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SNORING
Snoring - often considered comical - always means blocked
breathing. The blockage varies in what is blocked and how
severely.
Some snoring is so loud no one else can stay in the same room.
Loud snoring is often associated with the "sleep apnea "
syndrome. Patients who snore the most loudly are usually unaware
of their difficulty in sleeping. Because of bad sleep patterns
they awaken tired, stay sleepy all day, and often fall asleep at
the most inconvenient times. Measurements during sleep show
their blood oxygenation drops, and they often develop abnormal
heart rhythms. Some physicians suspect the rhythm problems can
cause death during sleep. Sleep apnea sufferers often have high
blood pressure.
Not everyone who snores loudly has the life-threatening "sleep
apnea" syndrome. When the snoring pattern includes long pauses,
physicians begin to suspect the presence of more severe forms of
sleep difficulties. Children tend to snore normally,
especially when they have colds. They appear to tolerate it
better than adults. Some pediatricians worry that there may be
some danger in this sleeping pattern in this age group as well.
The latest studies fortunately have shown no association between
the history of snoring and choking spells in children and the
presence of sleep apnea as measured by test.
Sleep breathing disorders often are caused by
abnormal reflexes in the part of the brain that controls
breathing. Studies show that 95% of patients have some
structural abnormality in the air passages. The obstruction can
be at the level of the nose,often by a deviated septum, or
polyps. Most often, in the cases of loud snoring, the soft
palate is the problem. Apparently growth and maturation lead to
a mismatch in size between the size of the palate and the space
in back of the throat so that during the relaxation of sleep,
blockage occurs.
Occasionally, the tongue and throat muscles, during the
relaxation of sleep, can collapse and obstruct the air passages.
Tumor or paralysis of the voice box can also compromise the
airway.
The evaluation of snoring includes a complete history and
detailed examination of the air passages. Other studies will
include x-ray examination of the airway, breathing tests, and
most importantly, a monitored sleep session in a sleep
laboratory looking for sleep apnea. These studies help to define
both the origin and the degree of danger it represents.
How we treat snoring depends on severity. Antidepressant
medications taken at bedtime seem to help some snoring. Surgical
treatments used are variations of standard operations which have
been applied to other problems for years. Surgery works well for
snoring, but has been disappointing for sleep apnea. There
doesn’t appear to be any advantage to surgery by laser compared
with any other technique. The most reliable treatment so far for
sleep apnea appears to be the CPAP device, a pneumatic ‘splint’
for the entire airway. We often rely on this device for
the intermediate long term as we monitor developments in the
definitive management of sleep apnea. Often, a well made
dental night guard can correct snoring when sleep apnea is not
involved.
Snoring isn't funny and doesn't have to be tolerated. Before
accepting any treatment for snoring alone, be sure to check with
your insurance, since most plans have determined treatment of
snoring without sleep apnea to be ‘cosmetic’, and therefore not
a covered benefit.
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