Frequently Asked Questions and Important Answers
Questions about Obstructive Sleep Apnea:
How is snoring treated with Somnoplasty?
Snoring occurs when floppy tissue in the airway relaxes during sleep and vibrates. Most snoring is caused by an enlarged soft palate and uvula at the back of the mouth. The Somnoplasty procedure gently reduces and stiffens the tissues in the soft palate and uvula, and does so without the pain associated with conventional and laser-assisted surgeries.
If you are a candidate and choose to have the procedure done, our physicians will use the Somnoplasty medical procedure to generate a low-power, low-temperature radiofrequency energy to treat a well-defined area in the uvula or soft palate. The procedure takes place in our office under local anesthesia and typically takes less than thirty minutes. You may experience some mild swelling and discomfort which usually lasts between 12 and 24 hours, and is usually described as being similar to a mild sore or "scratchy" throat. Any discomfort is normally treated with an over the counter analgesic, such as Advil or Tylenol. You will be able to go back to work or resume your normal activities immediately after the procedure.
During the next three to six weeks you should experience a gradual decrease in snoring. Approximately 25-30 percent of patients may need a second treatment. The treatment has proven to be effective in over 90 percent of patients.
What causes snoring?
Forty-five percent of normal adults snore at least occasionally. Nearly 25percent are habitual or chronic snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.
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. This area where the tongue and upper throat meet the soft palate and uvula is the collapsible part of the airway. Snoring occurs when these structures strike each other and vibrate during breathing. People who snore may suffer from:
Excessive bulkiness of throat tissue. Overweight people have bulky neck tissue. Cysts or tumors can also cause bulk, but they are rare. Children with large tonsils and adenoids often snore too.
Long soft palate and/or uvula. A long palate or uvula narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing.
Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. That is why snoring often occurs only during the hay fever season or with a cold or sinus infection.
Poor muscle tone in the tongue and throat. When muscles are too relaxed during deep sleep or from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway blocking the airway. Or the throat muscles draw in from the sides into the airway.
Deformities of the nose or nasal septum. Snoring can be caused by a deviated septum (a deformity of the wall that separates one nostril from the other) or other deformities of the structures and tissue of the nose and throat.
Is snoring a serious problem?
Snoring can be both a social and medical problem. Socially, snoring can cause problems such as embarrassment and the irritation and frustration of sleeplessness nights for the individual with snoring and other members of the household
Snoring can be related to medical problems too. Chronic snoring often disturbs sleep patterns and deprives the individual of the appropriate level of rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.
When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.
Can heavy snoring be cured?
Heavy snorers, individuals who snore in any position or are disruptive to other member of the household, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist or sleep medicine expert can provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer's health.
The appropriate treatment depends on the specific diagnosis for the individual with snoring problems. A thorough examination by a specialist will reveal if the snoring is caused by enlarged nasal or throat tissue, nasal allergy, infection, or other conditions.
In many cases, snoring or obstructive sleep apnea can now be treated by a procedure called Somnoplasty. This procedure uses radiofrequency to emit energy to shrink excess tissue in the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).
Which conditions can be treated with Somnoplasty?
The Somnoplasty System has been approved by the FDA for use in the treatment of three conditions:
- Habitual snoring (related to the soft palate and uvula)
- Chronic nasal obstruction (enlarged inferior turbinates)
- Obstructive Sleep Apnea.
Where do you perform Somnoplasty treatment?
The Yale Somnoplasty is located on the third floor of the Yale Physicians Building at 800 Howard Avenue. Convenient, secure and covered parking is available in the Howard Avenue Garage, located adjacent to the Yale Physicians Building. Click here for detailed driving and parking directions to the Yale Physicians Building from all major highways.
Are there any risks or side effects to consider with Somnoplasty?
As with any medical procedure, there are potential risks and side effects involved. We spend time with each of our patients to ensure that they fully understand that a specific result cannot be guaranteed; however, results can be closely predicted based on data from thousands of previous cases. Serious complications are very rare, and the most likely is an infection, which is treatable with medication.
Why choose a Yale specialist for Somnoplasty treatment?
Yale is one of just a few centers in southern New England with physicians certified to perform Somnoplasty. Yale ENT specialists have completed special advanced training in this technique and are board-certified otolaryngologists.
What can I do if I am light snorer?
If you are an occasional or light snorer, there are several remedies to try on your own:
- Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight
- Avoid tranquilizers, sleeping pills, and antihistamines before bedtime
- Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
- Establish regular sleeping patterns
- Sleep on your side rather than your back.
- Tilt the head of your bed upwards four inches
What does the patient experience during the Somnoplasty procedure?
The Somnoplasty procedure for obstructive sleep apnea is performed under local anesthesia in an outpatient setting. The protection of the delicate surface of the tissue, the controlled delivery of energy and the ability to maintain a constant, low temperature present a sharp contrast to conventional surgery. Patients undergoing traditional surgery can suffer significant pain and take narcotic medications for several weeks. After the Somnoplasty procedure, patients may experience swelling and some discomfort. Most patients have the discomfort alleviated by taking over-the-counter pain medications such as Tylenol for two to three days.
Typically, the Somnoplasty procedure for obstructive sleep apnea takes 30 to 45 minutes, with only five to 10 minutes required for the radiofrequency energy delivery to the targeted tissue. The procedure is performed on an outpatient basis in the comfort of the specialists patient care office. Almost all patients can return to their normal activities right after the procedure. Typically, more than one treatment is necessary to achieve optimal results.
Who is a candidate for the Somnoplasty procedure?
