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  • Diagnosis & Management of Pulmonary Diseases

  • Evaluation and Management of Sleep Disorders

  • Sleep Study

Snoring

Snoring is the sound produced in a sleeping individual due to blocked breathing. The sound is caused by the tissues at the top of airway striking each other causing vibrations. Snoring is commonly observed amongst older people and those who are overweight. Snoring may be a sign of a more serious condition known as sleep apnea. Sleep apnea is a disorder in which breathing is brief and repeatedly interrupted during sleep. It is an involuntary condition in the person who is asleep. In most of the cases the person will be unaware of the stoppage of breath as it does not trigger full awakening. As a result, the person’s sleep is fragmented and of low quality. It is most commonly seen in men than in women. Sleep apnea is of three types:

  1. Obstructive Sleep apnea – This is caused by blockage of the airway, often when the soft tissue in the rear side of the throat collapses and closes during sleep.
  2. Central Sleep apnea – This is not caused due to blocking of the airway, but instead occurs when the brain fails to signal the muscles to breathe.
  3. Mixed Sleep apnea – This is a combination of both types with blocking of the airway and cessation of signals from the brain to the muscles to breathe.

Causes and Symptoms:

In children, snoring may be a symptom of any problem related to the tonsils and adenoids. In adults and elderly people, snoring may be due to poor muscle tone in the throat and tongue, excessive throat tissue, long soft palate and uvula or obstructed nasal airways. Chronic snoring is an indicator of sleep apnea and should not be left undiagnosed. As people with sleep apnea are sleep deprived, the untreated condition may lead to difficulty in concentrating and mood changes such as irritability. Children may experience learning deficits and memory loss. Adults may have difficulty concentrating at work and focusing on the road when driving. People with the condition are at risk of developing high blood pressure, weight gain, memory loss, congestive heart failure, stroke, impotence and depression.

Treatment:

Many reliable and effective methods of treating snoring and sleep apnea have been developed.

  • Continuous positive airway pressure device (CPAP) – It is a mask that is fitted over the nose and/or mouth. Air is blown gently from the mask to keep the airway open during sleep. This is a highly effective method of treatment; however some patients may not tolerate sleeping with the mask. CPAP should be carefully used only after recommendation from the doctor.
  • Oral appliance therapy – It involves the selection and fitting of a specially designed oral appliance. This enables the airway to stay open without any obstruction in the throat. These are custom-made appliances and are proven to be highly effective.
  • Palatal stiffening procedures – These are second line treatment procedures to stiffen the palate or roof of the mouth and may involves palatal implants, injection snoreplasty and radiofrequency.
  • Surgery – Tonsillectomy, Adenoidectomy and Nasal Surgery (Septoplasty, Turbinate Reduction) are some of the commonly performed surgeries in children. The other surgical procedures are Tracheostomy, Weight Reduction Surgery (Bariatric surgery and Cervicofacial liposuction), Tongue Reduction Surgery, Maxillomandibular Advancement, Anterior Inferior Mandibular Osteotomy with Hyoid Suspension and Surgery of the Soft Palate (Uvulopalatopharyngoplasty, Laser-Assisted Uvuloplasty and Somnoplasty).
  • Bi-level positive airway pressure (BPAP) devices – are commonly used by people who are unable to adapt to using CPAP. This is an automatic device that adjusts the pressure while sleeping. It provides more pressure during inhaling, and less pressure during exhaling.
  • Adaptive servo-ventilation (ASV) devices – These are commonly used to treat both central sleep apnea and obstructive sleep apnea. The ASV device is an automatic device that stores information about normal breathing patterns and automatically uses airflow pressure to prevent pauses during breathing while the person is asleep.
  • Behavioral therapy – Doctors advise patients to reduce excess weight, develop good muscle tone, adapt healthy lifestyle and eating habits (no heavy meals and no calorie rich food), proper exercise and breathing habits. It is recommended to avoid alcohol consumption, quit smoking, and avoid intake of tranquilizers, antihistamines and sleeping pills before bedtime. Establishing regular sleep patterns, sleeping on the side rather on the back and elevation of the head of the bed are also useful options.

A healthy lifestyle with regular exercise, good eating habits and appropriate treatment with recommended medical or surgical options can greatly improve the quality of life of patients with sleep apnea.

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