“I can\’t stay up all night and listen to his snoring. I have to be in office by 8.30 every morning. So I have to wake him up when he snores,” said Shoba a 28-year-old IT professional. “She snores too,” shot back, her husband Mohan , 32 year old mechanical engineer. This is ruining our marriage, now we sleep in separate bedrooms, said shobha.
See, this is serious. The lack of sleep for both partners puts a strain on the marriage and creates a hostile and tense situation. This young man suffer from Sleep apnea and wake up several times at night and experience daytime fatigue, irritability, poor work performance, difficulty concentrating, restlessness and feeling ill. Because of his loud snoring, she cannot sleep well, and also get his kicks and jerks in bed. Due to low oxygen level in the brain, the sex hormone level also affected, causing more frustration I their life.
You no longer have to put up with sleepless nights due to snoring and the arguments like the above will stop and will be replaced by a more loving relationship, with no more sleeping in seperate bedrooms.
Please read on and see how we can help
Before going to the surgical treatment of snoring and sleep apnea, one should have a clear understanding about this common problem.
Understand snoring and sleep apnea
Snoring is the sound produced by upper airway passage obstruction-Nose and throat. Vibration of the elongated soft palate and uvula makes the noise by air turbulance.
Sleep Apnea is present when we do not breathe for 10 seconds or longer. This is dangerous. This causes our blood oxygen levels to drop and the carbon dioxide level gets more. This put pressure on the cardiovascular system mainly the heart work more to cope up supplying enough oxygen to brain and other tissues.
This apnea can happen a few times per night or several hundred times per night resulting in no deep sleep and many health problems.
There are two types of sleep apnea: central and obstructive. Central sleep apnea is much less common and is a problem in the regulatory function of the brain or heart. This occurs most frequently in people who have chronic congestive heart failure (COPD), stroke, and prolonged drug users.
Obstructive Sleep Apnea is more common and is caused by the physical blockage of the airway at night by the tissue in the back of the throat collapsing to block the airway. This keep oxygen from getting to the lungs as the muscles and tissue in the throat relaxes as you sleep, combined with the force of gravity causing the tongue to fall back and block the airway when you are lying down. This is more so in obese patients who has lot of fat deposition in the neck.
Snoring can be serious both medically and socially. Snoring can disrupt marriages and cause sleepless nights for bed partners.
Medically snoring can be a precursor of obstructive sleep apnea that has been linked to heart failure, high blood pressure and stroke.
Often people with large necks, overweight and large uvula and soft palate or nasal congestion or all of the above can be more likely to die in their sleep as their heart disease advances since the heart is already compromised.( Silent death while at sleep) .These are people who you hear of having a heart attack in their sleep.
People with untreated Obstructive Sleep Apnea suffer from daytime fatigue, sleepiness and irritability. Additionally they have higher rates of high blood pressure, heart disease, stroke, depression and erectile dysfunction.
Often people with severe untreated sleep apnea will fall asleep at a stop light or dose off (micro sleep) for a moment while driving, sometimes causing them to swerve or lose control of their car causing Road traffic accidents.
The daytime fatigue associated with the lack of quality sleep can affect your job performance, memory loss, affect your ability to concentrate , make you irritable and affect your marital relationships. This is more important in people who should be more alert in their jobs, like pilots, IT professionals, Golfers etc.
See an ENT doctor if you have the following signs-
and Snoring interrupted by a pause in breathing and then gasping (sudden intake of air)
and Daytime Fatigue and day time sleepiness
and Loud Snoring
and Trouble with concentrating, poor memory, depression, irritability, and or loss of sex drive
and Headaches, frequent nighttime urination, dry mouth, sore throat.
Diagnosis
1- Good history from the spouse is all that you need to make the diagnosis. Some bed partners come with voice recording of their spouse snoring.
2- Full ENT examination including fibre optic flexible naso pharyngo laryngoscopy in the clinic
3- MRI or CT scan to see the site of obstruction
4- Sleep lab study-Polysomnogram
5- Cardiac check up
6- Preanasethetic check up
Treatment
1. Weight reduction-very important
2. Stop alcohol, sedatives, sleeping pills etc
3. Treatment for nasal allergy, High BP, Diabetes etc if associated with it.
4. CPAP-Continous Positive Airway Pressure-can be tried, but most patients not happy to use it, cumbersome and expensive. It is useful in older patients who cannot undergo or unfit for surgery.
5. Surgical treatment-Laser or Coblator surgery
6. (please check-search this site for articles on different modalities of surgical treatment)
Coblation technology
Arthrocare Coblator II
Coblation® technology offers an alternative to standard surgical techniques, providing ENT surgeons with the level of precision and control they require to achieve successful outcomes. While most surgical devices, such as lasers and electrosurgery, use imprecise, heat-driven processes to remove or cut tissue, the radiofrequency-based –Cold Ablation-Coblation devices operate at a lower temperature (40-70 C)and are much more precise than traditional surgical tools. Instead of exploding tissue structures under high temperatures, Coblation technology gently dissolves target tissue, minimizing damage to surrounding healthy tissue.
Coblation® procedures employ radiofrequency (RF) energy to remove tissue and often provide a gentler alternative to other types of surgery.
Coblation procedures include: tonsillectomy, adenoidectomy, turbinate reduction, sinus surgery, and treatment of snoring.
Treatment of Snoring and Obstructive Sleep Apnea
Coblation Assisted Upper-Airway Procedures (CAUP)
CAUP for the treatment of snoring and upper airway obstruction is a multistage treatment concept which may include turbinate reduction, palate incision, volume reduction by upwards palatal channeling and uvular resection and channeling, pillar reduction by downwards channeling (anterior and posterior), tonsil channeling and other soft tissue reduction. CAUP has shown to be a very favorable procedure in the treatment of snoring and upper airway obstruction.
Main advantage of Coblator surgery over Laser(LAUP)
PAIN is LESS
NO FIRE HAZARD
CAN REDUCE THE BASE OF TONGUE
Laser Surgery to Cure Snoring and Sleep Apnea
I have been doing laser surgery using Co2 laser, since 1996.For the last 2 years, i have done more than 300 cases in SUT hospital, with 70-80% result.Laser has its own advantages too. It can be done easily in the minor theatre or OPD itself under a local anesthetic. But in obese patients and those with gag reflex this has to be done under a general anesthesia.
The post op pain varies from patients to patients, mostly moderate to severe, but can be controlled with analgesics.The pain last for a week.Few cases fail as the patient put on more weight after surgery, so redo numbers are nearly 5%.Since the arrival of coblator, Iam using both in some patients.
Conclusion-
There is need for better awareness among the public and the medical practioners regarding the social and medical complications of this problem.It is not something to be laughed at, and it should be taken seriously.
For more information and appointment for CAUP in SUT Hospital, Trivandrum, please follow the link below-
http://www.suthospital.com/php/seek_appt.php
http://suthospital.com/php/list_department.php?dept_id=15&linkid=3
