One of the more common scenarios I encounter in practice is meeting with a couple whose relationship is disrupted to some degree by snoring. The “snorer” sits sheepishly in the exam chair, while the other is not shy to tell me how their life has been damaged by sleepless nights. While I am sympathetic with those who lay awake listening to the wall-rattling snoring of their bed partner, my true concern is with the individual who exhibits this symptom.
Snoring is defined as upper airway noise created in the nose or throat occurring during sleep or at rest. It is the cause of marital and relationship discord, but can be a symptom of a more serious disorder called obstructive sleep apnea syndrome (OSAS).
My general approach to the snoring patient is first to take a careful medical history. Answers to the following questions can lead to more involved testing such as a “sleep study” (called a “polysomnogram”):
- Does the bed partner note the patient not only snores, but stops breathing at times (“apnea”) and seems to gasp?
- Does the patient have significant daytime sleepiness manifested by frequent naps, falling asleep while reading or watching TV, or when behind the wheel?
- Has the patient developed other medical issues such as high blood pressure, depression, heart disease, erectile dysfunction?
If the answer to any of these questions is “yes”, a formal sleep study should be considered. These studies can be done at home over several nights, or in a “sleep lab” in one night’s time. If my patient does indeed have significant sleep apnea demonstrated on the sleep study, I will discuss the variety of ways in which we can treat this condition, ranging from use of CPAP (continuous positive airway pressure) mask, weight loss, or multilevel surgery on the nose and lower throat I perform regularly.
If, on the other hand, my patient seems to have simple snoring without risk of true sleep apnea, I review, with the patient and other concerned parties, the possible treatments.
There are several predictable causes of snoring, the most common of which is excess body weight. There is no doubt overweight and obese individuals are far more likely to snore, and have associated sleep apnea. Obviously, successful weight loss may result in the resolution of snoring or apnea, and often is all that is required to achieve this. Dropping 50 pounds seems easy enough on paper, but in reality, requires major lifestyle changes. On occasion, adult and pediatric snoring can result from enlarged tonsils and adenoids, the removal of which often brings relief of the symptoms. Severe obstruction of the nose from cartilage or bone deformity, polyps or inflamed turbinate tissue can provoke snoring, and these problems are relatively simple to correct surgically.
Some patients are candidates for remodeling of the soft palate (palatoplasty), that can be accomplished through minor surgery or laser treatment (LAUP—laser assisted uvulopalatoplasty). I often perform a modification of this under an anesthetic I call a “mini-palatoplasty,” a more minor procedure during which I can permanently change the palate anatomy to discourage snoring. The success of these procedures is high, and the risks are minimal. Virtually all health insurers, however, do not pay for palate reshaping unless the patient has actual sleep apnea.
Lastly, my dental and oral surgery colleagues offer snoring patients a dental splint to wear during sleep (so-called “oral airway dilating device). These splints fit between the upper and lower teeth, and pull the lower jaw forward throughout the night, thus advancing the base of the tongue. Some patients cannot tolerate this treatment over the long term, as it often causes pain or arthritis in the jaw joint (TM –temporomandibular joint).
I do not perform “palate implants” (pieces of plastic surgically threaded into the soft palate tissues) as the long-term effectiveness of these are very questionable.
BOTTOM LINE: If a patient is willing to undergo surgical procedures, I can usually cure snoring. If snoring is accompanied by apneas and daytime sleepiness and fatigue, a more serious medical condition is likely and should be appropriately evaluated and treated. If you are overweight or obese, want to stop snoring and wish to stay away from surgeons like me, lose weight!