Snoring is defined as noisy breathing during sleep. It is caused by vibrations of the soft palate, uvula, base of tongue and other soft tissues in the throat when one inhales. It implies an increased resistance to the inflow of air during breathing at the level of the upper airways. As much as 50% to 60% of the male adult population, between the ages of 30 – 60 years, snores.
Snoring is a social nuisance. However, it can be a potential problem, especially if it disturbs the bed partner. It can lead to marital problems, irritation and anger at home. If a patient who snores has symptoms of tiredness, poor concentration, daytime sleepiness, choking sensations at night, this patient may have a serious medical problem called Obstructive Sleep Apnoea (OSA).
OSA is a disorder that is characterised by repetitive collapse of the airway, resulting in low oxygen levels and an elevated blood pressure. Apnoea is defined as an absence or stoppage in breathing for 10 seconds or longer. Patients with severe OSA, may stop breathing as often as once every minute, over the entire night’s rest. Diagnosis of OSA requires a thorough clinical examination and a flexible naso-endoscopy. A non-invasive painless sleep assessment is also strongly recommended.
“In Singapore, an average of 300 people die per year from sudden death in their sleep.”
– Sunday Times, Nov 2006
Obstructive Sleep Apnea can lead to heart attacks, heart failure, high blood pressure, strokes and sudden death while sleeping. Diseases associated with OSA:
Apnea is defined as an absence of breathing for 10 seconds or longer.
Severity of OSA is measured in terms of the number of stoppages of breathing per hour at night during sleep. Patients with severe sleep apnea can stop breathing as often as once every minute, over the entire night’s rest.
Diagnosis of OSA requires a thorough clinical examination, a flexible nasoendoscopy and an overnight sleep study (polysomnogram).
This is when the brain “forgets to breathe”. This happens in patients with disorders in the brain itself. For example, patients with brain tumours or patients with too much carbon dioxide in the blood, this would lead to suppression of the breathing centers in the brain.
OSA is a disorder that is characterized by repeated episodes of airway blockage that occur during sleep, and usually associated with snoring and reduction in blood oxygen level.
Apnea is defined as an absence of breathing for 10 seconds or longer. Severity of OSA is measured in terms of the number of stoppages of breathing per hour at night during sleep. Patients with severe sleep apnea can stop breathing as often as once every minute, over the entire night’s rest. Diagnosis of OSA requires a thorough clinical examination, a flexible nasoendoscopy and an overnight sleep study (polysomnogram).
Yes, for most patients who have snoring and are having un-refreshed sleep should have a sleep test done.
No. There are newer home based monitoring options that are just as accurate and reliable as the hospital overnight sleep test. The home based devices are also better, as the patient sleeps at home, in his natural regular environment; hence, the sleep is more physiological and would yield a more accurate result.
The current Watch PAT device has been shown to be effective and up to 93% accurate and reliable compared to the overnight full polysomnogram.
Photo of an overnight sleep test, done in hospital or at home (difficult to sleep with all the wires). May not be physiological, and test might not be accurate or reflective of a normal night sleep.
The Watch PAT device worn on the hand. Comfortable for the patient, sleep better and might be more reflective of a normal night’s rest.
Conservative measures in managing OSA can start with the following lifestyle adjustments:
This is a non-invasive method of treatment, it entails using continuous positive airway pressure by a mask worn by the patient on the nose or the face throughout the night. CPAP is the most effective and frequently used treatment for OSA, but the issue of compliance is a major problem. It only works if the patients use the mask, it would not work if it was kept in the closet. As the patient does not use the mask the whole night, it would not be effective.
CPAP machines come in the (a) manual and the (b) automatic.
This machine delivers a fixed pressure of air, pre-determined by your sleep specialist based on either an overnight sleep study with the CPAP on, or an average recording of the automatic CPAP use over a month. This machine may be cheaper than the automatic version but require closer monitoring and follow up by the sleep specialist.
