Sleep Apnea & Snoring
Oral & Facial Surgery of Northeast Texas – Texarkana & Paris TX
Did you know that snoring can be a warning sign of a serious medical condition known as obstructive sleep apnea? It can affect your daytime performance, your job, and your health. Fortunately, there are effective treatments that can reduce or even stop your snoring.
Why Do We Snore?
It is estimated that 45% of normal adults snore occasionally, but 25% are habitual snorers. Heavy snoring is more common in males and overweight persons and the problem usually grows worse with age.
Snoring is not simply a bad habit that a person can be trained to give up, but is caused by a partial obstruction of the airway in the back of the throat and nose. The characteristic rattling sound is the vibration of the soft palate and uvula or other structures in the upper airway. This is the result of the airway being constricted by one or more of these physical conditions:
- Poor muscle tone in the soft palate. This may worsen when muscles are relaxed by consumption of alcohol, drugs, or smoking.
- Enlarged tonsils and adenoids.
- A large uvula.
- Blocked nasal air passages, common with a cold or allergies.
- Obstructed nasal airways, caused by polyps, cysts, or a deviated septum.
- Excessive weight, causing tissues in the neck to be bulky and flaccid.
- Hypothyroidism and other glandular disorders.
People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.
Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.
Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.
The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.
In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. An oral appliance can help open the airway during sleep. The oral appliance can be utilized alone or in combination with CPAP. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP) which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the office.
In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.