About Snoring Treatment
In the information below we’ve provided some general information about the treatment for snoring. For specific information about how we can help you, contact us for a consultation.
What causes snoring?Snoring is the sound generated by the vibration of the structures at the back of your throat. Mild snoring is not associated with excessive daytime sleepiness or difficulty sleeping at night. Obstructive sleep apnoea (OSA) is a condition where your breathing stops for short spells when you are asleep. However, it is not uncommon for breathing to stop for a few seconds in healthy people during sleep. Only when apnoea occurs more than five times every hour, each time for more than 10 seconds, that it becomes a health problem and we call it OSA. During these episodes, there is at least 3% to 4% fall in your blood oxygen. You wake up briefly after each episode of stopped breathing to start breathing again. You do not usually remember the times you briefly wake up, but you have a disturbed night’s sleep. This is associated with excessive daytime sleepiness, waking with gasping, choking, or breath-holding. Snoring between these episodes is a frequent complaint of bed partners and is often the reason that prompts patients to seek medical attention. When we sleep, all the muscles in our body, including the throat muscles relax and become floppy. In most people, this does not block breathing. If you have OSA, the throat muscles become so relaxed and floppy during sleep that they cause a narrowing or even a complete blockage of the airway. When your airway is narrowed, it restricts the flow of air, at first this causes snoring. If there is a complete blockage, then your breathing stops (apnoea). Your blood oxygen level then goes down, and your brain detects this. Your brain then tells you to wake up, and you make an extra effort to breathe. Then, you start to breathe again with a few deep breaths. You will generally go back off to sleep again quickly and will not even be aware that you have woken up. Your bed partner will notice that you stop breathing for a short time, and then make a loud snore and a snort, and then get straight back off to sleep. For the diagnosis of OSA, you need to have at least five episodes of apnoea per hour of sleep. However, there are different levels of severity of OSA (mild, moderate, or severe). People with severe OSA can have hundreds of episodes of apnoea each night. OSA is classified as:
- Mild OSA – between 5-14 episodes an hour
- Moderate OSA – between 15-30 episodes an hour
- Severe OSA – more than 30 episodes an hour
- Overweight (BMI above 25) or obesity (BMI above 30)
- Thick neck (usually if the Collar size is more than 17 inches in males or 16 inches in females) because the extra tissue in the neck can squash the airway.
- Drinking alcohol before you sleep causes excessive relaxation of your muscles and makes the brain less responsive to an apnoea episode. This may lead to more severe apnoea episodes in people who may otherwise have mild OSA.
- Enlarged tonsils and adenoids
- This is the commonest cause in children
- Taking sleeping tablets or tranquilizer
- Sleeping on your back rather than on your front or side
- Having a small jaw or a jaw that is set back further than normal
- Smoking by causing an inflamed swollen airway
What symptoms could indicate OSA?Even if you have OSA, you may not be aware of it as you will not usually remember the waking times at night. It is often your sleeping partner (or the parent if it is a child) that is concerned about the loud snoring and the recurring episodes of apnoea that they have noticed. However, you may be aware of the following problems:
- Daytime sleepiness and being tired
- Poor concentration and mental functioning
- Not feeling refreshed on waking
- Morning headaches
- Being irritable during the day
- Pass urine frequently during the night
- Night sweats
- Reduced sex drive
Are there serious repercussions of OSA?In children, significant OSA has been linked to poor performance in studies and sports, and some studies have shown a weak link to reduced overall intellectual development. OSA can be a serious health problem in adults as studies have shown that OSA without treatment can either lead to or worsen the following medical conditions:
- Heart attacks
- Type 2 diabetes mellitus
How do you diagnose OSA?OSA is diagnosed based on your complaints, the findings on your physical examination, and results of tests.
Your symptomsIf you have daytime tiredness, sometimes a questionnaire is used to measure to estimate the level of sleepiness that you feel during the daytime. A score above 10 indicates that you may have a sleeping disorder such as OSA. However, it is important to remember that many people with a high score will not have sleep apnoea, and not everyone with sleep apnoea will have a high score. Therefore, it is vital that you do not consider the score on ESS as confirmatory as this has to be reaffirmed with your complete medical assessment and other investigations.
