Snoring and Sleep Apnea
Drs. Crumley, Wong, Bhandarkar, Armstrong and others have
had experience treating these disorders. Individuals who snore may also suffer from obstructive sleep
apnea syndrome (OSAS). There are a variety of treatments for each disorder,
and our Department has had extensive experience in treating patients who
suffer from both kinds of sleep disorders.
Please take a look at our brochure by clicking
here.
Many people snore. It
has been estimated that anywhere from 30 - 50% of the United States
population snore at some time or another. Significant snoring is sometimes
described as "heroic" snoring, in which the snoring loudness may be heard
more than two bedrooms away. Such snoring may cause several problems:
Snoring is not sleep
apnea, and sleep apnea is not snoring. Snoring is a social problem, as
indicated above, and may be associated with significant sleep disturbance,
waking episodes, etc. without OSAS. However, many patients with loud snoring
do have significant obstructive sleep apnea.
Obstructive Sleep Apnea
Syndrome (OSAS) is characterized by significant and prolonged interruptions
of breathing (airway obstructions) during the night. These cessations of
breathing may be associated with a substantial decrease in blood oxygen
levels, cardiac arrythmias (irregularities in the heart's normal beating
pattern), high blood pressure, and may even cause sudden death. OSAS is a
serious disorder and can become a major risk to one's health, causing
significant lung and heart problems over time.
Since this condition is
often found in people who snore loudly, such snorers should be aware of this
association and their spouses should monitor their sleeping patterns for
apneic episodes (where breathing stops for a short period of time -- 10 - 20
seconds). If breathing stops for more than 15 seconds, significant OSAS may
be present.
Symptoms of sleep apnea can include:
Most loud snorers should
have a polysomnogram (PSG) or sleep test performed. This is an overnight
test that is usually performed in a sleep laboratory, where one simply falls
asleep for a number of hours. During this sleeping time, the lab monitors
and tests a number of important processes in the sleeper's body, including
the heart rhythm (EKG), blood oxygen levels, number and duration of apneic
spells.
Based on the results of
the PSG, you may be classified as a snorer or a person with OSAS. People who
suffer from loud snoring but not OSAS have a number of treatment options, as
do those with OSAS.
For snorers, treatment
can include non-surgical or surgical approaches. Non-surgical treatment
methods include weight loss and positional changes (keeping the snorer of
his/her back). Surgical methods include Laser-Assisted Uvulopalatoplasty (LAUP)
or the new Somnoplasty.
For those suffering from
OSAS, treatment options generally include:
Weight Loss
Positional Changes while sleeping
Continuous Positive Airway Pressure (CPAP)
Uvulopalatopharyngoplasty (UPPP or UP3)
(Somnoplasty, Coblation,
or other RadioFrequency procedures are generally not effective for
treatment of Sleep Apnea, and are used only for snorers who are thought not
to have OSA.)
CPAP is the first line
of defense in the treatment of OSAS. In CPAP, pressurized air is
administered by way of a face mask which is worn during sleep. The pressure
of the air is adjusted in order to maintain adequate pressure to overcome
airway obstruction. In this way, most of the apneic episodes are eliminated.
Many patients find that while wearing this device, they experience a much
improved sleep pattern with an overall better night's sleep.
Some patients find,
however, that the CPAP device is cumbersome and difficult to use. Some
patients, in fact, will use CPAP for a year or two and then opt for surgical
therapy. CPAP, however, remains the best non-surgical treatment for
OSAS.
LAUP - Laser Assisted Uvuloplasty
LAUP is a surgical
method used to treat mild-to-heroic snorers and those with very mild OSAS.
This procedure utilizes a laser beam to, in effect, "tighten" floppy tissue
in the back of the mouth, thereby reducing the amount that these tissues
contribute to snoring. This procedure, although surgical, can be performed
in an outpatient setting and most patients find that postoperatively, there
is only mild discomfort, equivalent to a few days' worth of a sore throat.
Of course, this post-surgical pain can be mitigated through the use of pain
medicines supplied by our surgeons. LAUP is infrequently used any longer
since the newer Radiofrequency procedures (see Somnoplasty) have better
results with less post-procedure pain..
Somnoplasty and
Coblation are both radiofrequency treatments aimed at mild-to-severe
snorers with little or no apnea. This technology utilizes radio frequency
techniques to accomplish the same result as in a LAUP, with much less
post-operative discomfort. We have had experience with over 350
Radiofrequency procedures using the Somnus system. This product and
technique is produced and supported by
Gyrus, Inc., although other radiofrequency
systems (such as Coblation) are sometimes used as well.
This procedure is an outpatient
treatment and is conducted in our private practice offices (faculty
practice) at UCI Medical Center. Patients leave and may drive home or back
to work. Post-treatment pain is variable, but often requires a short
course of Tylenol-Codeine, particularly since a uvulectomy is virtually
always done in conjunction with the radiofrequency procedure. (In
performing the first 300 procedures, we discovered that fewer total
procedures were necessary in each patient, if the uvula were shortened or
removed at the time of the initial radiofrequency procedure.)
In general Radiofrequency procedures
of the palate are not covered by medical insurance since they are
usually performed to reduce or eliminate snoring (snoring being a non-reimbursible
disorder by most medical insurance companies.) Accordingly it is necessary
to pay in advance before having the procedure. We currently charge $2,150
for the first procedure (plus a $150 hospital/facility fee). (current info
as of May 2010) Generally the 2nd procedure, when necessary costs $550,
again, plus the $150 facility fee.
In order to be evaluated for
radiofrequency treatment of snoring, it is necessary to have an overnight
sleep test first. In addition, it is our policy not to perform Somnoplasty/other
radiofrequency/ or UPP (see below) on patients with BMI (body mass index) >
32, since the procedures are rarely successful in this group.
UPPP - Uvulopalatopharyngoplasty
UPPP, introduced by Fujita in the late 1970's, for over a
decade has been the mainstay in the surgical treatment of OSAS and severe
snoring. Thousands of patients have been effectively treated with this
technique. It should be noted, however, that UPPP does not cure all OSAS. It
does, though, significantly reduce the degree of OSAS in well over 50 - 60%
of patients, and typically eliminates or significantly reduces snoring.
There are a few patients who do not experience a significant correction of
the OSAS, and they may need to undergo other surgical methods. Most people
do, however, experience an improvement in their sleep patterns and overall
daily life.
The UPPP is performed in the main surgical suites at UCI
Medical Center, under general anesthesia, and typically requires an
overnight hospital stay for observation. Postoperatively, patients typically
experience a sore throat and some difficulty swallowing which may last as
long as 10 - 14 days, although most patients find they can return to work
after only a few days' recuperation. Of course, improvements in our
management of postoperative pain have made this procedure much less
traumatic than what their experience may have been even a few years ago.
If you are interested in pursuing any of these treatment
modalities, contact your family physician or contact our Department calling
714-456-7017, or read about the
UCI Center for
Snoring and Sleep Disorders.
(requires Adobe Acrobat Reader). (Note: as of 2006, the correct phone # for
the Center is 714-456-7017
or click
here to request an appointment via
the web.
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