What is Snoring actually?
Snoring is nothing but the noise caused by the air attempting to flow past some blockage in the upper airway. By basic principle of physics if we narrow the diameter of a pipe, resistance increases. And this resistance results in sound when air is flowing through it. This sound is manifested as snoring in our upper airway.
Why do I snore?
When you sleep, air passages at the back of the nose and mouth become partially blocked. This might be due to floppy or thick soft palate ( the area located on the roof of your mouth between the hard palate & uvula) blocking nose from behind or may be due to bulky tongue falling behind.
Is it a common issue?
Snoring is a common problem, and you are not alone.Nearly 16% of adult Indian population snore and about 3.6% of people have Sleep Apnoea. Snoring complaints have increased by 40% in the last three to five years.
If I have structural blockage then why don’t I snore during daytime?
When you are aware and conscious, there is an active effort of your muscles. So resistance cannot take upper hand. But when you are falling asleep, muscle tones drop and resistance increases to a significant extent. Particularly if you sleep on your back, palate and tongue falls back due to gravity, aggravating the block. This block is called dynamic block.
If I adjust my sleeping posture, can snoring be cured?
No, snoring cannot be cured by changing your sleep position. But if you lie on one side (laterally) its intensity can be reduced.
How my body is affected by snoring?
When you are snoring, actually inspired air is facing resistance to pass through. This results in fall of oxygen concentration in your blood (as suboptimal oxygen is passing). So whole night your vital organs are depriving of oxygen supply.
What is the difference between snoring and sleep apnoea (OSA)?
All Sleep Apnoea patients snore but all snores are not Sleep apnoeic.To make it simple, apnoea means no respiration. When oxygen concentration is falling gradually, a crucial point comes when you are undergoing a breath holding spell (so momentarily there is no sound) followed by a choking spell and arousal.If you don’t have this kind of breath holding spell, choking and arousal, then even if you snore, you are not a sleep-apnoea patient.
What are the risk- factors of OSA?
Obesity is the most important risk factor. Apart from this, smoking, excess alcohol intake, stress and different metabolic disorders particularly diabetics.
I don’t eat much and also try to lead an active life. Even then not able to reduce my weight. What to do?
Actually OSA and obesity is a vicious cycle. Means, obesity aggravates OSA which leads to chronic hypoxia (i.e. Oxygen deficiency), and this hypoxia aggravates your obesity further. So you have to manage obesity and OSA simultaneously.
I am not overweight neither am I fond of alcohol. Why do I snore then?
That means you might have blockage at the level of nose e.g. crooked septum, Polyp, turbinate hypertrophy. This is called upper airway resistance syndromes (UARS). You have less chance of developing frank OSA. Though we get non obese OSA patients also due to tongue and jaw-bone abnormality.
How do I assess that I need treatment?
If your spouse reports that you get apnoeic spells and choking with multiple arousals you need urgent treatment. Even if there is no apnoea, you need treatment if you are a heroic snorer. It not only imparts your health but also disturbs your partner’s sleep.You should also note for the common symptoms of snoring and OSA, e.g. excessive daytime sleepiness, early morning headaches, and lack of concentration, lethargy, personality change, and impotence.
Is snoring and OSA curable?
Certainly. You have to understand the basic reasons why it happens. Then you’ll realize that it is not a disease to be cured by some tablets or pills. Snoring and OSA management is basically a comprehensive programme. You have to obey your doctor’s advice for the maximum output.
What are the basic essential steps of treatment?
You have to reduce your BMI (which is nothing but weight proportionate to your height). There is a formula. If it falls less than or equal to 25 then you are normal, otherwise you are overweight. If it is more than 30, then you are obese.You have to do pranayams, Smoking and alcohol cessation, physical exercise, dietary modifications, stress management.
Conservative measures failed in my case. What is the remedy?
You have to go to the next step. That is assessment of the disease severity by Polysomnography (night time sleep study) and assessment of the levels of blockades by Sleep Endoscopy (DISE). Then we have to overcome the blockades to give you cure.
