Curing Snoring

Snoring is the disruptive noise made during sleep. We often do not know we are snoring until our bed partner pokes, prods or complains. The snoring can be so severe that some couples sleep in separate rooms or at separate ends of the house. Beyond the privacy of our bedroom, it can be embarrassing when napping on an airplane or sharing a hotel room with friends.

In many respects, snoring is just like playing a saxophone. A saxophone is made of a reed that vibrates and a long neck that contains a column of air that moves with the vibration. If we blow gently through the sax, the reed will not vibrate and there is no sound. We have to “honk” on it to make a noise or musical sound. This is achieved by our work to overcome an obstruction. In snoring, the tissues of the soft palate, nasopharynx, tonsils or base of tongue vibrate like the reed of the saxophone. The work of overcoming an obstruction is often related to a myriad of factors.

Obstructive sleep apnea occurs in individuals whose snoring is so severe that the airway collapses on inspiration. There is a cessation of air movement. Oxygen levels drop and the brain senses the drop in oxygen. The brain stimulates the body to move and disrupts normal deep sleep associated with dreaming. Patients often awake tired, need to nap during the day, have difficulty concentrating at work, and can doze at the wheel while driving a car. Truck accidents during the night and early morning hours may be related to sleep apnea. Untreated sleep apnea often leads to elevated blood pressure and is suspected to be a contributor to heart attacks.

Snoring and obstructive sleep apnea are often due to a combination of conditions, each of which would not alone cause the symptom. Therefore, the evaluation may include an assessment of weight, evaluation for sinus infections and allergies, as well as an examination of the tonsils, nasopharynx, tongue, and larynx. Flexible laryngoscopy demonstrates the dynamics of the snoring events.

Recommendations often start with the most simple and least intrusive suggestions. This includes a weight loss program and management of sinus, allergic and nasal problems that contribute to airway obstruction.

Sleep studies are recommended for those patients who do not respond to conservative management. Comprehensive studies are performed at sleep laboratories. Home sleep studies (e.g., SNAP) are excellent tools for screening patients with sleep apnea. Furthermore, they provide additional information about the quality and severity of snoring as compared to the studies at a laboratory.

Treatment of snoring and/or sleep apnea is based upon the history, the physical findings at examination, the response to conservative management, findings at flexible laryngoscopy, and the results of the sleep study. Each treatment has unique benefits. During your visits with us, we will find the best treatment for the source of your snoring.

Treatments to treat snoring

Radiofrequency volume tissue reduction (RFVTR) of the palate. After injecting a local anesthetic into the soft palate, a needle electrode is introduced into the muscle of the palate below the mucosa. Radiofrequency energy is applied to the muscle to coagulate a small area of muscle tissue. The electrode is withdrawn and the treatment is applied to several additional areas of the palate. Over the next several weeks, the coagulated muscle is absorbed and the body replaces the muscle with new collagen fibers that tighten the palatal tissue. There is no pain associated with this procedure. Most patients only notice a sense of fullness in the palate that lasts up to three days. After six weeks, if snoring is still a problem, the procedure can be repeated.

Injection snoreplasty. Injection of a sclerosing agent under the mucosa of the palate creates a mild blister. As the tissue heals, the body lays down new collagen fibers that tighten the palatal tissue. Some patients report only mild discomfort that lasts several days. After six weeks, if snoring is still a problem, the procedure can be repeated.

Pillar Implants (Restore Medical). Much like battons give stiffness to a sail on a sailboat and keep the sail from loughing (flapping), these implants are inserted into the soft palate to stiffen the tissue making it more difficult to vibrate. There is minimal discomfort. These implants can extrude and may need to be removed, but has not been reported to create any long term problems.

Laser-assisted uvulopalaoplasty (LAUP) or radiofrequency-assisted uvulopalaoplasty (RAUP). These office procedures shorten the palate (RFVTR palate and injection snoreplasty stiffen the palate). LAUP uses a laser while RAUP uses high frequency radiowaves to make incisions. After injection of local anesthetic, the palatal tissue is reduced until the patient has difficulty voluntarily making a snore. After the anesthetic wears off, pain is managed with analgesics and lasts about ten days or less.

Treatments to treat snoring & obstructive sleep apnea

Uvulopalatopharyngoplasty (UPPP). This operation is performed at the hospital under general anesthesia. The palate (and often the tonsils) is partially resected to remove excess or redundant soft tissue. The open wound is closed with sutures to create a larger and wider oral airway. An overnight stay in an intensive care unit carefully observing for any post-operative airway problems follows surgery. Pain after surgery is managed with analgesics, and often lasts two to three weeks.

Nasal continuous positive airway pressure (CPAP). This is a device that patients use during sleep. A specially fitted mask is worn over the nose (and mouth) and pressurized air keeps the airway expanded and open. The advantage of nasal CPAP is that patients with apnea will quickly see how good they feel when the apnea is reduced or eliminated. The disadvantage is that many patients prefer not to go to sleep hooked up to a machine that is plugged into an electrical socket.

Other adjunctive procedures used in the treatment of snoring and obstructive sleep apnea in adults include specially fitted dental appliances, RFVTR of the tonsils, nasal turbinates, or base of tongue, as well as surgery of the base of tongue. Children are often best treated with tonsillectomy and adenoidectomy.

Does health insurance cover?

Since obstructive sleep apnea has health risks associated with it, all plans provide coverage for the evaluation of the condition. If a diagnosis of apnea is confirmed, each plan has different criteria by which they decide which treatment modality they will cover and the limits of that coverage. If the diagnosis is snoring without apnea, health plans uniformly consider this a cosmetic or social problem but not a health risk and do not provide coverage for treatment.