What is snoring?
- Snoring is a fluttering noise due to partial obstruction of the upper airway when the muscles at the back of the throat relax during sleep.
- Most of the noise comes from the soft palate.
- People who snore have a floppiness of the back of their throat, soft palate, tonsils (if still present), and the tonsillar pillars (arches of muscle), maybe a thicker tongue, and/or a floppy voice box.
- In more severe snorers, there is often more floppiness and more fluttering regions.
- The throat collapses (like a soft straw), and flutters.
- It is not known why snoring is more common in men (30% snore), but 15% of women snore.
- Snoring is more common if overweight, and with nasal obstruction, and it worsens with age.
- In severe cases, complete obstruction (breath-holding) may occur intermittently during sleep. the medical term for this is – Obstructive Sleep Apnoea (ap-knee-uh).
Obstructive Sleep Apnoea
OSA causes a drop in the oxygen level which partially wakes the patient up. Repeated arousals may cause daytime sleepiness, irritability, poor concentration and memory, and sometimes impotence.
Straining against partial suffocation may increase blood pressure, risking a heart attack or stroke.
Obstructive Sleep Apnoea – Should a sedative be used?
Sedation, whether from alcohol, sleeping tablets, Morphine etc, worsens snoring and OSA, by relaxing the muscles and interfering with the body’s ability to arouse from the low oxygen level.
Sedation can be dangerous in patients with OSA
An overnight sleep study (PolySomnoGram) is done to assess patients for Obstructive Sleep Apnoea.
During a sleep study, we will measure Stages of sleep, oxygen levels, breathing, Electro-Cardio-Graph (ECG) etc.
Various simple measures may help snoring such as losing weight, avoiding alcohol or sedatives, sleeping on the side, unblocking the nose (eg Nazovent, hay-fever sprays, surgery), or wearing a Dental splint each night to pull the lower jaw and tongue forwards.
A trial of decongestant nasal spray might show if the nose alone is at fault.
Oxymetazoline Spray on alternate nights for two weeks before bed – was the nose blocked and the snoring quieter? (beware dependence on the spray – this is not a cure!)
If it works, then Nasal Surgery alone should stop the snoring, permanently.
Will surgery for snoring help?
If the snoring is disruptive enough, intervention may be necessary – Palate-trimming with a Coblator dissector.
In adults, I sometimes need to remove the tonsils (Palato-Pharyngo-Plasty – PPP), and even the Uvula – called Uvulo-Palato-Pharyngo-Plasty – UPPP or UP3).
If the nose is blocked, it also needs to be fixed, usually by straightening the septum, trimming the turbinates (the swellings on the side walls), and removing polyps if there are any.
If the noise is not just coming from the palate and nose (ie – noise coming from the tongue base), these techniques will fail.
Palate stiffening – Palate stiffening procedures are very ineffective, so I have stopped doing them
Palate trimming with aCoblator Palatoplasty (=CoblatorPP) is an operation to remove the uvula and trim the thin edge of the soft palate, so it can’t flutter (I used to do this with a Laser).
Recovery
Patients are in hospital just for the day, and perhaps night, and back to Full-time work in 5-7 days. (Part-time work earlier is OK.)
During the second half of the first week, the throat is sore, but tablets, gargles and lozenges control it.
CoblatorPP is a minor surgical procedure, under a General anaesthetic. It takes about 5-7 days to get back to work, 10 DAYS if also with Nasal surgery.
Blowing balloons or a wind instrument might be a problem after palatal surgery, due to weakening of the soft palate – voice change or swallowing problems are extremely rare.
- Some patients have a sensitive scar for a few months, which settles spontaneously.
- Coblator PP is successful for snoring and mild OSA in over 80% of cases, long-term.
- Some patients don’t snore deeply at all, just softly.
- The results for moderate or severe OSA are not as good, due to generalized floppiness.
- Only about 40% of patients are cured of OSA, although more will stop snoring.
- The selection of suitable patients (assessing for general sagginess) can achieve better results.
Other Surgery
I rarely perform a Uvulo-Palato-Pharyngo-Plasty (UPPP) nowadays.
Because it removes the Tonsils and many sutures to tighten the palate, it is more painful, requires more time in hospital and off work, and more painkillers.
I often do a Modified PPP, preserving or trimming the uvula, which is a bit less painful and less likely to affect speech and/or swallowing.
I use a Bizact dissector (or Coblator) to reduce pain and bleeding.
The limited Coblator PP and Modified PPP are much less painful, quicker, safer, and have largely superseded UPPP if the throat shape is suitable.
Tongue reduction techniques, either with Channelling, or Actual excision can help.
Coblator tongue channelling is a minimally-invasive procedure where 7 electrode-needle injections are made, and the muscle in the tongue is cauterized. This reduces the tongues volume and creates scar and stiffening. It is usually not very painful but causes some ulcers that can take a month to heal. Your ENT surgeon can perform this at the same time as palate and nasal surgery.
Mandibular Advancement Splints are effective, by pulling the jaw and the tongue forwards. It can be used as a primary treatment, or after failed surgery.
Even in patients with severe OSA, complex operations to pull the tongue base forwards can help, by creating more space and reducing obstruction.
Continuous Positive Airways Pressure (CPAP) is an effective and safe treatment for control of snoring and Obstructive Sleep Apnoea, and I usually recommend it for Severe OSA.
- The patient sleeps with a mask over the nose/face, pumping air, all night, every night, forever.
- Air pressure prevents collapse and vibration of the throat, stopping apnoeas and snoring.
Tracheostomy is the best treatment for severe OSA but is almost never nessessary.
Children who snore often have large tonsils and/or adenoids (which are like tonsils in the back of the nose). Children with OSA usually have enlargement of both, and surgery is necessary if Nasal steroids don’t help.
What next?
If you’re one of the many people who suffer from snoring and obstructive sleep apnoea, we hope this article has been helpful. We’ve outlined some of the most common treatment options available to you, both surgical and non-surgical. Contact us today if you would like to find out more about surgery as a potential solution for your snoring problem, Dr Kleid’s team will be happy to help.
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Dr Stephen Kleid
Ear Nose and Throat Surgeon (Otolaryngologist)
MED0001052799
Masada Medical Centre
26 Balaclava Road,
East St Kilda, Victoria
Dr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in St Kilda.
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Dr Kleid’s Team takes pleasure in assisting you with any questions when considering ENT surgery. Please call the Masada in Melbourne between 9 am – 5 pm on Weekdays.
Phone Masada Hospital 03 9038 1630 or Email Dr Kleid
Disclaimer
The information presented in this article is provided solely for educational and informational purposes. It is not intended to substitute professional medical advice, diagnosis, or treatment. Always consult with your physician or qualified healthcare provider regarding any medical condition or concerns you may have. Do not disregard or delay seeking professional medical advice based on the information provided in this article. The author and publisher of this article do not warrant the accuracy, applicability, or completeness of the content, and any reliance on the information presented is at your own discretion and risk.
Disclaimer
The information presented in this article is provided solely for educational and informational purposes. It is not intended to substitute professional medical advice, diagnosis, or treatment. Always consult with your physician or qualified healthcare provider regarding any medical condition or concerns you may have. Do not disregard or delay seeking professional medical advice based on the information provided in this article. The author and publisher of this article do not warrant the accuracy, applicability, or completeness of the content, and any reliance on the information presented is at your own discretion and risk.