Tests to confirm OSAIf you have any of the symptoms mentioned above that suggest OSA, or a high score on the Epworth Sleepiness Scale, I may recommend certain tests. Many types of test can be done while you sleep; the most common ones include:
- Pulse Oximeter – Monitors the oxygen level in your blood by a probe clipped on to your finger.
- Polysomnography – This is the best but also the least available and most costly test that monitors various aspects of your sleep. It monitors the airflow through your nose, your chest movement, the electrical activity of your brain, snoring volume, blood oxygen saturation, and a video of your sleep. You may be asked to spend a night in the sleep lab for these tests to be done.
- I may also suggest other tests to exclude other causes of your sleepiness. For example, a blood test can check for an underactive thyroid gland or overactive pituitary gland.
Clinical examinationIf you are bothered by significant snoring or have had tests showing OSA, a physical examination is carried out to see the site that is obstructing your airway. This includes an examination of your nose, throat, and voice box, most commonly by a bendy camera that is passed through one of your nostrils (flexible naso-laryngoscope). This is usually done in the clinic while you are awake.
What are the non-surgical treatment options?Before having any operation, it is advisable to consider the following treatment options as the majority of OSA patients will benefit/get cured by these:
Changes to your lifestyle and habits
- This is the first step, and you may find a significant benefit from making the following changes:
- Losing some weight if you are overweight or obese
- Not drinking alcohol for 4-6 hours before going to bed
- Not using sedative drugs
- Stopping smoking if you are a smoker
- Sleeping on your side
- Keeping props under the head end of your bed to elevate it and by using extra pillows
Continuous positive airway pressure (CPAP)This is the most effective non-surgical treatment for OSA and should be tried before considering an operation or if the changes mentioned above do not work or are not possible. CPAP involves wearing a mask when you sleep that is connected to an electrical machine that pumps room air into your nose at a slight pressure. The air pressure keeps the throat open when you are breathing at night, and so prevents the blockage of airflow. If CPAP works, then snoring is reduced or stopped, and there is an immediate improvement in sleep. Lifelong treatment is needed. Sometimes you can have problems with throat irritation or dryness, or bleeding inside your nose. We can treat these problems with newer CPAP machines that tend to have a humidifier fitted. Some people find the device cumbersome to wear at night. Due to these problems, around 40% to 50% of OSA patients fail to use CPAP for long.
Mandibular advancement devicesThese are devices that you can wear inside your mouth when you sleep. They work by pulling the mandible forward a little so that your throat may not narrow as much in the night. These devices look a bit like gum shields that sports-people wear. To get the best results, you should get one tailor-made to the shape of your teeth and gums and properly fitted by a dentist.
What are the surgical options for treating snoring/OSA?The operation aims to increase the airflow into your airway. The correct surgery for you would depend upon where your obstruction is and to what degree. As mentioned above, an accurate evaluation is critical to decide this so that the correct surgery is carried out for you
Tonsillectomy +/- AdenoidectomyThis is most commonly done in children with significant snoring or OSAS as relative large size of these structures is the most typical cause in that age group. Occasionally, adults have enlarged tonsils and will benefit from their removal.
Nose surgeryIt is rare for your nose to be the cause of obstruction. If it is, an operation to straighten the nose, the septum inside or to widen the inside can be done. This can also be very useful if a blockage in your nose is making it difficult for you to use the CPAP machine.
Palatal Z plasty / modified uvulopalatopharyngoplasty (UVPP)This is a procedure used to remove excess tissue in the throat to widen and allow air to move through the throat more easily when you breathe, reducing snoring. The tissues removed may include:
- The small finger-shaped piece of tissue (uvula) that hangs down from the back of the roof of the mouth into the throat
- Part of the roof of the mouth (soft palate)
- Enlarged throat tissue, tonsils, and adenoids
What to expect after UVPPIt takes about three weeks to recover from surgery. It can be quite painful, and it may be very difficult to swallow during this time. It is usual to notice small amount in blood in your throat or sputum while the wound heals itself. During the healing period, you may find yourself choking, especially when you drink thin fluid. You are likely to notice an improvement at about 3-4 weeks after the operation.
