SNORING & SLEEP APNEA

Snoring

Snoring and sleep apnea are related medical problems that the physicians at ENT of Georgia commonly care for. It is important to distinguish between the two, as their treatment and urgency are very different. At some point in their lives, nearly every person will snore. Snoring is the noise made by vibration of the tissues in the throat as air passes by them. Snoring can be intermittent or habitual, and it is nearly always a social problem for a bed partner.

One in four people have a problem with chronic snoring and can\'t stop snoring on their own. Chronic snoring can even be a sign of a more serious health problem, obstructive sleep apnea (OSA). On average, the bed partner of a snorer loses at least an hour of sleep every night. Because the partner\'s sleep is interrupted so frequently, it isn\'t deep and restful. As a result, they can be irritable, resentful, even unsafe at the wheel while driving. Sleep deprivation can also compromise the immune system and lead to low energy, decreased productivity and muddled thinking.

Snoring in children

In children, the most common causes of snoring and sleep apnea are enlargement of the tonsils and adenoids, or nasal airway obstruction from an upper airway infection or allergies. Pediatric patients who have obstructive sleep apnea tend to respond very well to the removal of enlarged tonsils and adenoids. This can often be done as an outpatient procedure, depending on the age and health of your child.

Adult snoring

In adults, the causes of snoring are often related to nasal obstruction from septal deviation or allergies, or excessive tissue in the throat which vibrates, including that due to excessive weight. Other causes of snoring are alcohol consumption, certain medications, and sleeping on your back.

What's your Snore Score?

Snoring can be a harmless annoyance or an indication of a more serious sleep disorder. This short quiz can help you to determine if your snoring is affecting your life and relationships.

Choose the number from the scale below that best describes the snoring in your situation.
0 = Never
1 = Infrequently (1 night per week)
2 = Frequently (2 - 3 nights per week)
3 = Most of the time (4 or more nights per week)

Situation: Your Score
Snoring affects my relationship with my partner.  
Snoring causes my partner to be irritable or tired.  
Snoring requires us to sleep in separate rooms.  
The snoring is loud.  
Snoring affects other people when I am sleeping away from home (hotel, camping, etc.).  
Total:  


If your total score is 5 or greater, please print these results to show to your physician.

How is Snoring Treated?

  • Simple lifestyle changes may provide relief:
  • Losing extra weight
  • Sleeping on your side, instead of on your back
  • Avoiding the use of alcohol and sedatives before bed
  • Quitting smoking
  • Using nasal strips, which widen the nostrils and improve airflow

The Pillar procedure is FDA approved for snoring and mild to moderate sleep apnea. During the Pillar Procedure, three to five tiny polyester implants are placed into the soft palate through a small delivery tool without incisions or stitches. Over the next few weeks and months the implants, together with the body's natural fibrotic response, add structural support to and stiffen the soft palate. This structural support and stiffening reduce the tissue vibration that can cause snoring and the palatal tissue collapse that can obstruct the upper airway and cause obstructive sleep apnea.

Other Treatment Options for snoring:

Allergy Treatments

  • Nasal Surgical Procedures including correcting a deviated septum or reducing excess tissue within the nose.
  • Pillar implants - In our office, three tiny inserts are placed in your soft palate to help provide support. Because no tissue is removed, there is minimal discomfort and very short recovery time, sometimes only a day!
  • Surgical procedures to remove excess tissue from the throat.

During your first office visit, your doctor will examine all parts of your upper airway and assess which areas are contributing to your snoring. The soft palate is almost always involved in chronic snoring, but there may be other factors as well, such as blockage of the nasal airway, tonsils and adenoids. A treatment plan addressing your specific anatomy may include lifestyle modifications, minimally invasive or surgical treatments. Only a full examination by our board certified ENT physicians can determine the treatment best for you. If your soft palate is a factor, the Pillar Procedure may be an effective treatment option for you, because it stiffens the soft palate to reduce or eliminate the tissue vibration that can cause snoring. The Pillar Procedure can be performed as a stand-alone procedure or used in combination with other treatments and lifestyle changes to help patients stop snoring. More than 25,000 people worldwide have been treated with the Pillar Procedure. ENT of Georgia has been treating patients with the Pillar Procedure since 2006.

