Not So Silent Night

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Wake up to the realities of snoring.

By By Joan Tupponce
Henrico Monthly
November 2014

Snoring can lead to some humorous moments on television sitcoms, but in real life it’s not a laughing matter, especially to the spouse of someone who snores. The loud, annoying sound that erupts ever so often can send a spouse packing to the other bedroom.

“It can affect a marriage,” said Dr. Matthew Bridges of Commonwealth Ear, Nose and Throat Specialists. “The majority of the time it’s usually the spouse of the person who is snoring that makes the appointment and comes in with the patient to tell us about the snoring.”

Reasons for snoring are varied. Primary snoring – snoring that isn’t associated with problems such as sleep apnea – can be associated with being overweight or gaining weight. “The easy solution to that is to lose weight,” Dr. Bridges said. “That can help.” Other nonsurgical interventions can be considered as well. “We always consider minimally invasive treatments first. For example, we can send the person to a dentist to get an oral appliance to reposition the jaw at night.”

Snoring can also be caused by allergies or nasal obstructions that can reduce airflow in the nose. “There are things we can do in-clinic to help with airflow improvement, assuming medication has not helped,” Dr. Bridges said. “A simple clinic procedure called ‘turbinate reduction’ can help shrink the tissue covering the thin bones in the nose called nasal turbinates. When they swell they block airflow. We place a small electric probe in the mound of tissue that will cause it to shrink,” Dr. Bridges said

People with a deviated septum, which can also cause difficulty breathing through the nose, may also snore at night, as can people with oversized tonsils. Both situations can be corrected through surgery.

The uvula, which hangs down at the tip of the palate, can contribute to snoring, especially if it is enlarged. “When you snore your palate is fluttering in the back of your throat,” Dr. Bridges said, noting there are several surgeries that may tighten the palate, which in turn will help reduce snoring.

When Dr. Bridges sees a patient who is snoring, the first condition he wants to rule out is sleep apnea. “Sleep apnea is a serious issue,” he said. “It’s a silent killer.”

The American Academy of Sleep Medicine reports that obstructive sleep apnea (OSA) is a common sleep disorder that affects up to 7 percent of men and 5 percent of women. It involves repetitive episodes of complete or partial upper airway obstruction occurring during sleep despite an ongoing effort to breathe. The most effective treatment option for OSA is continuous positive airway pressure therapy, which helps to keep the airway open by providing a stream of air through a mask that is worn during sleep.

OSA can increase the risk of high blood pressure, heart attack, stroke, heart failure and diabetes. The risk for OSA increases as people age. “If you have sleep apnea, you want to do something to stop it,” Dr. Bridges said.

Signs of OSA include loud and chronic snoring, morning headaches, the inability to concentrate, memory problems, irritation, depression or waking up with a dry mouth or sore throat. “People who have sleep apnea are typically super sleepy,” Dr. Bridges said. “They can fall asleep at the drop of a hat. They can’t concentrate. They can’t stay awake at their job. They could even fall asleep driving.”

When people who have OSA go into REM (rapid eye movement) sleep, the time associated with dreaming, their muscles relax and “everything gets floppy,” Dr. Bridges said. “Their tongue can fall back and block their airway. They can stop breathing for 10 seconds or more at a time. Patients with OSA stop breathing many times during the night.”

People who show signs of sleep apnea are often asked to participate in a sleep study that can be conducted in a sleep laboratory or at home. “They will monitor your vital signs and your sleeping patterns,” Dr. Bridges said.

If OSA is found, the person will usually be fitted for a continuous positive airway pressure (CPAP) machine, the gold standard for correcting OSA. The machine includes a mask and tube that connects to a motor that blows air into the tube. “The pressure is adjusted based on the degree of OSA,” Dr. Bridges said. Surgery is reserved for patients who do not tolerate CPAP or have severe anatomic blockage.

Constant snoring at night is not something to overlook. It would be beneficial for anyone who snores on a consistent basis to get to the root of the problem. “Snoring can be benign, or part of something more serious,” Dr. Bridges said.

Dr. Matthew Bridges, who earned his degree from the University of Virginia School of Medicine and who served four years in the United States Air Force, is double board certified in facial plastic surgery and otolaryngology and specializes in diseases of the ears, nose and throat. He has expertise in cosmetic surgery of the face as well.