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Snoring Treatment
How well did you sleep last night?
There is a great possibility
that you are visiting this page because someone has told you that you snore! We
hope that we can impress you with so much information that just by going to
various pages in our site all your questions are answered.
The above illustration demonstrates
most common clinical signs, symptoms, findings and contributing factors for
obstructive sleep apnea. Note that there are many factors causing the snoring
sound as well and by performing surgery in one or two area we cannot address all
the problems that you may have. (© Mansoor Madani, DMD)
First let’s begin by explaining
a few points about snoring and sleep apnea:
We all snore occasionally, but in most cases it
is a problem that self-corrects and does not bother
anyone. In some, it is compounded by a deadly
condition of impeded breathing. Basically, you stop
breathinganywhere from a few
seconds up to 20, 30, or even 100 times or more per
minute This stoppage of breathing plus snoring along with a
few other symptoms are known as obstructive sleep apnea.
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Dangers of Sleep Apnea |
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I
snore and stop breathing,
could I die from it?
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In fact, you can have very
serious complications if you suffer from sleep apnea.
With sleep apnea, you are more prone to
have:
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Heart attack (myocardial infarction) or MI
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Stroke
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Hypertension
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Emotional issues & mood
problems (getting agitated & upset easily, having shorter attention span,
depression, having anxiety)
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Sexual problems
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Car accidents
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Lose time from your work and unable to perform well at
work
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Increased chance of stopped
breathing altogether (higher morbidity & mortality), so a patient with
sever obstructive sleep apnea and other risk factors such as obesity, high
cholesterol level, hypertension, etc has much higher chance of dying young
and/or while they sleep!
It has been estimated that over 3800 people die every single year from
complications of sleep apnea in the United
States only.
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How about my life, my job? |
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Quality of life issues range
from sleeping in separate bedrooms, body fatigue, irritability,
nervousness, arguments and even divorce has been brought up by many
couples.
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Personal financial impacts range from an increased
cost of medical care, prescription & over the counter drug expenses.
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Institutional impacts at work could range from: |
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Job related Illness and injuries to self as well as
coworkers
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Increased Healthcare expenses to self as well as
employee
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Causing injuries to others (buss & truck drivers)
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Inability to focus & concentrate at work
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Inability to perform complex tasks
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Afternoon job performance issues
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Reduced problem solving ability
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Tired & sleepy at work
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Reduce productivity
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Why is it
that more men snore than women? |
| We have examined over 20,000
patients for snoring and sleep apnea and have operated on several thousand
patients. We estimate that ration of Men versus women are 9:1. We believe
that a major reason is the men’s body size, and their anatomy. We can’t
disregard genetics, hormones and other factors either. |
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Causes of Snoring and Sleep
Apnea |
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The above
illustration demonstrates many areas that make us snore or stop breathing
from our mouth. Please see the following areas as described in this site for
further information. But note that one single procedure such as laser
surgery to trim the uvula or Radioablation of various tissues in the mouth
or nose cannot eliminate all sources of the
obstruction. (©
Mansoor Madani DMD and with permission from the Atlas of Oral and
Maxillofacial Surgery Clinics of North America)
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We have been able to identify at least 10
different areas in the head and neck that cause you to snore:
Starting from the top of the airway:
1. Nose
also called the nasal cavity - you could have:
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A deviated septum (the wall that divides
your two nostrils) interestingly enough many
people have a deviated septum,
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Enlarged nasal turbinates: turbinates are
the structures in your nose that get enlarged when you
have a cold or for those that have a chronic congestion problem,
causing these structures to swell up and block your nasal passages.
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Polyps and other obstructive masses you
may have in your nose
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If you had a previous injury to your nose
you could have a nasal adhesions, meaning that
the septum of your nose is in fact attached to
the turbinate
2. Roof
of the mouth problems: soft palate and uvula (elongation or
excessive vibrating flap on the roof of the mouth)
3. Adenoids
(or pharyngeal tonsils or nasopharyngeal tonsils) are a mass of lymphoid
tissue situated at the very back of the nose, in the roof of the nasopharynx,
where the
nose blends into the mouth.
Normally, in children, adenoids are much larger than adults and in
combination with larger than usual tonsils can cause airway obstructions.
4.
Tonsils: on both sides of your mouth, once again they get smaller
without any surgery in most cases as we get older. Tonsils that are touching
each others are called kissing tonsils.
5. Large
Tongue: Base or far back and bellow end of the tongue drops in
the back of the throat and closes up the wind-pipe. (This is probably one of
the most crucial area of obstruction especially when one sleeps on their
back.)
6.
Receded chin
7.
Receded jaws
8.
Narrow breathing tube, windpipe or small oral and pharyngeal
airway.
9.
Floppy and large muscles that cover the sides of your windpipe
(medically defined as lateral pharyngeal walls constriction due to
pharyngeal muscle hypertrophy or enlargement and , constricted airway
passage)
10.
