Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep. Snoring, sleep apnea and other sleep-related breathing disorders represent the most common sleep disorders seen in our outpatient setting. Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea. Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of apnea (cessation of breath).
Various methods are used to alleviate primary snoring. They include behavior modification (such as weight loss), surgical and non-surgical treatments, and dental devices.
Surgical treatments include:
- Pillar implants – Permanent polyester implants which are placed in the area of the soft palate. Three to five implants are placed in an office setting with the use of topical and injectable anesthetics. This procedure is easily tolerated with very little post-operative discomfort. It is indicated for primary snoring and mild OSA.
- Laser assisted uvulopalatoplasty (LAUP) an outpatient treatment for primary snoring and mild OSA that involves use of a laser under local anesthesia to make vertical incisions in the upper palate, shortening the uvula and lessening airway obstruction.
- Radiofrequency volumetric reduction of the palate a procedure performed in an otolaryngologist’s office that utilizes targeted radio waves to heat and shrink tissue in the upper palate.
Obstructive sleep apnea
(OSA) is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur hundreds of times in one night. Most people with OSA snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They make choking, snorting or gasping sounds when their airway reopens. The result is a fragmented quality of sleep that often produces an excessive level of daytime sleepiness. After many years with this disorder, elevated blood pressure and heart enlargement may occur, leading to heart attack, stroke, and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, weight gain, poor performance at work, failing personal relationships, and increased risk for accidents, including motor vehicle accidents.
Obstructive sleep apnea must first be diagnosed with either a home sleep study (1-3 nights) or at a sleep center or lab during an overnight sleep study as determined by your insurance company. Continuous Positive Airway Pressure (CPAP) is the standard treatment option for moderate to severe cases of OSA and a good option for mild sleep apnea. This positive pressure airflow keeps the airway open, preventing pauses in breathing and restoring normal oxygen levels.
An oral appliance is an effective treatment option for people with mild to moderate OSA who are unable to successfully comply with CPAP therapy. Oral appliances look much like sports mouth guards, and they help maintain an open and unobstructed airway by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. Some are designed specifically for snoring, and others are intended to treat both snoring and sleep apnea. They should always be fitted by dentists who are trained in sleep medicine.
Surgery is a treatment option for OSA when noninvasive treatments such as CPAP or oral appliances have not been unsuccessful. It is most effective when there is an obvious anatomic deformity that can be corrected to alleviate the breathing problem. Otherwise, surgical options most often address the problem by reducing or removing tissue from the nasal passage, soft palate, uvula, tonsils, adenoids or tongue.
One of the most common surgical methods is uvulopalatopharyngoplasty (UPPP), which trims the size of the soft palate and may involve the removal of the tonsils and uvula. Adenotonsillectomy, the surgical removal of the tonsils and adenoids, is the most common treatment option for children with OSA as is usually curative. Other children with sleep apnea may still benefit from CPAP.