Sleep Apnea and Snoring

At San Francisco Otolaryngology, our physicians are uniquely qualified to treat patients with obstructive sleep apnea (OSA)- the most common type of sleep apnea that occurs when the airway has collapsed or is blocked during sleep. We can diagnose sleep apnea through at-home or laboratory sleep studies, and we offer both medical and surgical treatment for various causes of snoring and sleep apnea.

Our partnership with Reve Sleep Center allows comprehensive evaluation, management and follow-up of your personal sleep condition.


Sleep Apnea

Sleep apnea is a common disorder which causes pauses in breathing, or shallow breaths, while you sleep. Sleep apnea is usually a chronic condition that disrupts your sleep. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow. This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness. Otolaryngologists are uniquely qualified to treat patients with obstructive sleep apnea (OSA)- the most common type of sleep apnea that occurs when the airway has collapsed or is blocked during sleep.

Snoring

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in men or overweight persons, and it usually grows worse with age. Snoring is an indication of obstructed breathing. Therefore, it should not be taken lightly. An otolaryngologist can help you to determine where the obstruction may be and offer solutions for this noisy and often embarrassing behavior.

 

What causes snoring?

The noisy sounds of snoring occur 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 illustration) where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

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

People who snore may suffer from:

  • 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 tissue, too. 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. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters 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, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection.
  • Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Why is snoring serious?

Socially – It can make the snorer an object of ridicule and causes others sleepless nights and resentfulness.
Medically – It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.

Is there a cure for heavy snoring?

Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer’s health.

What treatments are available?

Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids.

Snoring or obstructive sleep apnea may respond to various treatments offered by otolaryngologists:

Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages.

Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radiofrequency. Laser Assisted Uvulopalatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to shrink the uvula and tighten a specified portion of the palate in a series of small procedures in a doctor’s office under local anesthesia. Radiofrequency ablation—some with temperature control approved by the FDA—utilizes a needle electrode to emit energy to shrink excess tissue in the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).

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.

Continuous positive airway pressure (CPAP): The patient may sleep with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or CPAP. The air pressure helps to keep the tissues of the throat open during sleep and avoid the collapse that leads to airway obstruction.

Oral appliance therapy may help to reduce snoring and treat mild sleep apnea. These devices reposition the lower jaw forward to create more space for air flow in the back of the throat.

Self-help for the light snorer

Adults who suffer from mild or occasional snoring should try the following home remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  • 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.
  • Establish regular sleeping patterns.
  • Sleep on your side rather than your back.
  • Tilt the head of your bed upwards four inches. 

 

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