If you snore loudly and frequently and do not have other breathing disorders, the Somnoplasty procedure may be an appropriate treatment for you. Yale specialists carefully evaluate each patient to determine if Somnoplasty is an appropriate treatment.
What is chronic nasal obstruction or stuffiness and how does it affect sleep?
Most chronic nasal congestion or obstruction is caused by enlarged turbinates, which are shelf-like, bony structures inside the nasal cavity. Somnoplasty shrinks the turbinates, which relieves the nasal congestion.
Somnoplasty uses low-power, low-temperature radiofrequency energy to gently reduce the tissues in the inferior turbinate. This radiofrequency energy is delivered beneath the surface layer, or mucosa, just enough to create an area of tissue "coagulation." Over the next three to six weeks after Somnoplasty, the treated tissue (coagulated area) does slough-off and is reabsorbed by the body, thereby shrinking the size of the turbinates and relieving the obstruction and congestion.
Chronic enlargement of the turbinates and the related symptom of nasal obstruction affect people throughout the day, as well as during sleep. A chronic stuffy nose can impair normal breathing, force an individual to breathe through the mouth and turn the simple acts of eating, drinking and speaking into an annoying and sometimes painful experience.
Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, as the nasal airway is the normal breathing route during sleep. Chronic turbinate enlargement and nasal obstruction are commonly associated with rhinitis, the inflammation of the mucous membranes of the nose. When the mucosa becomes inflamed, the blood vessels inside the membrane swell and expand, causing the turbinates to become enlarged and obstruct the flow of air through the nose.
Chronic nasal obstruction or stuffiness a common cause of excessive daytime sleepiness (EDS). People who suffer from EDS are constantly struggling to stay awake even after getting enough nighttime sleep. In spite of their best efforts, people with of excessive daytime sleepiness frequently fall asleep at inappropriate times. Key characteristics of EDS include:
- Constant feeling of drowsiness
- Fatigue
- Inability to concentrate
- Impaired memory
- Erratic behavior
- Irritability
- Impaired physical coordination
What is Obstructive Sleep Apnea Syndrome (OSAS)?
Obstructive sleep apnea syndrome (OSAS) is a debilitating sleep and breathing disorder defined as the cessation of breathing for 10 seconds or more (an apnea) at least five times per hour of sleep. Primarily affecting middle-aged, overweight males, it is characterized by frequent and regular episodes of obstructed breathing during sleep.
During sleep, the body's muscles relax, which can cause excess tissue to collapse into the upper airway (back of the mouth, nose and throat) and block breathing. When breathing is interrupted by an obstruction in the airway, the body reacts by waking enough to start breathing again. These arousals may occur hundreds of times each night but do not fully awaken the person, who remains unaware of the loud snoring, choking and gasping for air that is typically associated with obstructive sleep apnea. Afterward, the person quickly falls asleep again, and the pattern is repeated. During each of these breathless periods, the level of oxygen in the blood falls to dangerously low levels, raising blood pressure and putting a strain on the cardiovascular system. Obstructive sleep apnea sufferers never get "a good night's sleep" because repeated apnea and arousals deprive patients of REM and deep-stage sleep, leading to chronic daytime exhaustion and long-term cardiovascular stress.
What are the symptoms of sleep apnea?
Repeated awakenings prevent restful and refreshing sleep. As a result, one of the key symptoms of sleep apnea is excessive daytime sleepiness which can result in lower on-the-job productivity and greater tendency to have accidents. For example, studies have shown that people with sleep apnea are three to five times more likely to have automobile accidents than the general population. Symptoms of sleep apnea are as follows:
- Excessive daytime sleepiness
- Loud snoring punctuated by a breathing pause that resumes with a snorting, gasping sound
- Morning headaches
- Unrefreshing sleep
- A dry mouth upon awakening
- High blood pressure
- Irritability
- Depression
- Difficulty concentrating
- Excessive perspiring during sleep
- Reduced libido
What are the health implications of obstructive sleep apnea?
Obstructive sleep apnea can have a profound impact on an individual's health. Excessive daytime sleepiness caused by disruption of normal sleep patterns leads to a significant increase in the rate of accidents for obstructive sleep apnea patients, including a even-fold increase in automobile accidents. Over the long term, obstructive sleep apnea is associated with greater risk of hypertension and cardiovascular disease and the National Commission on Sleep Disorders Research estimates that 38,000 cardiovascular deaths due to sleep apnea occur each year.
In addition, loud snoring and intermittent breathing interruptions can affect the quality of sleep of the obstructive sleep apnea patient's bed partner. Witnessing an apnea can be a frightening experience because the obstructive sleep apnea patient appears to be suffocating. Frequently, it is a sleep-deprived bed partner who convinces the apneic patient to seek medical help.
Who suffers from obstructive sleep apnea?
Twenty-four percent of adult men and nine percent of adult women, or more than 20 million Americans, are estimated to have some degree of obstructive sleep apnea. Of these, six million are estimated to have cases severe enough to warrant immediate therapeutic intervention. However, obstructive sleep apnea was not well understood or recognized by primary care physicians until recently, and only a fraction of these 20 million obstructive sleep apnea patients have been diagnosed and treated by a physician.
While obstructive sleep apnea is commonly associated with obesity and male gender, it affects a broad cross-section of the population. Other risk factors include habitual snoring, which is often a precursor of more serious upper airway disorders such as obstructive sleep apnea. In fact, results from a recent study indicate that one in three men and nearly one in five women who snore habitually suffer from some degree of obstructive sleep apnea.
|
Advanced Medicine at Yale 
