SNORING

Snoring is more widespread then generally believed. Up to 45% of adults snore occasionally, while 25% are habitual snorers. Snoring is more common in males, increases with age in both sexes and is 3 times more common in the obese. The majority of people over the age of 65 snore.

The snorer himself rarely seeks medical attention. For reasons that are not understood, the snorer does not hear himself regardless of the loudness. Sounds in excess of 80dB have been recorded. The snorer usually comes at the insistence of a bed partner or former partner. Currently, the general public and many doctors are unaware of the potentially serious disorders associated with snoring. Complaints are often just related to the loudness and frequency. Since occasional, light snoring causes no ill effect, such patients probably don't need treatment. However, these people seldom seek medical attention.

The social embarrassment caused and felt by them cannot be ignored and it is not an uncommon for it to cause marital disharmony.

However, snoring and sleep apnoea are related! Snoring increases in severity over time and can progress to sleep apnoea.

Recent studies have linked snoring to systemic and pulmonary hypertension, right heart failure, cor pulmonale, secondary polycythemia and cardiac arrhythmias. During sleep severe snorers may experience apnoea, oxygen desaturation, carbon dioxide retention and nocturnal pulmonary hypertension and high blood pressure.

Causes 
Snoring occurs when floppy tissue in the airway relax during sleep and than vibrates. Some snoring is caused by an enlarged soft palate and uvula (little tongue) at the back of the mouth, the tongue, tonsils, adenoids, and congested nasal passages can also contribute to the sound. The level of snoring can be aggravated by excess weight, alcohol intake and smoking.

Treatment 
Your doctor will perform a full examination to determine whether you are a simple snorer or if you have a more significant breathing disorder. A sleep study can be arranged and the results interpreted by an ENT surgeon whose area of expertise is in upper airway obstructive disorders. Either condition can be treated - simple snoring may be managed by a Radiofrequency surgical procedure, and obstructive sleep apnea by a variety of other approaches.

Radiofrequency Palatoplasty (COBLATION) is one such treatment now available. The tissue in the soft palate and uvula are reduced and stiffened with less pain  than that associated with conventional laser assisted surgery. It  can be performed in an out-patient setting under local anesthesia. The procedure itself takes less than 15 minutes of surgical time. The unique design of the needle electrode and the automated control of the tissue temperature protects the mucosa. After the procedure, most patients take simple analgesics. They could experience a reduction of snoring within six to eight weeks. 

(Disclaimer: YOU WILL NEED TO DISCUSS WITH ME WHETHER THIS MODALITY OF TREATMENT IS AVAILABLE IN MY PRACTICE.)  

Non- surgical approaches include weight loss and other lifestyle modifications.


Other Treatments

Many treatments for snoring have been devised over the years. Initially the uvulopalatopharyngoplasty (UPPP) was devised as a means of decreasing palatal vibration by extensively resecting the uvula, soft palate and tonsils. Its main indication was for the treatment of sleep apnoea. Modifications to these procedures include the laser assisted uvulopalatoplasty (LAUP) and radio frequency uvulo palatoplasty (RFUP) and radio frequency palatal ablation (RFPA).These involve shrinking of the soft palate and uvula in the hopes of cutting down palatal flutter and thus reducing snoring. All these procedures enjoy some degree of success, ranging from 40% - 90% with a recurrence rate of more than 20%. Obesity was a major cause of failure in each of these procedures.

Nasal Procedures

Other surgical procedures directed at the nose in the hopes of improving nasal airway can certainly improve snoring but only if nasal obstruction is a possible cause. These procedures include a septoplasty, turbinate reduction and if necessary endoscopically directed sinus procedures. Other non-surgical procedures have been developed which at best provide temporary relief. These include dental appliances, lubricating sprays and external nasal strips.