Receded hyoid bone
(this is the bone which helps to support the tongue and serves as an
attachment point for several muscles that help to elevate the larynx, during
swallowing and speech. By being positioned further back in the neck the
tongue has more tendencies to drop in the airway and blocking it.
11.
Elongated epiglottis: this is also a flap of tissue that sits at
the back and bellows the tongue that keeps food from going into the trachea,
or windpipe, during swallowing. When it is excessively swollen or inflamed,
it can obstruct, or close off, the windpipe, causing blockage of the airway.
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The above
illustration demonstrates many areas that make us to snore or stop
breathing. The sound of snoring could arise from many locations or passages
in the upper airway. That is the reason that one single procedure can not
eliminate all sources of obstruction. (©
Mansoor Madani, DMD and with permission from the
Atlas of Clinics of North America) |
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Is there a single operation that can fix my snoring
problems? |
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Very
frankly and simply said the answer is NO! We tried with illustrating in
this site to show our visitors that there is no single, magic
cure to all your snoring and sleep apnea problems.
But having performed procedures on thousands of patients,
over 95% are happy to have had this procedure done in our center. As one
expects, the experience of a surgical team and the
clinical knowledge of the surgeon are of the utmost
importance in getting the best possible response to the treatment. Here is a
combination that works best:
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The
right patient with understanding and knowing the surgical limitations
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Normal
patient and bed partner’s expectations
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Presence
of abnormal anatomy
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An
experienced surgeon with many years of practice and knowledge
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The
right setting as far as the diagnostic tools, devices and up-to-date
equipment
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A
patient who will follow the post operative instructions
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An
individual who tries the best to lose weight
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Laser Surgery |
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There are several terms
that you must understand before having snoring treatment done.
An older multiple staged
laser surgery called LAUP:
this is a procedure that is primarily directed to reduce the length
of the uvula. The reason that it does not work effectively is because there
are the tissues around the uvula that continue to vibrate and cause
the snoring sound. One other drawback is that this
procedure is done under local anesthesia and multiple visits. Our extensive
research showed that
this procedure is ineffective and there is great chance of relapse with it.
Then there is the traditional
UPPP (Uvulo-palato-pharyngo-plasty)
- generally done in an operating room and under general anesthesia with
intubation. It has been reported in the literature that although traditional
UPPP is one of the most effective methods of treatment, several
patients had developed fluid reflux from their nose and also some had voice
changes. The incident of this unfortunate side effect has also been reported
to be between 3-10% of all cases.
What we have done is use the laser to
perform UPPP (UPPP with laser).
Additionally, we have modified
the surgery so that excessive amounts of tissue
are not removed hence reducing the chance of voice change or fluid reflux
from the nose. In fact of thousands of cases treated many have reported that
the quality of their voice and the clarity has been improved and no patient
had fluid running out of their nose after surgery. The primary goal and
effect of this procedure is to reduce the intensity of snoring and not to
cure body fatigue or severe obstructive sleep apnea. On average, based on
our published data, the intensity of snoring is reduced up to 60-75%,
significant enough to help patients sleep with their bed partners and be
successful in 95% of cases.
This technique has helped certain
individuals with very mild obstructive sleep apnea. Every patient is going
to respond differently to these treatments and although hundreds of patients
were able to discontinue the use of their
CPAP (a sleep device that pumps air into your body through a nasal mask
if you suffer from sleep apnea) we do recommend continuation of the device
even after surgery. The LA-UPPP is not a cure for sleep apnea.
How is
laser surgery for treatment of snoring done?
After a careful analysis of your problem(s)
and detailed discussion of the technique we use in
our center, you are guided to a state-of-the-art examination room. Your
mouth, nose and throat are carefully examined using a
high-tech digital camera. You can actually see the problem(s) and
clearly understand the cause as well as limitations of any kind of surgery.
Your questions are carefully answered. During this period of evaluation,
you must discuss with us any medical problems you may have. That should
include any past hospitalizations, surgeries, important medical conditions,
any drugs you may presently take and so on. You can,
in fact, access our
forms online, print them out and bring
it with you. Please tell us if you had a recent cold or if you take aspirin
(or any other blood thinners). Of course, history of allergies or other
important medical information should be brought to our attention.
Once we reviewed all the procedures,
alternatives (which includes weight loss & CPAP,
dental appliances
as well as no procedures at all) risks and complications then we are ready
to proceed with your care. If you are extremely overweight or have major
signs of sleep apnea we may recommend a sleep study prior to your
treatment. All our patients are given that option to rule out sleep apnea
but once again we want you to know that LA-UPPP is not a cure for sleep
apnea.
Diagnostic digital radiographs
are taken from your head and neck to evaluate,
jaws, teeth, sinuses, nose, airway and other visible structures in the
x-ray.
