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Ear, Nose, Throat Surgery
Snoring/Sleep Apnoea
What is sleep apnoea (snoring)?
During sleep all the body's muscles become less active and more floppy. In most parts of the body this does not matter and indeed helps one to relax and sleep comfortably. When the muscles that help hold open the throat behind the tongue relax, this leads to partial collapse and narrowing in this area. Even in normal people this increases the resistance to the flow of air when breathing in, but this is usually of no significance. When this narrowing that occurs with sleep is more than normal, then the airway behind the tongue collapses much more. To start with, this causes snoring and then, when the collapse is complete, it causes apnoea, which means "without breath" - actually stopping breathing. Fortunately, the body is able to sense this increased obstruction to breathing (thank goodness it does!) and the sufferer wakes briefly, before suffocation can occur, takes a few deep breaths, followed by a rapid return to sleep. This obstruction and waking often becomes a continuous cycle, every minute or so, that can go on hundreds of times a night, every night. Usually though, the individual does not remember all these episodes of waking.
What causes sleep apnoea (snoring)?
The things that cause sleep apnoea do so by increasing the normal narrowing of the throat during sleep. Anything that makes the throat narrower to start with (for example enlarged tonsils or a set-back lower jaw) means that it is easy for the throat to close off a bit more and block the airway. A partially blocked nose generates lower pressures in the throat whilst taking a breath in, which tends to suck the walls of the throat together. Probably the most important factor is being overweight with a big neck. Extra fat in the neck squashes the throat from outside, particularly when the throat muscles become floppier with sleep.
Who gets sleep apnoea (snoring)?
The most common sufferer of heavy snoring and sleep apnoea is a middle-aged man who is overweight with a big neck. However there are many patients with sleep apnoea who are not particularly overweight. In some patients we simply do not understand why they have sleep apnoea. In children the commonest cause is enlarged tonsils. Today sleep apnoea is a common reason for recommending that a young child has a tonsillectomy. Sleep apnoea and heavy snoring, severe enough to interfere with sleep quality, is probably much more common than is realised. At least three in every thousand men have severe sleep apnoea.
Symptoms of sleep apnoea (snoring)
Because sleep can be so disrupted by the body having to wake up briefly to reverse the upper airway obstruction, sufferers experience severe daytime sleepiness. To start with this occurs only during potentially boring activities such as reading, watching television or driving on motorways. However when the sleepiness gets worse it begins to interfere with most activities, with patients falling asleep talking or eating sometimes. Snoring will usually have been present for many years, and have gone well beyond a joke within the family. There are many other symptoms that one would predict in someone seriously sleep deprived (irritability for example) but the twin symptoms of snoring and daytime sleepiness are the best pointers to the diagnosis.
Treatment
When sleep apnoea (and snoring) are not severe then simple approaches can help. Losing some weight, not drinking alcohol after 6.00 pm (alcohol relaxes the upper airway muscles even more), keeping the nose as clear as possible, and sleeping on one's side or semi-propped up can all help. There are also now simple dental devices which can be worn at night, some of which are like sports-type gum shields, that can greatly reduce snoring. When snoring is very objectionable, with the patient and the patient’s partner is desperate for a solution, then an operation on the back of the throat may help as a last resort.
Surgery
While making lifestyle changes should be the first step in treating your snoring, these measures are not always effective. If that is the case, you might want to consider a form of surgery called laser-assisted uvulopalatoplasty (LAUP). This relatively new procedure has been found to stop or reduce snoring in most people.
LAUP involves removal of excess tissue from your soft palate and uvula with a small, hand-held laser. The operation makes your airway larger, so vibrations are decreased. The procedure is performed under a local anaesthetic and takes about 30 minutes. Depending on the severity of your snoring, you may need more than one session – some people may need up to five or six sessions before their snoring is improved. If you need multiple treatments, they will likely be spaced four to six weeks apart.
In general, this surgery does not have serious side effects and you can continue your regular activities immediately after the procedure. Some people may have a sore throat for about one week. In a very few cases, laser surgery can raise or lower the pitch of the voice. Before you decide on laser surgery, talk it over with your doctor.
There are also several other surgical options for sleep apnoea, depending on the cause:
- If your sleep apnoea is caused by a jaw deformity, an operation to correct the deformity (which usually involves lengthening of the jaw bone) will be performed. This is successful in most people.
- If no cause can be found for your sleep apnoea and it is not considered to be life-threatening, a procedure called uvulopalatopharyngoplasty (UPPP) can be performed, where a surgeon trims and tightens throat tissues while you are under a general anaesthetic. However, this procedure has only a 30-50% success rate and can affect your ability to have CPAP therapy at a later date.
- If your sleep apnoea is caused by large tonsils and/or adenoids, these can be removed in a simple operation called a tonsillectomy or adenoidectomy.
Click here for the post operative care sheet for Snoring.
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