Kim Richard Jones, M.D., Ph.D.
Adult and Pediatric Otolaryngology
Kathy Yu, M.D., M.P.H.
Adult and Pediatric Otolaryngology
Erin Blackburn, Au.D./CCC-A/F-AAA
Carolina ENT Associates 55 Vilcom Center Drive, Suite 140
Chapel Hill, NC 27514
phone: 919.942.7278
fax: 919.942.9029
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Snoring

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Snoring is perhaps more of a social problem than a medical problem. However, about 15% of people who snore may also have obstructive sleep apnea, which can be a medical problem. Unfortunately, there is no good way to distinguish between those patients who simply snore from those who snore and also have sleep apnea. Thus, if you snore, you may want to read the section in this website regarding sleep apnea, and discuss with your doctor whether you should be tested for this disorder.


What Causes Snoring?

Snoring is caused by the vibration of the soft palate as air passes between the nose and the throat while sleeping. In some people it can also be caused by vibration of the back of the tongue. The reason this occurs only during sleep (thankfully!) is that while we are awake, there is a slight amount of muscle tone present that keeps these structures from falling against the back of the throat, even if we are laying on our back. However, as we drift into deep sleep, this muscle tone goes away, and the palate and tongue can partially collapse and start to vibrate as we struggle to pull air through the suddenly narrowed breathing passage. If they collapse enough to completely block the throat, apnea can occur (see above). Snoring and sleep apnea are more common in obese patients (because the fat in the neck narrows the breathing passage) and are also somewhat more likely in persons with a long soft palate, a large uvula, or a thick tongue. They are also more common in older patients, probably because of the decrease in muscle tone as one gets older. Both are also made worse by the use of muscle relaxants or alcohol before bedtime.


Treatments for Snoring

If you have an Internet account, you have probably been bombarded with emails touting various cures for snoring. Also, you may have seen ads in many newspapers and magazines. Here’s a tip: none of these products work. Breathe-Rite strips (the flexible sticky strips you put on your nose) may work on a limited number of people who can’t breath through their nose at night, but otherwise there are currently no medicines (prescription or otherwise) that cure snoring. There are a number of other treatments that may help snoring however, ranging from taping a tennis ball to your back (this keeps you from sleeping on your back) to various surgical therapies.

If you’re overweight, the best treatment is to lose some weight. Research has shown that unfortunately, the relationship between snoring and weight loss is not linear. That is, a little weight loss will not result in a little decrease in your snoring. Rather, there appears to be a “set-point” for each individual, so that if you are above this weight you’ll snore, and below it you won’t. For those of you who started snoring as adults, think back on about how much you weighed when you didn’t snore, and you can get a rough idea of your set-point.

If your set-point is many pounds ago, there are some other treatments for snoring available. First, there are dental appliances that fit in your mouth at night to help to keep your tongue from falling back. While these work for some individuals, the resultant jaw discomfort often causes most people to abandon their use. That leaves surgical treatments, of which there are a number available. An important consideration is that except for uvulopalatopharyngoplasty (UPPP), most of these procedures are fairly new, and there is little data regarding their long-term effectiveness. Results at one year have been included for most of the procedures, however. Please see below for a summary of their approximate costs, advantages and disadvantages.:


Uvulopalatoplasy (UPP)

What’s involved: The palate is anesthetized with Novocaine and an electrocautery (“electric knife”) is used to remove most of the uvula. The palate is then burned across its surface so that the resulting scar tissue tightens and stiffens the palate.

Where done: Clinic

Advantages: Has been well-studied short-term. Few complications. Initial success rate (reduction in snoring of 50% or more) about 90%, success rate at one year about 75%.

Disadvantages: Can result in moderately severe pain and swelling that can last for several days.

Cost: <$400.00


Laser-Assisted Uvuloplasty (LAUP)

What’s involved: Same as above, except a laser is used instead of electrocautery.

Where done: : Clinic. Was originally fairly popular, but because of poor long-term results (see below), I don’t know anyone in the Triangle that is still doing these.

Advantages: None when compared to other procedures.

Disadvantages: Significant pain and swelling. May have to be repeated several times before desired effect is obtained. Initial success rate of 85% drops to 55% after 18 months.

Cost: approx. $900.00


Somnoplasty

What’s involved: Uses electrocautery delivered through a needle inserted in the palate. A special feedback circuit allows the needle to heat up enough to scar the palate, but not to burn. The resulting scar stiffens the palate and reduces snoring.

Where done: ENT clinic at UNC Hospitals.

Advantages: Very little pain. Takes about 30 minutes, and may return to work the same day.

Disadvantages: High cost. May also require more than one treatment before desired effect is obtained. Only one study of long-term success has been reported. This showed that initial success rate of >90% drops to about 60% after one year. Procedure may be repeated, however.

Cost: approx. $1400.00 for first session, $500.00 for each subsequent session.


Injection Snoreplasty

What’s involved: A chemical is injected into the palate that causes a loss of blood supply to the central portion of the palate. This area turns black-and-blue and then becomes scar tissue over the next 4-6 weeks and stiffens the palate.

Where done: Clinic.

Advantages: Somewhat less pain than uvulupalatoplasty. Low cost (see below).

Disadvantages: Is the newest of the snoring procedures. Seems to be more variability in results than seen with other procedures. In my hands (I have done about eight of these) short-term success rate is about 60%. Long-term success rate unknown at this time.

Cost: $150.00


Uvulopalatopharyngoplasty (UPPP)

What’s involved: Major surgical procedure under general anesthesia. The uvula and a portion of the palate are removed and the edges of the palate sutured together. If tonsils are present, they are also removed.

Where done: Operating room with overnight stay.

Advantages: Only procedure presently approved for sleep apnea. Has never been directly compared to the other procedures listed above for snoring alone, but probably has greatest likelihood for long-term success.

Disadvantages: Requires 5-7 days recovery. Long-term success for snoring ~ 55%.

Cost: Approximately $5700.00. This includes surgeon’s fee, use of operating room, and one night hospitalization. Is usually covered by insurance if you have sleep apnea.



Summary

As you can see, there is presently no foolproof treatment for snoring. Certainly weight loss is the best solution if you have the willpower to stick to a diet, increase your amount of exercise, and not expect quick results. If you are not overweight, one of the surgeries listed above would probably be your best option. Which one depends primarily on the amount of money you are willing to invest and how much discomfort you are willing to tolerate to reduce your snoring.

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