Snoring and Sleep Apnea: Causes and Treatment Options
What causes Snoring?
Snoring is a result of partial blockage of the upper airway when the muscles and lining of the throat relaxes and collapses during sleep. This leads to vibration of these structures, causing a loud snore. There are many factors that can predispose a patient to snore at night. These include poor ability to breathe through the nose, eating heavy meals before bedtime, alcohol intake before bed, allergies, and sleeping in certain positions. While snoring is bothersome to a patient’s bed partner, it can also be a sign of obstructive sleep apnea, which is a more serious medical problem. It is important to know, however, that not all patients that snore have sleep apnea.
What is Obstructive Sleep Apnea (OSA)?
When we sleep at night, the muscles and tissues of the throat, which are normally active during the day, relax, and can collapse into the throat, blocking the ability for the body to breathe in oxygen and breathe out carbon dioxide. When only partial collapse occurs, there is vibration of the tissues, which results in snoring. However, when complete, or near complete, collapse occurs, this results in “apnea”, or the absence of breathing. As the body’s oxygen levels decrease, and carbon dioxide rises, a signal is sent to the brain that results in arousal from sleep. Many patients with sleep apnea are not aware of these awakenings, but often report snoring, gasping/choking awakenings at night, feeling unrefreshed in the morning, and sleepy during the day. Other symptoms may include headaches when waking in the morning, and feeling restless at night.
Collapse and blockage of the airway which leads to obstructive sleep apnea (OSA) often occurs at many sites, including the nose, soft palate/uvula, tonsils, sidewalls of the throat, back of the tongue and the structures above the vocal cords.
Sleep apnea can affect people of ALL ages, however risk factors include weight gain, male gender, aging, nocturnal acid reflux, and having other specific medical conditions. A hereditary component to sleep apnea has been identified, and people with certain structural characteristics of their jaw, face, throat and neck may be predisposed to OSA as well.
Why Is it Important to be Treated for Sleep Apnea?
Obstructive sleep apnea (OSA) leads to poor quality of sleep, and greatly worsens quality of life, due to daytime sleepiness, inability to function optimally during the day, and bed partner sleep disturbance. However, untreated OSA has been found to greatly increase risk for cardiovascular disease such as heart attack, hypertension, stroke, certain abnormal heart rhythms (atrial fibrillation), and early death. It has also been shown to contribute to cognitive and memory problems, lung problems and metabolic issues (including problems losing weight).
How Can I Know if I have Sleep Apnea?
If you experience snoring, poor sleep or daytime sleepiness, speak with your regular doctor, or make an appointment directly with Dr. Phillips. During your visit with Dr. Phillips, he will discuss your sleep and medical history, and perform a full examination. If there is suspicion for possible sleep apnea, there is a sleep apnea test that is available. This is called a sleep study.
During the sleep study, you will either spend one night at a certified sleep center, where your breathing, heart rate, muscle and brain activity will be monitored. This is a non-painful, easy diagnostic test. Alternatively, you may be sent home with an electronic device to monitor your breathing, oxygen levels and heart rate, which is called a home sleep study. The information from both tests will help Dr. Phillips determine whether you have sleep apnea.
What Treatments are Available for Snoring & Sleep Apnea?
Dr. Phillips has dedicated his career to studying snoring and sleep apnea, and is committed to providing a comprehensive and individualized approach to treating each patient. He is excited to provide multiple treatment options for both snoring and sleep apnea.
Conservative Medical Therapies
- For some patients, weight loss can make a big difference in reducing sleep apnea and snoring. One well-known study showed that a 10% reduction in weight can lead to a 25% reduction in the severity of sleep apnea. Other medical therapies that Dr. Phillips may discuss include control of acid reflux, treatment of nasal allergies and congestion at night, avoiding alcohol and other sedative medications, regulating sleep patterns, and positional therapy. Positional therapy involves keeping a patient from sleeping on their back, and encourages elevation of the head of your bed at night.
Positive Airway Pressure (CPAP)
- Probably the most well-known therapy for sleep apnea, positive airway pressure (CPAP, BiPAP or AutoPAP) is a non-surgical device which uses forced air pressure to push the tissues of the nose and throat open at night, to allow for an open, non-obstructed airway. This sleep apnea machine consists of a mask which is applied to the nostrils, nose, or nose and mouth together. The mask is attached to a hose, which attaches to a machine that sits at the bedside delivering a specific air pressure during the night.
Part of Dr. Phillips’ expertise includes managing patients with CPAP therapy, and he is able to work with each individual patient that uses CPAP to help improve the experience as much as possible. He is able to adjust equipment and settings for optimal treatment. Unfortunately, many patients are unable to tolerate CPAP or use it effectively enough to adequately treat their sleep apnea. Dr. Phillips most commonly sees these patients, who seek alternative treatments for sleep apnea.
Oral Appliance Therapy
- For patients with snoring, mild and moderate obstructive sleep apnea, an excellent alternative to CPAP is an oral appliance. This consists of a custom-made dental device for sleep apnea, which fits over the upper and lower teeth at night, and is contained completely within the mouth. The device can be adjusted to allow the jaw to protrude forward slightly at night, which keeps the tongue and soft tissues from collapsing into the airway. Dr. Phillips is excited to provide two different oral appliance options, both of which are custom made for each individual patient.
Sleep Apnea & Snoring Surgery
- Many patients and doctors believe that surgery for sleep apnea consists of a single surgical procedure which is performed the same way on every patient. However, there are multiple surgical procedures which can be performed, each of which is designed to target a patient’s unique pattern of airway obstruction. Dr. Phillips has expertise in providing a tailored approach to each patient’s unique anatomy in order to achieve the best possible surgical outcome. Surgical procedures may range from very minimally invasive, office-based snoring treatments, to directed surgery of the nose, soft palate, uvula, tonsils, lateral side walls of the throat, back of the tongue and lower airway tissues. These options are discussed extensively in on the Sleep Surgery page.
Upper Airway Stimulation Therapy
- Dr. Phillips is excited to be one of the few surgeons who is able to offer the most state of the art therapy in sleep apnea treatment, called Inspire Upper Airway Stimulation Therapy. This treatment consists of a small implanted device which delivers gentle stimulation to the tongue at night, to keep the airway open while sleeping. This therapy is discussed in greater detail on the Upper Airway Stimulation page.