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Snoring

Snoring is one of the main causes of marital disharmony. It affects men and women (up to 50% of males snore regularly), becoming worse with age and weight. Snoring can also be a great social embarassment, when visiting friends / relatives, on holiday, on long-haul overnight flights, in the train etc. Patients who come to us have usually tried the standard remedies, such as sleeping on their side, nose clips, throat sprays etc. These solutions may be effective in mild problems, generally our patients need more investigation and treatment than this. Snoring and sleep apnoea are two ends of the same disease spectrum, if left untreated, simple snoring may develop into mild apnoea, then severe apnoea and so on.

 

Daytime sleepyness

Snoring can cause increased sleepyness during the day, due to poor quality sleep caused by a range of conditions from sleep arousal (nearly waking up due to the sound of your own snoring) to obstructive sleep apnoea, to your partner constantly digging you in the ribs. Daytime tiredness obviously affects the ability to function / perform properly. You can assess the significance of your own daytime sleepyness by working out your Epworth Sleepyness score, which has been designed and validated by sleep experts in Australia:

Score these day to day situations as to the likelihood of you falling asleep, 0=never, 1=sometimes, 2=often 3=most times

1. Sitting reading
2. Relaxing in a chair after lunch without alcohol
3. In a meeting
4. Sitting talking to someone
5. As a passenger in a car for more than one hour
6. As a driver in a car whilst stopped in traffic for more than 1 minute
7. Lying down in the afternoon when circumstances permit
8. In a public place such as cinema or theatre

A total score of 10 or more is said to be indicative of possible sleep apnoea or significantly disturbed sleep, and warrants at least an initial consultation with one of our ENT doctors.

 

Medical conditions associated with snoring

The feeling of tiredness during the day has been very strongly linked to an increased risk of car/lorry accidents, for understandable reasons. Sleep apnoea is also related to other significant disease, such as heart attacks, heart rhythmn disturbances, high blood pressure, insulin resistance, loss of memory/libido/concentration. Therefore, addressing snoring as a problem can lead to a distinct improvement in general health, and, since the treatment is mainly aimed at improving breathing, your quality of life and ability to exercise etc should also improve.

 

Cause of snoring

The cause of snoring is sound production at the back of the throat due to turbulent airflow, which occurs at night due to loss of muscle tone in sleep, with collapse and narrowing of the breathing passages. We don't snore whilst awake because muscle tone holds our airway open.

 

Treatment

The treatment of snoring from a surgical viewpoint is to treat the cause of the problem - factors in the airway that precipitate obstruction to the breathing tube, and high velocity, turbulent, noisy breathing. The main procedures for this include nose unblocking surgery and tonsil reduction). Weight loss can be vital in those whose body mass index is high. Always bear this in mind that it may be part of your treatment plan, without it any other treatment may be less effective.

 

Palatal surgery (LAUP, Somnoplasty, Pillar implants)

This is usually performed as a last resort, once all other attempts to open the airway have been undertaken, this includes offering a mandibular advancement device and CPAP. Scientific evidence based on observation of the airway and correlation with sound analysis of the patient's snoring suggests that if snoring is of a low pitched, rumbling nature, it comes from the soft palate area. If it is a high pitched, sucking sound, it is more likely to come from the back of the tongue or throat itself. The clinic offers 3 different options for palatal treatment. The most invasive, and commonly performed procedure is the laser palatoplasty, or LAUP. This involves using the scanned carbon dioxide laser to remove the soft palate by vapourisation, usually under local anaesthetic. This effectively takes away the vibrating part of the airway responsible for a large proportion of the snoring sound. Our surgeons have performed over 500 of these procedures, problems after surgery, such as bleeding, occur less than1% of the time. Somnoplasty is less invasive and painful than LAUP, and is also performed under local anaesthetic. During this procedure, radiofrequency probes are inserted into the soft palate and by passing a low power electrical current through them, the palate is heated internally until it is damaged. causing scar tissue to build up, and causing contraction of the soft palate. These effects cause stiffening of the palate, and this damps down the ability of the palate to flap at night, which is what causes the snoring sound. Pillar implants again are inserted under local anaesthetic, they are directly implanted woven material which, like somnoplasty, causes stiffening of the soft palate. This is a new technique not currently available in the clinic, it is hoped to start treatment early in 2006. It is thought this will become the favoured palatal treatment, being effective yet relatively painless, and easily reversed.

 

Snoring/Sleepyness/Apnoea consultation

The initial consultation is with one of our Consultant Surgeons. A full history will be taken, your Epworth Sleepyness Score will be measured, as will your body mass index. Nose, throat and neck examination will be carried out, as will flexible endoscopy and the Muller manouvre. At this stage your doctor will have a pretty good idea as to what is causing your snoring / apnoea problem, since the cause of these conditions is always in this area. You will be advised as to what is the correct treatment for the cause of your problem, from weight loss to CPAP to airway ublocking surgery to mandibular advancement to palatal treatment.

To view pricing information for snoring procedures, click here.

If you are interested in the technical information relating to this condition and its treatment by laser, click here to be redirected to the "doctor's version" of this page.