Snoring is no laughing matter

Monday, 02 June 2014

Obstructed airways during sleep can lead to serious health problems in the long run.Fortunately, snoring can now be easily cured by a variety of minor surgical procedures by Dr. Harihara Murthy,
Consultant – ENT surgeon, Nova Specialty Hospitals
Bangalore, 21 May, 2014: As a matter of day-to-day life, many people suffer from a range of health problems that appear minor on the surface but have the potential to develop into a serious issue with the passage of time and age. Snoring is one such condition. It is mostly dismissed as a natural phenomenon and is often the butt of jokes, but health experts warn that snoring should not be taken lightly because it arises from obstructed breathing.
While snoring is more commonly found in men, women are also hugely affected by the problem. Various studies suggest that about 45 percent of men and 30 percent of women snore occasionally or regularly while sleeping.
Causes
Snoring is a health disorder in which the tissues within the airways of the nose and throat vibrate. In other words, it is caused by the blockage of air as it passes through the narrow paths at the back of the mouth and nose.
Why do people snore? There are many reasons. Snoring could be a sign of an allergy. Obesity is another cause due to enlarged throat tissues in fat people. Children are often prone to snoring due to tonsils and adenoids. This is due to growth of adenoids, blocking the airway. Occasionally, this condition may be found in adults as well.
The condition could also be attributed to the quality of the tongue and throat muscles. If these become weak or loose, the tongue could lean backward into the airway or the throat muscles may slide inwards through the sides, obstructing the flow of air.
Yet another common reason for snoring is nasal polyps. These are unusual growth of tissues that obstruct the nasal passages.
In addition, the nose-to-throat air passage may get restricted by a long soft palate or a long uvula, causing them to throb and collide against each other. This leads to the airway getting partially blocked, leading to snoring.
The condition is often aggravated by the consumption of alcohol or other intoxicating substances that cause drowsiness.
Health Risks
Regular snoring may indicate an underlying medical problem such as Obstructive Sleep Apnea (OSA). It is a common sleep disorder marked by repeated halts in breathing due to obstruction in the airway. OSA is not easily detected as it affects a person only while sleeping and usually impacts middle-aged people. In addition, the size of the neck can also multiply the chances of developing OSA. The risk increases if the neck size is 17 inches or more in men and 16 inches or more in women. However, snoring does not necessarily mean that a person is suffering from OSA.
Some of the negative health effects of OSA include:

  • Prolonged gaps in breathing while sleeping
  • A broken sleep pattern
  • A drop in one’s concentration levels
  • Excessive day-time sleepiness
  • Morning headaches
  • Weight gain
  • Very light sleep
If left undiagnosed, OSA can lead to problems such as high blood pressure, increasing the risk of heart attacks. Snorers therefore need to consult an ENT (ear, nose, and throat) specialist to check if they suffer from this condition.
OSA Detection
To determine OSA, sleep study is conducted where a specialist observes the sleep pattern. This is usually done during an overnight stay at a sleep center.
Once OSA is established, the next step is to check the level of problem. This is done by performing sleep endoscopy. Under this procedure, a tiny camera is inserted in the nose to assess the degree of obstruction in the airway.
Another effective method to evaluate OSA is Dynamic MRI (magnetic resonance imaging), where a series of images help ascertain the cause and level of airway blockage accurately.
Cure
The first step to curing snoring is to make changes to one’s lifestyle. Shed off excess weight, follow a regular sleep pattern, maintain a gap of at least two to three hours between dinner and sleep, and avoid alcohol as much as possible, especially in night time. Also, sleeping sideways instead of on the back can help relieve the problem.
Besides these lifestyle changes, snoring can also be minimized using CPAP (continuous positive airway pressure) procedure. In this, a device opens the clogged airway by creating air pressure over a mask worn either on the nose or face.
In case of a serious snoring problem, you need to see an ENT doctor to determine the cause and the right treatment. The right surgical procedure will be prescribed depending on by the level of obstruction, as determined by sleep endoscopy and dynamic MRI tests.
There are many surgical cures which revolve around the tongue, uvula and the nasal passages, depending on the level and nature of obstruction.
Nasal Obstruction

Coblation Turbinoplasty: This surgery is performed to reduce the volume of the nasal tissues to minimize the congestion. Such a surgery is recommended for patients suffering from deviated nasal septum, turbinate hypertrophy and adenoid hypertrophy. However, it is important to keep in mind that the surgery will only minimize snoring and not cure the problem completely.

Soft Palate Obstruction
  • Uvulopalatoplasty (Laser or Coblation): In case of Laser Assisted Uvulopalatoplasty (LAUP), surgeons use a laser to remove the uvula and parts of the palate to create more space in the throat. A new technique, coblation uvulopalatoplasty is performed to get rid of soft tissue in the soft palate and uvula. 
  • Pillar implants: This is the latest treatment for snoring that is simple and safe and takes only half-an-hour to perform. It involves insertion of three implants (pillars) into the back of the roof of the mouth. The pillars reduce the fluttering of the palate that is a common cause of snoring, leading to a significant drop in snoring intensity.
  • Somnoplasty (Radio-frequency ablation): This involves removing soft tissues of the throat (uvula and soft palate) by using very low levels of radiofrequency heat energy. It shrinks the tissue volume, opening the passageway for air. Somnoplasty takes only half-an-hour and is done under local anesthesia.
  • Zetapalatopharyngoplasty (ZPPP): One of the most recent techniques, this process covers two side of the soft palate. It removes the frontal mucosa and divides the soft palate.
Tongue Base Obstruction
  • Tongue Channeling or Coblation Tongue Channeling: Latest technique to treat snoring and OSA, it primarily revolves decreasing the size of the tongue. For this surgery, a mix of radio- frequency energy and plasma wand are used plasma wand and radio-frequency energy to contract the mass of muscle behind the tongue.
  • Genioglossus Muscle Advancement: It is a surgical procedure to draw the tongue forward, creating more space in the airway.
  • Sliding Genioplasty: This surgical procedure involves moving the chin forward, clearing the airway.
  • Tongue Radiofrequency: The procedure uses radiofrequency energy is used to contract the tongue. Through this procedure, the four areas of the tongue—back, sides and below—are treated with controlled energy.
  • Hyoid Suspension: As the name suggest, the procedure involves the hyoid bone. Here, the surgery steadies the movement of the bone, which may cause obstruct the airway.
  • Epiglottopexy: A procedure which minimizes the problem through limited removal of epiglottis, the part of the tongue that helps to swallow food. This could be performed either through laser or other techniques.
However, one should keep in mind that patients suffering from bi-level obstruction may need more than one procedure to cure OSA/snoring. Pediatric Obstructive Sleep Apnea
A condition which is marked by blockage of the upper airway. This may be complete or partial blockage. It is a disorder that affects children.
Snoring is noisy and embarrassing. It often makes the person an object of ridicule and leads to resentment in bed partners who find it difficult to sleep. Snoring also disturbs sleeping patterns of the snorer, denying adequate rest. It can cause serious health problems in the long run. With a variety of quick, simple and minimally invasive treatments now available, there is no need to put up anymore with the social and medical consequences of snoring.