Snoring and Sleep Apnea
What causes snoring?
Snoring is caused by vibration of the soft tissues in the throat including the soft palate / uvula, enlarged tonsils, tongue, walls of the throat, and the vocal cords.
What is sleep apnea and how is it related to snoring?
Snoring is a sign of resistance to the passage of air into the lungs and may be a sign of breathing trouble, but there can be significant obstruction without snoring, Apnea is the most dangerous consequence of the spectrum of what is called "sleep disordered breathing." With apnea, breathing totally stops for at least 10 seconds. With hypopnea there is significant drop in the oxygen level in the blood for 10 seconds though breathing does not stop completely. Many years of inhaling against constant resistance can progress to the more severe levels of" obstruction. So while children can have apnea, even just loud breathing when asleep can eventually become very serious.
Is snoring any more than just funny to some and annoying to a roommate or spouse?
Even mild snoring without observed apneas maybe a sign of a problem that can be dangerous or even life threatening. It is often an indication that the person is not getting enough refreshing sleep, We know that the average adult requires about 8 hours of quality sleep. If there is significant upper airway resistance they may not be getting enough time in REM or dream-stage sleep and even deeper stages. Without this, there is daytime sleepiness with memory loss and poor performance in school or at work. This is in addition to potentially causing serious medical problems such as heart attacks and heart failure, stroke, and high blood pressure. There may be other consequences such as morning headaches, personality or mood change, sexual impotence, and even bed wetting from straining to breathe. But the drowsiness alone can be dangerous. Studies show that people with sleep deprivation have slower reaction time when driving than people who are legally drunk. This sleep disturbance also affects anyone trying to sleep within earshot.
Is it only over weight people who have this problem?
As many as 25% of adult males and 10% of women may have sleep disruption. This translates to about 30 million Americans, We used to think only obese people had obstructive sleep apnea. It is termed Pickwickian Syndrome after a character in Charles Dickens' The Pickwick Papers. We now know that even slender people can have significant difficulty if there is an anatomic blockage. Snoring can occur in chronic nasal congestion from allergy, drinking alcohol, or smoking. They can have a deviated nasal septum or a growth in the nose, large tonsils or adenoids, long soft palate, large tongue, short mandible, or poor mobility of the vocal cords from injury or a neurologic problem. In reflux, stomach acid rises into the throat and can cause choking. This can be very frightening and even confused with asthma.
How do you evaluate if someone has sleep disordered breathing?
First we take a complete history, often including a sleep questionnaire. Then we do an examination of the mouth, nose, neck, and throat to see if they have any of the medical or anatomic problems mentioned. Often we use fiberoptic periscopes to look at the air passages for blockage and how they function when breathing. We may order a sleep study, which measures how loudly they snore, the oxygen level in the blood, heart rate, how hard they have to work to breathe, and their brainwaves to see if they are getting quality sleep.
What treatments are available?
Treatment depends on the cause and severity of the problem. For some it may be as simple as sleeping on their side rather than their back, elevating their head or using a different pillow. Eliminating sedatives or alcohol several hours before bed, stop smoking, or treating a medical condition such as allergy may be all that is necessary. If they are overweight just losing 10 to 20 pounds may make a significant difference. If the obstruction is severe we may recommend a breathing device at night called CPAP - for continuous positive airway pressure - that blows air into the nose when they start to inhale. There are also dental devices to hold the tongue or mandible forward. Surgical options again depend on the location and severity of the problem. A tracheostomy may be literally life saving. In less severe instances we may do procedures that shorten the palate or pull the tongue forward or make the back of the tongue smaller. However, most often for simple snoring all we need to do is to open the nasal passages and / or perform a simple office procedure to stiffen the soft palate so that it no longer vibrates against the back of the throat.
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Sinus Disorders
The sinuses are small, hollow chambers inside the nose and head that reduce the weight of the facial bones, give the bones shape and support, assist in mucus drainage from the nose, and help the voice resonate. Healthy sinuses are filled with air. When their mucous membranes swell from allergies, the common cold, infection or another cause, the sinuses become blocked, the pressure inside them drops, and they can fill with fluid, which easily leads to bacterial infection (called sinusitis, or rhinosinusitis if the nasal tissues are also affected). Blocked, inflamed or infected sinuses can be very painful.
There are four groups of sinuses: maxillary, in the cheekbones; ethmoid, along the nose; frontal, above the eyes; and sphenoid, behind the ethmoids. Any or all of these may be involved in an allergy or sinus infection, so accordingly, discomfort may occur in many areas of the face and head, including the cheeks, eyes, forehead and teeth.
Sinusitis may be acute (short-term, as after a cold or flu) or chronic (more than 8-12 weeks). Acute sinusitis symptoms include thick yellow or green discharge from the nose, sharp pain, headache and fever. Symptoms of chronic sinusitis are less obvious and may include nasal blockage or congestion, post-nasal drip, reduced sense of smell, and malaise.
A diagnosis of sinusitis is made after a description of symptoms, a physical examination and potentially one or more imaging tests such as an x-ray, CT scan, or endoscopic examination under local anesthesia. Treatment may include a nasal spray, antibiotic, corticosteroid or antihistamine. In some cases the patient may wish to undergo surgery to clean the sinuses, improve drainage or realign a deviated septum.
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Allergy Disorders
Allergies are a common cause of inflamed sinuses and headaches as well as runny or itchy nose, sneezing, itchy or watery eyes, blocked or itchy ears, rashes and wheezing. Allergies are in essence an overreaction by the body’s immune system to one or more objects in the environment, called allergens. Common allergens include dust, pollen, animal dander, mold and certain foods. Nasal endoscopy, blood tests or skin “scratch” tests are often all that is needed to determine the presence and cause of an allergy. Then the physician and patient can work together to plan treatment and management of symptoms.
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