Sleep apnea

Chronic snoring can be a sign of a serious medical condition, obstructive sleep apnea. This is defined as a lack of airflow for ten seconds or more during sleep, or successive periods of a less than half-normal breath for the same period of time. While snoring can be disruptive to bed partners, obstructive sleep apnea is associated with a decrease in REM sleep and possibly with decreased levels of oxygen during sleep. These can result in mood swings, lack of concentration and energy, and the risk of developing hypertension and cardiac and pulmonary disease. Untreated obstructive sleep apnea is significantly associated with elevated risks of strokes, heart attacks, and cardiac rhythm abnormalities. It is important that chronic snoring is distinguished between obstructive sleep apnea early due to the significant health consequences associated with the disease. Only a physician can determine if you have obstructive sleep apnea. Please alert your physician if you think that you or someone you know might be suffering from obstructive sleep apnea.

Diagnosis

Your ENT of Georgia physician will take a careful history of your sleep condition, followed by an extensive examination of your airway, from the tip of your nose to your lungs. In pediatric patients, the diagnosis is often made by a parent who notices pauses in a child\'s breathing, gasping for air, snorting, or even retraction of the chest while apnea episodes are occurring. In adult patients, an overnight sleep study (Polysomnogram) is usually necessary in order to definitively diagnose obstructive sleep apnea. Our office will find a sleep center with which your insurance company contracts, and arrange for this study if indicated.

Epworth Sleepiness Scale

In contrast to just feeling tired, how likely are you to doze off or fall asleep in the following situations? Use the scale below to choose the most appropriate number for each situation:

0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Situation: Your Score
Sitting and reading  
Watching television  
Sitting inactive in a public place (movie theater)  
As a car passenger for an hour without a break  
Lying down to rest in the afternoon  
Sitting and talking to someone  
Sitting quietly after lunch without alcohol  
In a car while stopped for a few minutes in traffic  

Total:

 

If your total score is 9 or greater, please print these results to show to your physician.

The Epworth Sleepiness Scale is a recognized self-testing method to determine levels of sleepiness while performing common daytime activities. This brief assessment is not a substitute for professional medical advice.

How is Obstructive Sleep Apnea Treated?

If Obstructive Sleep Apnea is diagnosed, there are medical and surgical procedures which can help or completely eliminate these events. Initial therapy is usually with Nasal CPAP (continuous positive airway pressure), which is essentially a mask which fits over your nose and blows in air to keep the airways patent. You would first have a repeat sleep study with the mask in place, while an optimum pressure that eliminates apnea while maintaining patient comfort is calculated. You would then obtain this equipment from the sleep center and a "fitted" mask, with a machine that is set at the level determined by the CPAP Titration Study. Most of these machines are easily portable for those who travel frequently, and better technology makes machines that are quieter and better tolerated. This treatment is 100% effective for those patients who keep the mask on all night long, and patients usually notice a significant improvement in their daytime function after initiating nasal CPAP therapy.

For those who are unable to tolerate nasal CPAP or who wish to pursue a permanent surgical cure for apnea, several options are available. Although the exact details of each procedure are beyond the scope of this web site, they typically involve surgical improvement of the nasal airway and/or treatment of enlarged tonsils, soft palate, and uvular enlargement or redundancy, and even procedures aimed towards relieving obstruction at the base of the tongue. In certain patients with obstructive sleep apnea, the Pillar Procedure is performed in the office or at the same time as other airway surgeries. The Pillar Procedure stiffens the soft palate and can prevent its collapse into the airway during sleep. Regardless of which avenue you choose to pursue, realize that obstructive sleep apnea is dangerous to your health and can even be life threatening. There are devices and procedures that can eliminate it, so do not hesitate to notify your ENT of Georgia physician if you think you might suffer from a sleep disorder. Obstructive sleep apnea can be a complex condition. Our practice will continue to work with you to provide the relief you deserve.