeping patterns.

  • Sleep on your side rather than your back.

  • Elevate the head of the bed by 4-6 inches.