Snoring — When is it Serious?

Loud snoring occurs in an estimated 20-25% of adults. This results in many sleepless nights for the snorers’ bed partner, also known as the snoree. This may lead to the snoree kicking the snorer into another room, or the snoree may decide to head to the couch. Not only does the snorer have problems at home — loud snoring can be very embarrassing on business trips and camping trips. When the snoring effects relationships with the snoree, family, friends and business partners, treatment should be considered.

What causes snoring? Snoring is due to vibration of the soft palate and the uvula, the “ding-dong” in the back of the throat. As a person ages or weight increases, the soft palate and the uvula become longer, making snoring worse. Alcohol and muscle relaxants at bedtime make snoring worse by increasing the floppiness of the soft palate and uvula. Nasal congestion and obstruction can also make snoring worse by causing turbulent airflow within the upper airway.

A severe form of snoring is known as obstructive sleep apnea (OSA). OSA occurs when the soft tissues of the palate, throat, and back of the tongue collapse during sleep. The typical patient with OSA will snore very loudly. The snoring stops suddenly due to obstruction of the upper airway. However, the chest continues to move in an attempt to move air. The patient then gasps for air and the snoring starts again. When this occurs, oxygen levels decrease and carbon dioxide levels increase in the blood. This leads to the common symptoms of OSA:

• Morning headaches
• Fatigue
• Falling asleep easily during the daytime (excessive daytime somnolence)
• Memory Impairment
• Impotence
• Palpitations (abnormal heartbeats)
• Excessive leg movements

If you or your loved one has these symptoms, seek medical care. A sleep study, or polysomnogram (PSG) is often ordered to determine the severity of the OSA. Patients with OSA have an increased risk of hypertension, stroke, heart attack, and sudden death. Treatment of OSA definitely improves the quality of life, and the patient may avoid early death.

Treatment of OSA and snoring are different. OSA can be treated nonsurgically with a CPAP (Continuous Positive Airway Pressure) mask. This is a very effective treatment to stent the airway open with air pressure. Oral appliances are sometimes recommended to move the jaw forward at night. If a patient is unable to tolerate the CPAP mask or oral appliance, refuses the mask, or has mild OSA, surgical therapy is recommended. Depending on the level of obstruction (i.e. nose, palate, or tongue) your surgeon will recommend one or more procedures on these structures. The typical patient with OSA will undergo tonsillectomy (if they haven’t been removed in the past), and uvulopalatopharyngoplasty (UPPP), resulting in a shortening of the soft palate and tightening of the back of the throat. Nasal surgery is added if necessary. If these procedures fail to improve the problem, or if the patient has severe OSA, surgery to advance the back of the tongue may be recommended. These procedures are performed at a hospital, require overnight admission, and are covered by insurance.

On the other hand, treatment of snoring without OSA is an outpatient procedure in your surgeon’s office and is not covered by insurance. Procedures are aimed to reduce the length and increase the stiffness of the soft palate and uvula. Laser assisted uvulopalatoplasty (LAUP) was a commonly performed procedure for snoring. However, the pain associated with the procedure has made LAUP less popular among patients and surgeons. Radio frequency reduction of the soft palate is a new procedure that causes less injury to the soft tissues, and therefore, the patient experiences less pain. Two treatments performed six weeks apart are often required, and occasionally the uvula is removed simultaneously.

All patients with snoring or OSA can improve their sleep with the following recommendations: Lose weight, avoid alcohol and muscle relaxants, stop smoking, get at least 6-7 hours of sleep, avoid erratic schedules. Sleep and wake times should be consistent. Exercise frequently, but don’t exercise at night. This can make falling asleep difficult. Place a humidifier next to the bed.

Dr. Raj TerKonda is board certified in both otolaryngology — head and neck surgery, and facial plastic and reconstructive surgery. He joined the staff of Longmont Clinic in August 2000.