How successful is UVPP?The success of UVPP is dependent on proper patient selection based on good examination by an experienced clinician. In carefully selected patients, it can cure snoring in 80% of those who have had this surgery.
What are the risks / potential complications of UVPP?Like any other surgery, UVPP has some possible known complications, including:
- Swelling, infection, and bleeding
- Pain and trouble swallowing
- Drainage of secretions into the nose and a nasal quality to the voice
- Speech may be affected by this surgery
- Narrowing of the airway in the nose and throat
- Recurrence of snoring or OSA after a year or two
What causes snoring?
Snoring results from the vibration of throat tissue due to airflow. Usually, this occurs due to excessive volume and laxity of the soft palate /uvula and the back end of the tongue (lingual tonsil/base of the tongue).
During the assessment, I will perform an endoscopy to evaluate the exact site/s of actual narrowing. If this confirms that the narrow throat region leading to snoring is the palate and/or tongue base, your snoring is likely to improve/resolve by removal of excessive tissue and/or stiffening of the palate to reduce the narrowing and movement.
Coblation treatment for snoring?
Coblation is my preferred technique to stiffen or/and remove excess tissue from your soft palate and uvula. This is usually done under general anesthesia and takes 20 – 30 minutes. You are ready to go home after 4 hours.
The actual procedure involves removing the uvula (the dangling bit in the center of the palate), channelling under the surface of the palate and activating the instrument to remove and shrink tissue to reduce the size of the soft palate.
Sleep with your head elevated for the first few days/nights.
It is common to experience some pain and throat swelling. Sucking on ice chips, gargling with aspirin solution (if not allergic) and taking Paracetamol/Ibuprofen can help relieve pain and swelling.
Similarly, you may notice some difficulty in swallowing or speaking for the first few days – all of these side effects will settle down within a week.
You will notice an improvement in 3-4 weeks after the procedure.
Palatal Z plasty/modified UVPP treatment
If the amount of tissue in soft palate is excessive, stiffening procedures with coblation is not adequate. In such cases, you will require removal of the excess soft palate and tonsil area tissue. This will create extra space at the back of your nose and throat to breathe better while asleep.
Z plasty is a refined mechanism to achieve this and provides a better outcome and fewer problems compared to the traditional surgery (you may know the conventional operation as UVPP).
This procedure is done under general anesthetic, i.e., while you are asleep. It involves strategic repositioning of the throat tissue with minimal removal to create more space behind your palate. This is done through your mouth with no visible scar and usually takes 30 – 45 minutes.
I usually combine this procedure with coblation, which involves shrinkage of the base of the tongue.
You will experience pain comparable to tonsillectomy, and this can take up to two weeks to resolve. During this period you will be given (in liquid form) pain killers, antibiotics and steroids and will have to rely on liquid or semisolid soft diet. Most patients are back to normal diet and swallowing in two to three weeks. However, for the first couple of months, you may experience fluid going up your nose from the throat, particularly if swallowed quickly.
You must schedule at least two weeks off from work to recover after this surgery.
You will notice an improvement in breathing and snoring after the swelling settles down, usually in 2-3 weeks.
Sleep with your head elevated for the first few days/nights.
You will experience significant pain and throat swelling. Sucking on ice chips, gargling with aspirin solution (if not allergic) and taking Paracetamol/Ibuprofen can help relieve pain and swelling.
Similarly, you may notice some difficulty in swallowing or speaking for the first few days – all of these side effects should settle down within 2-3 weeks.
You will notice an improvement in 3-4 weeks after the procedure.
- Minimally invasive
- Can be done in the clinic under local anesthetics
- No serious side effects
- Can be repeated
- It may not work
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