Snoring and Sleep Apnea

Snoring and sleep apnea are two conditions often used interchangeably and may be incorrectly treated as a result. Many of these patients are simple snorers or primary snorers, while the others could have a serious sleep disorder called Obstructive Sleep Apnea (OSA).  Dr. Gamble specializes in treating snoring and obstructive sleep apnea in children and adults.

Snoring Causes and Treatments

Diagnosing the cause of habitual or disruptive snoring and treatments for snoring, including lifestyle changes, medical devices, outpatient procedures, and surgeries can reduce snoring and enhance sleep quality.

Snoring is the vibration of relaxed throat tissue which occurs during sleep when the air flow through the nose and mouth becomes partially obstructed. Snoring can range from extremely mild to severe, and even dangerous. Loud snoring can not only be a nuisance for a sleeping partner, but has been linked to:

• Carotid artery atherosclerosis
• Increased risk of heart attack (by approximately 34%)
• Increased risk of stroke (by approximately 67%)

Close to 50% of adults snore at least occasionally, and approximately 10-12% of children snore most nights (habitual snoring). While snoring can affect anyone, twice as many men snore than women and snoring typically increases with age. Snoring can be classified into three categories:

1. Grade one snoring (simple snoring): Snoring is infrequent, not particularly loud, and does not affect breathing or create significant health problems
2. Grade two snoring: Snoring occurs more than 3 days per week and may affect sleep quality, daytime wakefulness, and cause mild to moderate breathing problems while asleep
3. Grade three snoring: Loud snoring occurs nightly and often involves obstructive sleep apnea (OSA), a condition in which the airways become partially or totally blocked during sleep

Causes of Snoring

The obstruction of air flow during snoring is often a result of the muscles in the soft palate, throat, and tongue relaxing during deep sleep. The narrower the airway becomes, the louder the snoring will be because the air flow needs more force to enter, thus an increase in vibration. Factors and conditions which can affect the airways and contribute to snoring are:

• Mouth anatomy: A long uvula (the tissue that hangs in the back of the throat) or soft palate can create a narrow opening between the nose and throat
• Being overweight: Excess tissue in the back of the throat
• Obstructed nasal passages: Blockage from a deviated septum (crooked cartilage between the nostrils), nasal polyps, or nasal congestion from allergies or sinus infections
• Alcohol or sedative use before bedtime: May over-relax throat and tongue muscles allowing them to collapse and block airway
• Tension in the jaw muscles: Can cause jaw misposition allowing throat tissue to obstruct the airway
• Sleep position: Back sleeping allows tongue and throat tissue to drop to the back of mouth
• Lack of sleep: Sleep deprivation can cause the throat to over-relax when sleep finally occurs
• Obstructive sleep apnea (OSA): Serious condition in which the throat becomes partially or completely blocked preventing breathing for short periods of time

Snoring may be a sign of OSA if accompanied by:

Daytime Somnolence

• Excessive drowsiness
• Morning headaches
• Choking or gasping at night
• Irritability
• Sore throat
• Lack of focus
• High blood pressure
• Nighttime chest pains

Studies estimate that approximately 1 in 15 Americans suffer from at least moderate sleep apnea. If you snore and have symptoms associated with sleep apnea, you should be evaluated by an otolaryngologist. To diagnose the cause of your snoring, your doctor will collect information regarding the frequency and severity of your snoring, as well as perform a physical examination. Your doctor may recommend additional tests, including:

• Imaging tests (x-ray, CT scan, or MRI): To check for structural problems, such as deviated septum
• Polysomnography: Sleep study in which blood oxygen levels, breathing and heart rates, brain waves, and body movements are evaluated

Snoring Treatments

Depending on the cause and severity of your snoring, treatment can range from simple lifestyle changes to the use of medical devices or surgery. Behavioral modifications that are often the first line of treatment to reduce snoring include:

• Weight loss: Especially if snoring began after gaining weight
• Sleeping on your side: Use of a body pillow behind your back can keep you from rolling onto your back
• Opening the nasal passages: Using nasal strips, decongestants, or a neti pot can enhance breathing
• Raising the head of your bed: Approximately 4 inches of elevation can keep tissues from falling back into the throat
• Limiting alcohol and sedatives before bed
• Avoidance of sleep deprivation: Adults should get 7-8 hours per night, and children need 9-12 hours depending on age
• Quit smoking: Smoking can weaken the throat

Treatments for Snoring

Snoring that continues to be disruptive despite lifestyle changes may require the use of medical devices or a surgical procedure. Snoring treatments include:

• Continuous positive airway pressure (CPAP): Most common treatment for OSA in which a device pumps air through a mask placed over the nose keeping the airway open
  

  Continuous Positive Airway Pressure (CPAP)

• Tonsillectomy/adenoidectomy: Outpatient surgery commonly performed on children with enlarged tonsils or adenoids (which are often a cause of snoring) and has been successful in reducing snoring in adults
• Radiofrequency tissue ablation (somnoplasty): Out-patient procedure which utilizes a low-level radiofrequency signal to heat and shrink the soft palate, thereby reducing snoring
• Uvulopalatopharyngoplasty (UPPP): Traditional surgery in which excess throat tissue, the uvula, and part of the soft palate may be removed to prevent obstruction
• Laser-assisted uvulopalatopharyngoplasty (LAUPPP): Minimally- invasive outpatient procedure in which a small laser is used to remove the uvula and shorten the soft palate
• Mandibular advancement splint: Dental appliance that repositions the jaw, tongue, and soft palate keeping the airway unobstructed
• Pillar® procedure: In-office treatment involving the placement of polyester implants into the soft palate in order to stiffen the tissue, which reduces snoring
• Injection snoreplasty: In-office procedure in which a chemical (usually sodium tetradecyl sulfate) is injected into the soft palate creating scar tissue and inflammation that stiffen the palate and decrease vibration

Dr. Gamble and Dr. Kubala are ear, nose, throat, and sinus surgeons with offices located in Plano and Dallas. If you would like to schedule an appointment with our office, please call our Plano office at 972-378-0633 or Dallas office at 214-239-1641.