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Sleep Apnea and Snoring

Snoring and sleep apnea are related medical problems that the physicians at North Fulton ENT commonly care for.  It is important to distinguish between the two, as their treatment and urgency are very different.  At some point in their lives, nearly every person will snore.  Snoring is the sound made by vibration of the tissues in the throat as air passes by them. Snoring can be intermittent or habitual, and it is nearly always a social problem for a bed partner. 

Snoring in children
In children, the most common causes of snoring and sleep apnea are enlargement of the tonsils and adenoids, or nasal airway obstruction from an upper airway infection or allergies. Pediatric patients who have obstructive sleep apnea tend to respond very well to the removal of enlarged tonsils and adenoids.  This can often be done as an outpatient procedure, depending on the age and health of your child.

Adult snoring
In adults, the causes of snoring are often related to nasal obstruction from septal deviation or allergies, or excessive tissue in the throat, including that due to excessive weight. 

Sleep apnea

The extreme of snoring is sleep apnea.  This is defined as a lack of airflow for ten seconds or more during sleep, or successive periods of a less than half-normal breath for the same period of time.  It is important to distinguish one from the other, as procedures for snoring are not often covered by insurance companies, while obstructive sleep apnea has several dangerous medical consequences and thus its treatment is usually covered by most insurance companies.  While snoring can be disruptive to bed partners, obstructive sleep apnea is associated with a decrease in REM sleep and possibly with decreased levels of oxygen during sleep.  These can result in mood swings, lack of concentration and energy, and the risk of developing hypertension and cardiac and pulmonary disease.  Untreated obstructive sleep apnea is significantly associated with elevated risks of strokes, heart attacks, and cardiac rhythm abnormalities.  Please alert your physician if you think that you or someone you know might be suffering from obstructive sleep apnea.

Diagnosis
Your North Fulton ENT physician will take a careful history of your sleep condition, followed by an extensive examination of your airway, from the tip of your nose to your lungs.  In pediatric patients, the diagnosis is often made by a parent who notices pauses in a child’s breathing, gasping for air, snorting, or even retraction of the chest while apnea episodes are occurring.  In adult patients, an overnight sleep study (Polysomnogram) is usually necessary in order to definitively diagnose obstructive sleep apnea.  Our office will find a sleep center with which your insurance company contracts, and arrange for this study if indicated.

Treatment
Treatment for snoring often involves very simple maneuvers or medical interventions.  Nasal steroids or decongestants, Breathe-Rite^® strips, proper sleep posture, weight loss, and avoidance of alcohol or sedatives at bedtime will often be enough to cure habitual snoring.  For those cases that do not respond to these forms of treatment, we offer an in-house laser procedure for snoring which is highly successful.

If Obstructive Sleep Apnea is diagnosed, there are medical and surgical procedures which can help or completely eliminate these events.  Initial therapy is usually with Nasal CPAP (continuous positive airway pressure), which is essentially a mask which fits over your nose and blows in air to keep the airways patent.  You would first have a repeat sleep study with the mask in place, while an optimum pressure that eliminates apnea while maintaining patient comfort is calculated.  You would then obtain this equipment from the sleep center and a “fitted” mask, with a machine that is set at the level determined by the CPAP Titration Study.  Most of these machines are easily portable for those who travel frequently, and better technology makes machines that are quieter and better tolerated.  This treatment is 100% effective for those patients who keep the mask on all night long, and patients usually notice a significant improvement in their daytime function after initiating nasal CPAP therapy.

For those who are unable to tolerate nasal CPAP or who wish to pursue a permanent surgical cure for apnea, several options are available.  Although the exact details of the procedure are beyond the scope of this Web site, they typically involve surgical improvement of the nasal airway and/or treatment of enlarged tonsils, soft palate and uvular enlargement or redundancy, and even procedures aimed towards relieving obstruction at the base of the tongue.  Regardless of which avenue you choose to pursue, realize that obstructive sleep apnea is dangerous to your health and can even be life threatening.  There are devices and procedures that can eliminate it, so do not hesitate to notify your North Fulton ENT physician if you think you might suffer from a sleep disorder.

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