Snoring and Sleep Apnea

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:

Marital Discord
Sleep disturbances (from spousal prodding)
Waking episodes (from one's own snoring)
Frequent association with OSAS

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:

• Excessive daytime tiredness or sleepiness
• A feeling of "dullness", or not capable of maximum performance
• Napping during work hours
• Falling asleep while driving
• Sore throats
• Headaches
• Hypertension (elevated blood pressure)
  

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 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..

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 if a uvulectomy is done in conjunction with the radiofrequency procedure.  (In performing the first 200 procedures, we discovered that fewer total procedures were necessary in each patient, if the uvula were shortened 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 $1,950 for the first procedure (plus a $150 hospital/facility fee). Generally the 2nd procedure is less expensive.     When a 3rd treatment is necessary (less than 10% of the time), there is an additional $400/procedure.  We do use Radiofrequency procedures for the tongue, in patients with sleep apnea, who have had the appropriate UPP procedure, and continue to have sleep apnea.  This is usually reimbursable by medical insurance companies (third party payors.)

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.