SNORRING

Snoring is the act of breathing through the open mouth with vibration of the soft palate & uvula that cause sound which can vary between a soft noise to a loud disturbing sound. This happens usually during sleep. The cause of snoring is a blockage in the upper airways due to various problems such as tongue falling into the throat during sleep; septal deviation and allergies which may obstruct the nose, throat weakness which may cause its collapse during sleep, mis-positioned or short lower jaw, fat accumulation in and around the throat and long and/or bulky palate and uvula.

The narrowing of the airway creates fast air currents and negative pressure which further causes collapse of the air passages. When the airflow becomes irregular, the soft palate and the uvula start to vibrate, striking the back of the tongue and the back of the mouth. These vibrations create the snoring sound.

About 45% of normal adults snore at least occasionally, but children can snore too, mainly due to enlargement of their tonsils and adenoids which may occlude the upper airways.

Snoring can be a serious social problem mainly due to the disturbance and resentfulness it creates for the people. But more important it is associated often with sleep disturbance called Obstructive Sleep Apnea which deprives the snorer of appropriate night rest and may cause serious consequences.

Obstructive sleep Apnea is a situation when loud snoring interrupted by frequent episodes of total obstruction of the upper airway which may last for more than 10 seconds each and occur several times per hour. These stops in breathing may occur as many as several hundred times per night and may cause reduction in blood oxygen level, elevation in blood pressure, cardiac arrhythmias and increased burden on the heart. Because the snorer does not get a good and efficient night's sleep he may be sleepy during the day which decreases his work performance and his driving or equipment operation.

Adults who suffer from mild occasional snoring should try first, to loose weight and to increase their physical exercises in order to develop good muscle tone. Sleeping pills, alcohol and heavy meals should be avoided before bedtime.

Heavy snorers should look for medical advice by an otolaryngologist, who will provide a thorough examination of the upper airways and the neck. A sleep study in a Sleep Laboratory is often necessary to decide how serious the problem is, whether sleep apnea exists and to what degree.

The mode of treatment depends on the cause and the severity of the snoring and the sleep apnea as diagnosed by the physical examination and the sleep laboratory. In any case, treatment should be tailored, decided upon and conducted by doctors experienced in this field, and in a set-up of a hospital where decisions and quality assurance control are the rule. This is particularly important since there is a controversy among physicians regarding the appropriate treatment in various situations.

Snoring and/or obstructive sleep apnea may respond to the following surgical treatments which are performed in our department. Each procedure has indications and contraindications, side effects and complications. These should be discussed extensively between the physician and the patient before the operation.

Uvulopharyngopalatoplasty (UPPP): This is an operation to treat obstructive sleep apnea by surgical removal of the tonsils, the uvula and part of the soft palate. This expands the air passage and improves (or eliminates) the snoring and sleep apnea.

Thermal ablation palatoplasty: This is a group of surgical procedures which are used to treat snoring and mild to moderate cases of sleep apnea (Laser, Radiofrequency and bipolar cautery). Radiofrequency ablation is used by special needle electrode which delivers energy to contract excess tissues from the palate, uvula, base of tongue and nasal turbinates – according to the site of pathology. The use of laser is more controversial and less popular today because of treatment side–effects.

Genioglossus and hyoid advancement: This is a surgical procedure for severe sleep apnea, which aims to pull the tongue forward in order to expand the airways.

§ In snoring children with sleep apnea, tonsillectomy & adenoidectomy usually solve the problem.

§ In any case, especially if surgery is contraindicated or unwelcome, there is an alternative treatment by a nasal mask that delivers air into the airways under positive pressure, thus eliminating the snoring and apnea (CPAP).

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