Is it essential to go to a Sleep Lab for a sleep study?
No, it is not essential. Now-a-days home level sleep study is also available. Technicians will go to your home and spend whole night at your bedside to perform the test.
Is Polysomnography test quite costly?
Not really. Particularly home level portable devices are now-a-days available which gives reliable results at a very affordable price. And technicians need not to spend the night at your residence.
Can I Straightaway opt for Sleep Surgery after Polysomnography?
The recent protocol doesn’t suggest so. Because blockades vary from person to person. Unless and until we are sure about the exact structures causing obstruction in your airway, Surgical planning (i.e. which surgery is recommended in your case) is not possible.
How would you assess the sites of obstruction in my airway?
By a procedure called DISE (Drug Induced Sleep Endoscopy).
What is Sleep Endoscopy?
It is nothing but flexible fibre optic nasopharyngo-laryngoscopy in a snoring patient whose sleep is artificially been induced by anesthesiologist in O.T. setting (with all back-ups) for a period of 8-10 minutes only. We actually assess the levels of obstructions (i.e. vellum/oropharynx/tongue base/epiglottis) during snoring events.
Could I go home same day after DISE?
15 mins you’re out of O.T. & certainly within 1hr your drowsiness will be over and by 2 hrs you will go home.
How would you plan my surgery?
We will sit together and visualizing the sleep endoscopy video, we will discuss the scenario and exchange our opinions. If you need multiple level obstruction correction then you will have to decide whether you’ll opt for single stage or multi-stage operation.
What is the duration and recovery period of these surgeries?
If you require nose job (including septoplasty and turbinoplasty ) and palatal channeling then approx 1 ½ hr. O.T. time and 1-2 day stay. Recovery period 1 week. If you require palatoplasty (in any form) with tonsillectomy then approx 2 ½ hrs and 3 days stay. Recovery period 10 days. If we do tongue-base channeling then it is a 15 mins. Procedure only with no extra recovery period. But, if you require glossectomy (tongue-base ablation) then the total multilevel procedure would take approx 4 hrs. Recovery period would be 2-3 weeks.
What is channeling?
It is a novel minimally invasive technique by which we debulk and stiffen a tissue (e.g. – palate, tongue) to reduce the incidence of snoring using COBLATION® Plasma Wand. Procedures take less than 15 mins; can be done under Local Anesthesia, without the discomfort and inconvenience associated with traditional surgeries.
I’ve heard, snoring surgeries are very painful and I’ll have to take liquids for weeks. Is it true?
COBLATION® channelings (unlike lasers) are nearly painless procedures. Because working principle is by plasma (excited ion field) at 60°c -70°c only. It can be done even as OPD procedure under LA. You will be able to take soft-semisolid diet from next day. But if you need major palatoplasty procedures then pain will be a bit more. Even then soft semisolid diet is permissible from 7th day onwards.
I don’t want surgery for OSA. What is the other option?
You can take CPAP (Continuous Positive Airway Pressure). This is a portable machine with a pipe and a mask to be worn on the face while sleeping. The machine will send oxygen to your body overcoming the airway resistance.
What would you recommend for me? CPAP or Multilevel Sleep Surgery?
If your BMI is > 40 and you are unwilling for surgery, then CPAP would be your best option.
But if you are a simple snorer or OSA with high AHI score but low BMI or you don’t want to carry that CPAP machine whole life then you are a good surgical candidate.
Are snoring surgeries successful?
In pediatric age group, Sleep apnoea surgeries are nearly 100% successful, because just tonsil-adenoidectomy is enough to give optimal result.
In adults, multi-level sleep surgeries can never give 100% result as you would get from CPAP machine. Surgery might give suboptimal (e.g.90%) success rate, but once done it is permanent. Whereas long term acceptance of CPAP machine (especially in young adults) is not good.
Disclaimer : COBLATION is a registered trademark of Arthrocare Corporation, a subsidiary of Smith and Nephew, Inc. The mark COBLATION is being referred to only as a technology for conducting ENT surgeries and all intellectual property rights vest with the registered proprietor.