This is a dynamic machine that will titrate and adjust the amount of pressure required by the patient (user) based on each breath to breath variation. This machine records the average duration of use by the patient every night, records the average pressure required by the patient, records the leak of air between the patient’s nose/mouth and the mask, and provides an AHI reading, which tells the doctor how many times per hour the patient still stops breathing (if at all) while on the machine. This machine may be slightly more expensive but is probably more user friendly for the patient and more comfortable for usage.
The CPAP machine is very effective provided the patient can tolerate it the entire night. Compliance is the main problem. Most people do NOT use the machine the entire night and every night of the week. Hence, the treatment effectiveness is based entirely on the patient’s use.
Long term follow up and research done on over 20,000 patients on CPAP and those who underwent surgery. This study was published in the American Otolaryngology Journal in 2006, showed that patients who underwent surgery LIVED LONGER on average than patients who were using CPAP.
These are mouthpieces that are worn while sleeping to prevent the airway from collapsing. It works by repositioning the tongue or mandible forward.
Snoring Surgical treatment has been shown to be effective and curative in certain subsets of patients. Surgery ranges from the use of laser techniques, palatal implants to reduction of the soft palatal tissue, minimally invasive tongue surgery and jaw advancement.
The key to surgical success is patient selection. The most important role for the ENT surgeon is to:
Nose surgery is important for a few reasons:
Nasal turbinate reduction is a procedure to shrink the nasal turbinates—small structures inside the nose that help humidify and filter the air we breathe. Enlarged turbinates can cause nasal congestion, difficulty breathing, and sleep issues like snoring.
Nasal turbinate reduction can be done through surgery techniques such as Laser, Radiofrequency, Micro-debrider and Coblation.
Nasal Turbinate Reduction with the Radiofrequency is effective.
An endoscopic procedure to preserve as much mucosa and submucosal tissue as possible while removing the underlying Turbinate bone. This procedure results in faster healing and more physiological outcomes.
Endoscopic Sinus Surgery (ESS) is a minimally invasive surgical procedure aimed at improving drainage and airflow within the sinuses, treating chronic sinusitis and other sinus-related conditions. It uses an endoscope (a thin, flexible tube with a camera and light) to access the sinuses through the nostrils, allowing for precision and minimal external incisions. ESS is typically considered when other treatments, such as medication or conservative measures, have failed to resolve symptoms.
Palate surgery is important for many reasons:
Palate Surgery For Snoring and Mild Sleep Apnea is effective.
Traditional UvuloPalatoPharyngoPlasty (UPPP) – for selected group of patients, average results from 3,000 over patients showed UPPP at best results were 59% after very careful and prudent selection of patients.
Tongue surgery is important for a few reasons:
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drpang@asiasleepcentre.com
Snoring is noise produced during inspiration when one is asleep. It is due to the vibration of the soft palate, uvula base of tongue and other soft tissues in the throat when one inhales. It implies an increased resistance to the inflow of air during breathing at the level of the upper airways. As much as 30% of the adult population, or 60% of men over 40 years of age snore.
Snoring itself is not an illness, but it can be a potential problem, especially if it disturbs other people’s sleep. The snorer may be the target of irritation or anger, may even strain household or marriage relationships.
Snoring if associated with symptoms of tiredness, poor concentration, daytime sleepiness, choking sensation at night, may be a sign of a potential serious medical problem – Obstructive Sleep Apnoea (OSA).
Snoring is dangerous if it is associated with daytime tiredness, morning headaches, nighttime choking / gasping or difficulty in breathing. Snoring and Sleep Apnea can lead to heart attacks heart failure, high blood pressure, strokes and sudden death while sleeping.
NOSE, PALATE, TONSILS, ADENOIDS, TONGUE
YES.
There are a number of different treatment options, the efficacies of which are pretty similar. This is due to nose block and palate vibration / flutter. Thus, treatment is directed at opening up the nose passage and stiffening and strengthening the palate. The theory is that the stiffer the palate the less likely the palate would vibrate and hence, no more obstructions and better oxygen levels at night during sleep, therefore better rested sleep.
Yes. It would work for selected group of patients with identifiable nose, palate or tongue obstruction and/or narrowing.
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