Snoring

What You Need to Know About Your Snoring

What is snoring?


Snoring is the sound made by the fluttering of the loose soft tissues in your throat that occurs during sleep. When we are awake, our throat muscles keep the air passages open. When we sleep, especially during the deepest, most satisfying stages of sleep, our muscles relax, allowing the tissues to collapse together. (Can include a video from eyemaginations )

Why do I snore?


There can be many reasons why an individual might snore, and various combinations exist in each snorer. Successful therapy frequently must address several areas.
  1. Anything that narrows the air passage
    1. Excess weight: The fat that increases the width of the neck also presses inward
    2. Unusual anatomy the takes up space in the throat
      1. Large tonsils or adenoids
      2. A recessive upper or lower jaw
      3. Large tongue
      4. Large uvula
      5. Congenital narrow air passage
      6. Cysts or tumors in the throat
  2. Things that cause the muscles to be more relaxed
    1. Sedating medications, like tranquilizers or antihistamines
    2. Alcohol
    3. Muscle relaxants
    4. Lack of conditioning
    5. Sleep deprivation (this makes your body get very relaxed)
  3. Things that increase the effort of breathing create a greater negative pressure in the throat that sucks the walls of the throat together.
    1. Nasal blockage
      1. polyps
      2. deviated septum
      3. enlarged turbinates

Why do I need a sleep study?


A sleep test is the only way to determine whether you have sleep apnea. This is a condition with serious health risk. Apnea means "no breathing" and it can cause high blood pressure and heart arrythmias. Excessive daytime sleepiness can also lead to serious accidents at work or while driving. The treatments for sleep apnea are different from those done for snoring. Finally, your insurance company will pay for treatment for sleep apnea, but you will have to pay for snoring treatment.



Is snoring the same as sleep apnea?


Snoring can be a sign of sleep apnea, but not all snorers have it. As we snore, the tissues of the throat flutter together.

Obstructive sleep apnea is a condition in which the tissues of the throat not only flutter, but they come together completely, blocking the air passage for a period of time until they brain wakes one up enough to get the muscles to re-open the throat. This awakening may not be all the way to consciousness, but it is awake enough to make it feel like you haven’t slept enough the next morning, especially when this occurs tens or hundreds of times each night. It is while your air passage is blocked that the level of oxygen in your blood decreases, and this is what then leads to high blood pressure and heart problems.



What if the sleep tests indicate that I do not have sleep apnea?


You will want to do all the things you can do yourself to improve your condition:

  1. Lose weight
  2. Get more exercise
  3. Get enough sleep
  4. Avoid alcohol or sedatives before bed
  5. Tape a ping pong ball to your pajama back to prevent you from getting onto your back
  6. Ear plugs for your bed partner

What if all that doesn’t work?


We will try to improve your condition by working with you to

  1. Remove any obstructions found in the throat
  2. Stiffen tissues in the throat to prevent fluttering
  3. Improve the nasal air passages
  4. Keep the tongue from falling backward during sleep
  5. Reduce the uvula and palate tissue

What treatments are available in Dr Mann’s practice to accomplish these goals?

  1. CPAP treatments- The same machine used for those with sleep apnea can be used successfully for snoring. A mask is worn over the nose connected to a machine that forces the air passages open with air. It is very effective, when tolerated and used regularly. The machine typically must be purchased for about $1000. Masks will need to be purchased from time to time. 
  2. Nasal airway can be improved with:
    1. Nasal sprays
    2. Removal of nasal polyps – this is done in the outpatient department at the hospital and is covered by insurance. 
    3. Straightening of deviated septum – this is an outpatient procedure done at the hospital, involves a couple of days of downtime, and is covered by insurance. 
    4. Turbinate reduction - this can be done safely and painlessly in the office or the outpatient hospital setting, and is also covered by insurance. 
  3. Tissues can be stiffened.
    1. The palate can be stiffened with radiofrequency. This is a procedure that is done in the office under local anesthesia. The procedure is nearly painless, and there is no post-procedure down time. One to four treatments may be required to accomplish the goal. Over time, the procedure may need to be repeated in order to maintain the benefit. This is not covered by insurance.
  4. Excess tissues can be removed
    1. Tonsils and adenoids, if enlarged, can be removed. This is done in an outpatient setting in the hospital, and is covered by insurance. There is significant down time - about 1 week out of work. 
    2. Enlarged tonsils can be reduced with radiofrequency treatment. This is done in the office under local anesthesia. Because we do not do a deep removal, there is less pain than from typical tonsillectomy. There is little down time. The procedure may need to be repeated to gain the maximum effect. 
    3. Enlarged tonsils can be reduced with the laser. The procedure hurts more than the radiofrequency, but less than complete tonsillectomy. 
    4. A portion of the uvula (that part that hangs in the middle of the back of the throat) can be removed as well as a portion of the palette. This is useful if the structure is enlarged or the passage is narrow. This is an outpatient procedure, and can be done with the laser. This procedure requires a week or more to heal from, and can be very uncomfortable initially. On the other hand, the results are more dependable, and frequently accomplishes the goal in one treatment.
    5. Additional portions of the palate can be removed using the laser or radiofrequency. This is also likely to be painful for a week.

We can discuss these procedures with you in detail when the time comes. 



What do we recommend for the treatment of snoring without sleep apnea?


First, we must remember that this is a chronic disorder, for which there is no cure. We can treat the condition, but constant vigilance may be required to maintain the benefit. For example, excess weight gain following surgery could lead to recurrence of the problem. Tissues that we stiffen may loosen up over time as the forces of nature typically do soften scars. Therefore, any program designed to treat snoring must be a long term program. You must be vigilant, and we must have ways of maintaining a result once it is achieved. Also, understand that there is a group of patients for whom no amount of surgery will be of help. We try to identify these people ahead of time, and recommend them to CPAP. Some of our attempts at surgery will be unsuccessful - probably 20% - after all has been tried. 



Keeping in mind that we want to decrease expense for you, and decrease the time lost from work and maximize the benefit, we recommend the following program:

  1. weight loss is frequently helpful
  2. Avoid alcohol and sedatives at night
  3. Sometimes a device to keep you sleeping on your side can help
  4. Consider removal of the tonsils if they are very big. We can shorten your palate while we do this and take care of the problem. Some of this procedure may entail out-of-pocket costs.
  5. If your anatomy is otherwise normal, we will recommend a series of palate stiffening procedures. If this is unsuccessful, we will recommend tissue removal procedure, with the laser, or a dental appliance
  6. If you have excessive tissue in the throat, we will instead recommend Laser treatment as a first choice.
  7. Those who fail treatment will be encouraged to use CPAP. 
  8. All payments are made for services rendered, and no guarantees are made. No refunds are available.