Treatment of Snoring and OSA by Laser Surgery in India
Many patients come to my clinic daily with the complaints of snoring which has become a terrible blight on their married lives. Recent figures suggest that 30% of men and 20% of women are affected by their own snoring, and that\’s before you consider the effect that sleepless nights can have on their partners. Recently I see more youngsters are forthcoming for snoring treatment just before and after the marriage.
Obesity was blamed once for heavy snoring, but not always, very slim patients come with loud snoring and OSA. There is also a familial tendency for snoring because of their particular configuration of the upper airway.
As well as affecting marriages and sex lives, snoring can also lead to daytime tiredness and sleepiness which makes it difficult to function at work.
Snoring is no longer considered a laughing matter. Snoring can be the cause of various health problems including high blood pressure, heart failure and even death.(? Silent death while asleep).
What causes Snoring
The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose-the upper airway. This is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula (the fleshy structure that dangles from the roof of the mouth back into the throat). When these structures strike against each other and vibrate during breathing causes the snoring. Air turbulence at the narrow part causes vibration of the soft tissue. Persons who snore have at least one of the following problems:
1) Poor muscle tone (lack of tightness) in the muscles of the tongue and throat.
2) Excessive bulkiness of tissues of the throat.
3) Excessive length of the soft palate and uvula.
4) Obstructed nasal airways.
Is Snoring serious
Socially â€“ Yes. It is disruptive to family life. It makes the snorer an object of ridicule and causes other household members sleepless nights and resentfulness. Snorers become unwelcome roommates on vacations or business trips.
And medically â€“ Yes. It disturbs the sleeping patterns of the snorer himself, so that he may not sleep restfully. Furthermore, heavy snorers tend to develop high blood pressure at a younger age than non â€“ snorers.
Snoring and OSA (Obstructive Sleep Apnea)
Apnea meaning stoppage of breathing while asleep.
The most exaggerated form of snoring is known as obstructive sleep apnea, when loud snoring is interrupted by frequent episodes of totally obstructed breathing. This is serious if the episodes last over 10 seconds each and occur more than 7 times per hour. These episodes of apnea may be as high as 400-500 in one night and each apnea last even up to a minute.
Persons with obstructive sleep apnea may spend little of their nighttime hours in the deep sleep stages that are essential for a good rest. Therefore, they awaken unrefreshed and are sleepy much of the day. They may fall asleep while driving to work or while on the job.
Any cure for snoring and Sleep Apnea?
This is the question, which is foremost in the mind of the patient. Over the years numerous treatment methods have been tried with varying results. Various mechanical devices have been patented, but none work effectively. The efficacy of this kind of treatment is always in doubt.
Whatever the cause of the snoring, the first line of treatment is always to improve general health. Regular exercises, good sleeping habits combined with avoidance of alcohol and sleeping pills and loss of weight will help a majority of mild and occasional snorers. Heavy snorers, those who snore in any position they sleep in, and the so-called “obnoxious snorers” need more help that the suggestions above.
How to make the Diagnosis
A good history from the family member, friend or the spouse gives a fair idea of the severity of the problem. Sometimes the spouse brings the sound recording of the snoring partner.
ENT Examination-The heavy snorer requires a thorough examination of the nose, mouth, palate and neck. Treatment will of course depend on the diagnosis. Nasopharyogolaryngoscopy and CT/MRI imaging of the upper airway and Brain must be done. Xray Chest, ECG and other blood tests are done. Get a cardiac and pre anesthetic evaluation before undertaking surgical treatment.
A sleep study done in a sleep lab will give good indicators of the severity of sleep apnea. Many patients spend as much as half their sleep time with blood oxygen levels below normal coming to 50-70%. During their obstructive episodes, the heart must pump harder to circulate the blood faster. This can cause irregular heartbeats, and after many years it leads to elevated blood pressure and heart enlargement. The immediate effect of this oxygen starvation is that the person must sleep in a lighter stage and tense his muscles enough to open his airway to get air into his lungs. Since snorers with severe sleep study may be the only way to discover it.
How Laser Surgery work
In this operation the excess of tissue in the air passage which is causing the obstruction is excised with the help of Carbon Dioxide Laser. This operation replaces other older and more extensive operations done previously. This operation is simple, safe and effective and is effective. The patient after having the operation can be discharged the same day or the next (if done under GA) and will have substantial relief from this serious problem.
Laser Assisted Uvulopalatoplasty (LAUP) Two target the main culprit of snoring â€“ excess vibration of the soft palate and uvula are removed by Co2 laser
You sit in a chair as if at the dentist while the ENT surgeon uses a laser to remove the uvula and remodel the excess vibrating soft tissue.
LAPT-Laser Assisted Partial Turbinectomy, LAS-Laser Assisted Septoplasty
This minimally invasive form of laser surgery can reduce enlarged fleshy ridges or â€˜turbinates\’ at the entrance of the sinuses, or correct a deviated septum (a buckled partition between the two nostrils). The treatment is painless and there is no bleeding.
Both the above procedure are intended to increase the airway at the nasal level. If your nose tends to block up at night, this can increase a tendency to snore. Laser treatment under local anesthetic can be used to remove the problem in minutes and restore a fully working airway.
Is the treatment painful?
No pain during operation. The pain will be LESS, not painless, the pain depends on ones pain threshold; most patients tolerate it well with commonly used analgesics like Paracetamol, Diclofenac and occasionally Tramadol.
Any Alternative Treatment
CPAP and BIPAP are the only available alternative treatment, but it\’s not easy to live CPAP dependant rest of their life. Most patients buy the expensive equipments and don\’t use it at all.
I have been doing Laser surgery since 1996.Over the years I found that doing under local anesthesia may requires revision. So I prefer to do severe OSA cases under General Anesthesia. The cure rate is 80-90% in case of Snoring and 70-80% in OSA. If a revision procedure is done after a year the results are even better.
Are there any side effects?
Following the procedure there will be some discomfort and the area treated will feel sore. A course of pain killers will be provided and an aftercare programme.There is no voice changes unless one speaks guttural fricative sounds (Hebrew and sub-Saharan language).
There are no long lasting side effects.
To conclude, remember, snoring means an obstructed breathing and obstructions can be serious. It is not funny and definitely not hopeless.
Are you a loud snorer? Don\’t lose hope.
There is hope for this type of hopeless patients-Laser surgery being done in Trivandrum, Kerala, Gods own country-at the Jubilee Hospital, Palayam, Trivandrum.
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