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Snoring
is an extremely common phenomenon. When it is loud enough to raise the concern
of or irritate others it is usually not only a social but medical problem as well.
Snoring that occurs every night, in all positions, can be heard in another room
and is associated with excessive tiredness or difficulty in awakening usually
represents a medical problem. Left untreated, this often makes the snorer the
object of ridicule and results in a progression of symptoms. This includes progressively
loud snoring and increasing daytime sleepiness, deterioration of work/school performance,
difficulty in awakening, weight gain and ultimately heart, blood pressure and
circulatory problems including stroke and sudden death. Loud snoring has been
associated with behavior problems and poor school performance in children. This
is almost always due to enlarged tonsils
and adenoids
in children. Children respond extremely well to removal of tonsils and adenoids.
Adult snorers are are evaluated by a sleep study prior to the initiation of any
therapy in order to determine the presence of sleep disordered breathing, the
type of sleep disordered breathing and treatment options. CPAP
( Continuos Positive Air Pressure ) or BIPAP ( Bilevel PAP which allows a different
pressure for inhalation and exhalation as opposed to CPAP ) are generally considered
the most efficacious treatment modalities.
Those that cannot tolerate sleeping with a mask over their nose ( CPAP/BIPAP )
or those that have difficulty breathing through their nose may benefit from nasal
surgery such as repair of a deviated nasal
septum or turbinate reduction and/or uvulopalatopharyngoplasty
( UPPP ), a surgical procedure on the throat to alleviate snoring and sleep apnea.
These surgeries are not universally effective and must be carefully matched to
the patient’s breathing disorder of sleep. Patients with deficient chins,
for instance may require procedures to pull the chin and tongue forward in addition
to other procedures.
The initial evaluation of the snoring patient always begins with the
patient’s physician taking a history and performing a physical
examination. The physician will then decide whether to request a sleep
study or polysomnogram in addition to other pertinent tests. It is only
through the careful and individualized consideration of all of these
factors that a treatment algorithm is developed. This treatment may include
treatment of underlying medical conditions such as obesity and hypothyroidism.
CPAP/BIPAP is usually included as part of the initial therapy because it is almost
universaly effective. Compliance is frequently a problem, and because of this,
surgical procedures may be necessary.
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