Snoring and disturbance of sleep can be damaging to a family. It may also signify a dangerous situation known as, obstructive sleep apnea (OSA). This condition is when someone continuously stops breathing at night. Such patients are at greater risk for heart attack and stroke. Treatment for sleep apnea is medically necessary; treatment for snoring is considered "cosmetic" by insurers. Usually a sleep study is performed to diagnose these conditions, as medical history and physical exam are not enough.

Snoring, and mild sleep apnea, may be addressed through either:
1. Radiofrequency (Rf) treatment to the palate
2. Pillar implants to the palate 

Both techniques are performed in the office. These procedures are relatively painless. For the radiofrequency, a probe is inserted into the palate, and radiofrequency energy is applied to stiffen and shrink the tissue. For the pillars implants, a soft segment of suture type material is inserted into the palate at three sites to stiffen the area - much like the battens in a sail stopping the sail from luffing. Unfortunately, insurance does not cover the cost of Rf treatment or pillar implant for snoring.

Continuous airway positive pressure (CPAP) is a tremendously effective tool to treat OSA.  A mask is worn at night while air is blown through the nose, and sometimes mouth, to keep the airway from collapsing. At times, the mask is hard for patients to accept and other means to treat sleep apnea are investigated.

A tracheostomy bypasses the upper airway and will cure sleep apnea. The issue of having a tube in the anterior neck often prohibits patients from considering this therapy.

Minimizing obstruction to the upper airway may improve sleep apnea as well. The nose might be addressed with a septoplasty and/or turbinate reduction. The tonsils and/or adenoids might be removed to make more room. The palate might be trimmed; this is called a uvulopalatopharyngoplasty (UPPP). A UPPP should reduce the noise of snoring as the floppy palate tissue that often blocks the patient's airway is minimized. This surgery needs to be done carefully as the palate is important for snoring, and over resection could lead to liquids coming out the nose during swallowing. The tongue is a frequent contributor to obstruction: an oversized tongue may be reduced with Rf treatment in the operating room. Lastly, obesity contributes greatly to OSA; weight reduction is highly desirable, and surgery for weight reduction is possible.

Sleep Apnea:  A Detailed Description, or...Snoring: Not Funny, Not Hopeless
Sleep apnea is defined as a cessation of airflow during sleep for 10 seconds or longer. Central sleep apnea is caused by the central nervous system, or more commonly known as the brain. Obstructive sleep apnea (OSA), which is more common, is caused from a collapse in one's airway. To best assist with defining the sleep disorder, a sleep study is required.

Symptoms
The most common symptom of sleep apnea, snoring, is present in approximately 60 percent of men and 50 percent of women over age 60. Simple or primary snoring is not dangerous medically, though it can cause significant social problems, e.g., divorce. While simple or primary snoring has been known to cause interpersonal problems, e.g., your spouse insists that you sleep on the couch, this kind of snoring is not medically dangerous. Sadly, it is actually the threat of divorce that often brings a man in to see us. Thankfully, the MetroHealth Department of Otolaryngology is capable of improving or eliminating primary snoring. But because snoring may be a symptom of OSA, we need to investigate the possibility of this dangerous disease state prior to executing "cosmetic" snoring relief.

Even though only four percent of men and two percent of women have OSA symptoms, OSA's impact is broader, affecting a total of nine percent of men and four percent of women. The symptoms of OSA include daytime sleepiness, loud or persistent snoring, observed apneas (when someone witnesses the patient stop breathing during sleep) or choking, morning headaches, and poor cognitive function. Obesity is the most common risk factor for developing OSA. Patients with untreated OSA are at considerable risk for an adverse cardiovascular event, such as high blood pressure, heart attack and stroke. The life expectancy of a patient with untreated OSA is considerably shorter than that of the normal population.

Managing Sleep apnea
Treatments for OSA include:
1. Reduction of risk factors (e.g., weight reduction)
2. Medical therapy
3. Surgical therapy

Medical therapy typically involves continuous positive air pressure (CPAP), which is a mask that fits over the nose to blow in air and "pneumatically splint" the airway open. CPAP is an effective treatment that will eliminate the symptoms of OSA. Unfortunately, some patients have trouble tolerating CPAP and therefore, surgical options are available. A tracheostomy will bypass the obstruction, and alleviate OSA, although this is a cosmetically unappealing option. Depending on the patient's anotomical makeup, we are often able to trim the palate, remove the tonsils, and possibly operate on the nose and jaw to minimize the collapse that may take place.

Patients with the symptoms of OSA are encouraged to undergo an evaluation to rule out this disease. Your primary care physician can arrange for a sleep study, or the Department of Otolaryngology or Division of Pulmonary Disease at the MetroHealth Medical Center can be of assistance.