Although
people who snore loudly are the target of bad jokes and
middle of the night elbow thrusts, snoring is no laughing
matter. Loud snoring can be a signal that something is seriously
wrong with your breathing during sleep. Snoring is a sign
that air is not freely flowing through the throat passageway.
The sound of snoring comes from efforts to force air through
the narrowed passage. For most people, loud disruptive snoring
is merely a social problem that may strain relationships.
Yet for many adults, loud habitual snoring is the first
indication of a potentially life threatening disorder: obstructive
sleep apnea (OSA). Apnea is the pausing of airflow of more
then 10 seconds while an individual is sleeping.
SLEEP
APNEA SYMPTOMS
Loud
snoring, with episodes of pauses and gasps during which
the snorer struggles unsuccessfully to breath, is a prominent
symptom of OSA. The muscles of the soft palate relax and
sag, obstruct the airway and cause the vibration and rattling
sounds of snoring. Snoring is present in 90% to 95% of patients
with OSA. Sleep apnea may be present in children who are
overweight and those who have enlarged tonsils and adenoids.
People
with sleep apnea don't get enough oxygen and their sleep
is poor. Sleep apnea can lead to daytime sleepiness, chronic
fatigue, morning headache, irritability, impaired memory
and judgment, mood disturbance, and decreased libido. There
is evidence that it can trigger hypertension, cardiovascular
disease, and stroke.
YOUR EVALUATION
An
oral and maxillofacial surgeon will want to obtain a medical
history and may talk with the bed partner or other members
of the household about the patient's sleeping and walking
behavior. The doctor will perform a head and neck exam looking
for problems that might affect sleep-related breathing.
The patient may be referred to a sleep laboratory to spend
the night to monitor various aspects of sleep.
SPECIALIZED TREATMENT
For
those with disruptive snoring and mild sleep apnea, losing
weight, avoiding alcohol and heavy meals within two hours
of bedtime, avoiding sedative use, and sleeping on one's
side are practical interventions that can improve or even
cure snoring and sleep apnea. Radio frequency treatment
of the soft palate performed in the office setting may also
be helpful.
To
treat severe sleep apnea, continuous positive airway pressure
(CPAP) is a highly effective therapy. This is a light mask,
worn over the nose during sleep, which forces air through
the nose to keep the airway open. Some snoring and sleep
apnea patients are helped by oral appliances that open the
airway by bringing the jaw, tongue and soft palate forward.
Surgical
intervention may be viable alternative for particular patients.
Surgery can be a permanent way to control this condition;
however, it is important to keep in mind that no surgical
procedure is universally successful. If the airway collapses
at the soft palate, a laser assisted uvulopalatoplasty (LAUP)
or a uvulopalatopharyngoplasty (UPPP) may be helpful.
In
both procedures, the uvula and portions of the soft palate
are resected to widen the airway. The UPPP is a major inpatient
surgical procedure, while the LAUP is an office procedure
performed under local anesthesia. If collapse occurs at
the tongue base, a hyoid suspension or repositioning the
jaw with a mandibular osteotomy may be indicated.
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TALK
WITH YOUR DOCTOR
Sleep
apnea is a serious condition and individuals with OSA may
not be aware of a problem. If someone close to you has spoken
of your loud snoring and has noticed that you often wake
up abruptly, gasping for air, you should consult your oral
and maxillofacial surgeon.
Portions of the above information provided as a courtesy
by:
American
Association of Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr Avenue
Rosemont, Illinois 60018-5701
847/678-6200 Fax: 847/678-6286
Website: www.aaoms.org
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