Nasal Obstruction

Snoring is noisy breathing during sleep due to upper airway obstruction. It may result from an excessively long soft palate or uvula, redundant tissue in the back of the throat, enlarged tonsils and adenoids, nasal septal deviation, a big tongue, abnormalities of the lower jaw, or obesity. Sleep apnea is the condition where the affected individual stops breathing while asleep for a length of time during which the oxygen saturation in the blood begins to decrease. This leads to awakening and resumption of breathing. The person with sleep apnea may awaken hundreds of times during the night without realizing it. Bed partners will usually notice the problem, however. The affected individual may report being excessively tired during the daytime because of poor sleep at night. Most persons with sleep apnea snore, but not all snorers have sleep apnea.

Snoring is simply a cosmetic problem and leads to no long term health risk, except for its occasional disruption of the family unit. Sleep apnea, however, can lead to long term heart and lung failure, as well as the minute possibility of sudden death syndrome. Therefore, it is a serious condition that requires treatment. There are central nervous system causes of sleep apnea that require neurologic consultation, but the most common cause of sleep apnea is obstructive sleep apnea. This may result from any of the snoring causes listed above, with the exception of nasal disorders. Although chronic mouth breathing may lead to snoring, it should not cause sleep apnea.

Any person who suffers from symptoms of obstructive sleep apnea should have a sleep study performed. During this study, the oxygen saturation and the breathing will be monitored. A report will be made that determines whether or not the person truly has obstructive sleep apnea. If the report is positive, the sleep apnea should be treated. If it is negative, the person may decide if he wishes the snoring to be treated. It should be kept in mind that most insurances will not pay for the treatment of snoring, unless obstructive sleep apnea is present. If the person desires treatment for snoring, but denies symptoms of sleep apnea, a sleep study should still be performed to rule out unrecognized sleep apnea.

The following treatment options exist for obstructive sleep apnea: weight loss, nasal continuous positive airway pressure (CPAP), various jaw and tongue advancement procedures, tonsillectomy with adenoidectomy, uvulopalatopharyngoplasty (UPPP), and tracheostomy. Of these treatments only tracheostomy is curative in every patient. The success rates of the other treatments vary widely.

Weight loss is paramount. Any procedure for obstructive sleep apnea will have a greater success rate if excessive weight is lost. Nasal CPAP is an apparatus that forces air down the nose to keep the airway open while asleep. Although CPAP is quite successful, it can be very uncomfortable, it tends to dry out the nose, and it has no long term benefit. It is of great use, however, when a person has complex medical problems that limit surgery or is attempting to lose weight before undergoing surgery. Procedures to advance the jaw and tongue have little benefit when performed alone, but when combined with operations on the palate and pharynx, they can increase the success rate. For children with obstructive sleep apnea, tonsillectomy with adenoidectomy is usually curative.

The most widely accepted treatment for adults with obstructive sleep apnea is UPPP. In this procedure, the uvula is removed, the palate shortened, and the pharynx tightened. This eliminates the excessive tissue that tends to obstruct the airway. If there is no obesity or if excessive weight is lost, UPPP has a very high rate of success. The vast majority of persons experience an improvement in their sleep apnea, and a great number are cured. When severe heart and lung disease is already present, the only available treatment for obstructive sleep apnea is tracheostomy.

If no sleep apnea is present, then snoring may be treated in a number of ways. Weight loss, changing sleeping positions, "Breathe Right" nasal strips, and oral appliances have all been shown to reduce snoring. Surgical options include UPPP as described above versus palatoplasty performed in the office over multiple visits, using an electrosurgical, radiosurgical, or laser device. The advantage of UPPP is that the operation is done in one procedure with faster healing and less pain. The advantage of in-office palatoplasty is lower cost and minimal anaesthesia, but its major drawback is the requirement for multiple procedures and thus more drawn out and protracted pain, before final results are achieved.