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Snoring & Obstructive Sleep Apnoea

What is snoring?

We are all familiar with the noisy and rather embarrassing phenomenon of snoring but how and why does it happen? It happens when while sleeping and breathing, turbulent airflow makes the soft palate tissues of the roof of the mouth and the throat vibrate and create this peculiar sound we know as snoring.

At times, during sleep, muscles relax and the back of the throat contracts, or even closes off for a while. As the ingoing breath passes through this now much smaller than usual opening, tissues around it start to vibrate and the peculiar sound of snoring is created. This narrowing can occur not just in throat but in nose or mouth as well. Different people may have different areas narrowing and causing snores. Of all, snoring involving soft palate tissue is probably the worst as the sufferer most likely has nasal obstruction and is breathing through the mouth to compound the problem.

As we all know, snoring is taken more as a social problem rather than a medical one. After all, it is usually more problematic for those around the snorer rather than the snorers themselves. Haven’t we all heard of couples where one partner prefers to sleep separately so as to sleep in peace without the other’s loud snoring creating a ruckus and creating havoc with their own rest!

But do you know that snoring can sometimes actually be a sign of a way more serious problem? Snorers need to be investigated for serious conditions such as sleep apnoea and other sleep-related breathing disorders.

Sleep apnoea is basically a stoppage of breathing, or a pause, during sleeping. There are two types of sleep apnoeas – central and obstructive.

Central sleep apnoea occurs when the brain fails to send appropriate signals to breathing muscles to start respiration.

Obstructive sleep apnoea occurs when despite trying; air does not flow in and out from the nose or mouth of the sleeper. In this case, snoring is not the core issue, it is actually one of the symptoms of obstructive sleep apnoea.

Under obstructive sleep apnoea, the patient starts to snort and gasp as their throat collapses which leads to brief spells of wakefulness from sleep. As the number of such episodes can run into hundreds every night, the sleep is fragmented, sleepiness dogs the patient throughout the waking hours and the risk of high blood pressure, heart attack and strokes etc. increases.

  • The doctor takes detailed sleep history from both the patient and his/her bed partner.
  • Next, a physical examination is conducted to check the patient’s weight, height and BMI (body mass index) numbers. The neck circumference is also measured.
  • Nose and throat are checked to assess width (or rather, lack of it) of oral and nasal passages.
  • The doctor may also recommend an overnight sleep study in a sleep lab to assess the specifics of the patient’s sleep.
  • The doctor may also seek a sleep endoscopy (DISE) to get a clearer assessment of structural issues causing obstructive sleep apnoea. In it, sleep is induced and an endoscope is passed through the nasal and oral passages of the patient to check for the exact location of narrowing.
  • If required, the doctor may also order CT scans of nose and paranasal sinuses, and dynamic MRI (cine MRI).

There are two broad categories of treatment available for such patients – non-surgical and surgical.

Non-surgical ways to treat snoring and obstructive sleep apnoea:

  • Behavioural changes such as weight loss, abstinence from smoking and alcohol, switching sleeping positions, and changing medications.
  • Dental devices designed by a dentist that have to be worn every night. These are used to hold the jaw and the tongue forward but can cause jaw joint problems and excessive salivation in the user.
  • Nasal devices and medications such as nasal saline sprays, nasal steroid sprays and nasal decongestants. (Actually, these devices can also help patients with allergy, irritation, deviated nasal septum and sinusitis issues beside snorers.)
  •  A device called nasal CPAP that provides a constant and higher than normal air pressure to prevent airway narrowing during in- and out-breath. This rather uncomfortable device requires the patient to wear a mask connected by tubing to a pump that keeps the air pressure high. This device requires constant acclimatization on part of the patient.

Surgical ways to treat snoring and obstructive sleep apnoea:

As snoring occurs due to narrowing of the breathing passage in a patient, a surgical procedure to reduce that specific obstruction may be advised. This surgery can cover tongue, nasal passages, palate and uvula (the fleshy extension at the back of the soft palate).

Depending on the merits of the case, the procedure can be undertaken as a single surgery, or as multiple procedures undertaken together or in a phased manner; as detailed ahead:

  • Nasal surgery: The narrow nasal passage is widened by correcting deviated nasal septum, reduction in size of inferior turbinates, and/or removal of nasal polyps and other obstructions.Radiofrequency ablation is the most advanced and the best recommended procedure for this surgery. Microdebriders are another excellent choice as these pulverize polyps quickly and safely.
  • Oral surgery: If snoring is caused by long, floppy palate and uvula, the ENT surgeon can either remove the tissue or stiffen it up. Radiofrequency ablation and laser are the most advanced and the best recommended procedures for this surgery.
  • Oropharyngeal surgery: The ENT surgeon can undertake procedures such as midline glossectomy, tongue base reduction, repose tongue suspension, and genioglossal advancement to widen the oropharyngeal (middle part of the throat) air passage.

Advanced surgical options: In rare cases, the ENT surgeon can choose more complex procedures such as epiglottectomy, hyoid suspension, or  maxillomandibular advancement.

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