Snoring
Snoring is a very common sleep disorder that can bothersome to the patient's family or friends, but may actually be the first sign of a more serious sleep disorder. This page will describe snoring and its management.
Causes of Snoring
Snoring is caused by vibrations of portions of the upper airway during sleep. The pertinent anatomy of the upper airway and its relationship to breathing while asleep is shown here. There are two structures that usually are the source for the noise: the soft palate and the base of the tongue.
The major concern with snoring is that obstructive sleep apnea (OSA) is very common in people who snore. OSA can have serious health consequences if it is untreated. If your spouse snores, you should closely observe him or her at night to see if there are breaks or pauses in breathing. This is a typical finding in OSA. Another sign of OSA is daytime somnolence. If either of these is present, or if the snoring is excessively loud, you should definitely bring it to your doctor's attention.
The etiology and the risk factors for snoring are very similar to those of OSA, so the discussions on that disorder linked above will overlap much of the material here. Snoring is known to be more common in overweight individuals. Difficulty breathing through the nose can worsen snoring. Certain anatomic features, like large tonsils, a large soft palate, or (most often in children) large adenoids can worsen snoring.
Treatment for Snoring
Before treatment for snoring can be considered, it is important to make determine if significant sleep apnea is present. This usually requires an overnight sleep study. Treating the sleep apnea usually also will correct the snoring. Since there can be health consequences of untreated sleep apnea, this takes priority.
If only snoring is present, it is actually treated using methods similar to treatment of mild sleep apnea. Losing weight, even a small amount, can be quite effective in reducing snoring.
If nasal obstruction is present, anything that improves nasal airflow may reduce snoring. Nasal swelling can occur with allergies, and a variety of different medications can be effective. If there is a deviated nasal septum, a septoplasty may be helpful. Some people have found breathing strips or other techniques to spread the nose useful.
Various pillows or other tricks to help reposition the snorer may be useful. Snoring is usually worse on one's back, so anything that encourages the snorer to sleep on his or her side can help out. Compliance may be a problem with anything that is uncomfortable or impractical.
Somnoplasty and Other Surgical Treatments of Snoring
Various surgical techniques can be useful in reducing the severity of snoring. These procedures do not eliminate snoring, but may make it less loud so is better tolerated by the patient's spouse. Snoring is most often caused by fluttering of the soft palate, so the goal of the operations is to stiffen up the palate and prevent this movement.
Laser or Cautery Assisted Uvulopalatoplasty (LAUP or CAUP)
A LAUP ("lay-up") or a CAUP is an office-based procedure in which the surgeon makes a linear cut about 3/4" long on either side of the uvula, and may trim a portion of the uvula. As this incision heals, it causes some scarring of the back of the palate. This shortens the palate and reduces its tendency to vibrate. A LAUP or a CAUP is generally not felt to be sufficient for severe sleep apnea, but seems to help in mild cases. The cautery cuts as well as the laser, and there doesn't appear to be any large advantage to using one method over the other (except that lasers are a lot more expensive than cautery units).
Somnoplasty
Similar in principle to a LAUP or a CAUP is somnoplasty. Somnoplasty is a new procedure that uses radio frequency energy to heat tissue in the palate, causing formation of a lesion that gradually scars down and reduces the size and floppiness of the palate. The improvement is not immediate, but rather develops gradually over 3-6 weeks. The handpiece used to deliver the energy for somnoplasty has a thermocouple that keeps the temperature at just the right level during treatment. Three regions of the palate are typically treated at one time, and improvements are often seen after just one treatment. Somnoplasty is also an outpatient procedure and is quite a bit less painful that a LAUP, CAUP, or UPPP.
 The diagram to the left shows how somnoplasty works. The handpiece has a small needle that, after numbing up the palate, is placed in the middle of the soft palate. The radio-frequency energy then creates a lesion shown as the white spot in the illustration.
|