After
many years of research, working with CO2 & Nd YAG laser, radiofrequency,
ultrasound, Bovie, EllmanTM, CoblationTM and
SomnoplastyTM/SM as well as the surgical blade and more recently
with palatal implants, we will determine what
technique works best for you. In general, we use the CO2 laser in our
present practice to trim the elongated uvula and the part of the roof of the
mouth adjacent to the uvula. If tonsillar tissues are present, they will be
treated with radiofrequency to make the tonsils smaller or even remove a
portion of the tonsils. This technique reduces pain and allows you to
return to your work or school the day after surgery or a
few days later.
All
of patients are sedated (an IV line with a small amount of medication given
to relax you). It requires patients not to eat or drink for six hours prior
to their treatment. If you are considering having a procedure done on the
day of your first visit, this is an important consideration. A responsible
driver must also accompany you. Procedures are performed on site at our
facility, so you don’t have to go to a hospital and be admitted. Recovery is
very fast from this type of anesthesia.
The
procedure is fairly simple and done right in our
state-of-the-art Bala Cynwyd center
(just outside Philadelphia). In general, most
patients prefer to be asleep for this procedure. The experience of the
surgeon has a lot to do not only with how fast the procedure could be done
but how well and how precise. We have performed thousands of laser surgery
cases. We are extremely proud to be invited as the guest editor of the
prestigious
Atlas of Oral & Maxillofacial Surgery Clinic of North America on the
subject of snoring and sleep apnea.
For
surgeons contemplating doing these procedures we highly recommend getting a
copy of this wonderfully written guide before embarking to perform such
services for their patients. A link to the publication
can be found
here. |
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A few things you may want to know about laser surgery
for treatment of snoring...
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Actual
procedure time is
short:
Procedures are performed in our center and in
the shortest period of time on average in less than 1 ½ hours.
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Length of stay in our center is very short:
We encourage our patients to anticipate up to 3-4 hours of stay in our
center on the day of their surgery.
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The degree of pain while you are having surgery done:
You are sedated and anesthetized during the procedure so you will wake up
without much pain, your throat will be numb and it will
feel like you are a having difficult time
swallowing at first. This will last between 4 to
8 hours and the sensation will come back. Just like any other surgical
procedures, expect pain afterward.
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Shorter period of pain:
Unlike surgical procedures done in the operating room the duration of pain
is exactly 14 days with various severity depending on one’s pain
tolerance. If you follow the comprehensive instructions we give you, your
recovery will be smoother and with least amount of complications.
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In-office procedure:
Procedures are performed under monitored anesthesia in the center, so you
don’t have to waste a whole day in the hospital and possibly another day
for preparation to go to the hospital.
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Bleeding:
Laser coagulates the tissues as it ablates or removes tissues, generally
bleeding is rare. Of course if we encountered bleeding dissolvable sutures
will be used to control the bleeding. These sutures do not need to be
removed.
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Fast recovery: You can return to work the following day after
surgery. Once again
note that you must take pain medication and they may contain narcotics and
you must avoid driving, operating heavy
machinery or driving trucks, or
flying a plane (if you are a
pilot) and so on if you take such medication.
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No hospitalization: Procedures are performed in our center so no
hospitalization is needed.
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General anesthesia versus IV sedation: No operating room and nasal
or oral intubation needed. All patients will be offered IV sedation, so
you will be asleep but breathe by yourself and
will be monitored extensively.
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Breathing while you are having the surgery:
You breathe by yourself during the procedure under anesthesia which means
lower risk of respiratory or breathing complications
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Return to work:
We encourage all patients to return to work the next day after surgery.
Once again with the above precautions. Every
patient is going to respond differently to the procedures and some may
need a day or two to stay at home.
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Our State of the art technology
plus a one of a kind and very impressive power point presentation will
surpass your expectation of a 21st century surgery center. |
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What are the potential benefits of surgery? |
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Once again, every individual reacts
and responds differently to any surgical treatment. Although the following
statements are all positive, less than 5% of
patients with more severe type of problems reported that surgery did not
correct all their problems. Here is what over 95% of our patients have told
us after they had laser surgery:
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My snoring sound is reduced by about 60-75%
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I wake up in the morning much more alert
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I sleep much better
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Quality of my sleep is different
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I breathe much better from my mouth
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My wife (husband or bed partner loves me again!)
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I wish I had it done earlier
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It was certainly cheaper than divorce!
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Dr. Madani is one of the pioneers of a new laser surgery technique to
treat snoring and mild sleep apnea. The material contained herein is provided
for informational purposes only and should not be considered as medical advice
or instruction. Individuals with suspected or diagnosed sleep apnea syndrome,
any sleep disorder or other conditions discussed in this site should consider a
personal evaluation in our facility or contact a qualified professional for
further treatment.
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