Snore and obstructive sleep apnea
Is snore a normal phenomenon?
No, whenever you snore you are considered to be abnormal or diseased. Though sometimes normal people snore, when they are so tired, drink alcohol or sleeping pill, the evening before go to bed. However, these 2 conditions are not normal usual healthy life. Whenever you snore you are having a certain degree of upper airway obstruction.
What cause snoring?
Snoring noise is produced by vibration of the structures in the throat like soft palates, uvula, tongue base, tonsils or mucosa lining the throat or even the epiglottis and nasal turbinates.
Why some snores while the other not?
The people who snore have a relatively narrow airway inside the throat which usually caused by abnormally large tongue base, the soft palate positioned too low, uvula too long, redundant anterior and posterior tonsillar pillar, enlarged tonsils, excess mucosal lining of the throat, abnormal position of skull base, large epiglottis and congestion or enlarged turbinates inside the nose
When you fall asleep, all of the muscles comprising the mentioned structures in the airway are relax. The tongue fall back on top of the soft palate. This further narrowing your already small airway.
The lungs do not care how narrow the upper airway is, it continue sucking in the same volume of air. The narrowed airway thus squeeze the inhaled air into a small column with faster velocity and sucking in the surrounding structures, this cause vibration of the collapsing structures mentioned earlier. In adult the sites of narrowing are usually multiple while in children who snore the problems are almost exclusively tonsils and adenoid gland.
Snore and then so what?
When the narrowed airway is not severe you may be just a habitual snorer without bad consequence to yourself, but you may drive your bed partner crazy or out of the room or in the worst case out of your life with the disease arise from sleep deprivation. When the narrowed airway are getting more severe, you will no longer simply just snoring but there will be accompanying cessation of breathing (apnea) or marked reduction of air entry into your lungs (hypopnea). We call this disease “Obstructive Sleep Apnea (OSA)”.
Apnea and Hypopnea cause reduction of the oxygen content in your blood which every cell in your body including brain depend on. When oxygen content drops to a certain degree it will signal the brain to wake up and resume normal breathing, otherwise you may become a victim of “sleeping death”. The degree of awakening is not enough to make you fully conscious but it is enough to cause you the symptoms of sleeplessness.
What happen if one has obstructive sleep apnea?
The bottom lines of this disease are “lack of oxygen” plus “lack of sleep”.
In most cases of snorer the apnea or hypopnea occur several times throughout the night. Within the past decade, scientists have made extensive studies on the effect of intermittent apnea and hypopnea to our health.
Recently, the following frightening conclusions have been drawn on the ill-effect of obstructive sleep apnea on our health.
1. It leads to cardiovascular disease eg. heart failure, heart block, coronary artery blocking disease. The risk is 20 times more than normal people.
2. Sleep-death in 10% of the patients if left untreated.
3. It directly associate with hypertension: half of apnea patients have hypertension.
4. It leads to occlusion of vessels of the entire body.
5. It impairs your memory, judgment, decision making.
6. Decrease your libido or sexual drive.
7. It associates with general inflammation in the body and thus increases free radical.
8. It increases the incidence of stroke and increase death rate in the patients who already had stroke.
How do we know that we have obstructive sleep apnea?
The following clues are highly suggestive
1. Your bed partner evidences your cessation of breathing as choking, fighting for breath or frequent awaking and grunting snore
2. Loud snoring in any sleeps position or even sitting or lies on your chest
3. Feel unfreshening as if lack of sleep even after enough sleeping time
4. Excessive daytime sleepiness
5. Morning headache
6. History of frequent (or accident relating to dosing)
7. Impair judgment
8. Memory impairment
9. Having high blood pressure (hypertension)
10. Loss of sex drive
11. History of unexplained stroke, heart pain, heart failure
12.The best lab test for obstructive sleep apnea is sleep test or polysomnogram.
The standard one is done while you are admitted for 1-2 night, while the more practical and convenient one can be done at home or hotel at lower cost.
Can obstructive sleep apnea be treated or cured?
Definitely it can be treated or cured depend on the severity. After examination and lab test, our doctor will tell you how severe the disease is. The principle of treatment is to enlarge the narrowed airway.
1. Habitual snorer without apnea (just a noisy snoring without apnea or hypopnea). We developed a simple surgery on your palate to cure your snore permanently with less than 1 week recovery time under local or general anesthesia.
2. Snore with mild degree obstructive sleep apnea, we have developed and modified surgical technique to permanently cure this problem with 1 week recovery under local or general anesthesia.
3. If the disease is severe, with multilevel obstruction, it usually response favorably to continuous positive airway pressure machine (CPAP), which is a pumping instrument that force room air to bypass the obstructing part of the airway. The patients have to use this machine every time before they fall asleep.
The alternatives to CPAP is surgery or oral device or in combination. We have modified the surgical technique to the level that can cure the severe disease or at least make them harmless to your health. There are innovative multilevel procedures which address all level of obstruction starting from nose, soft palate, uvula, tongue, tonsil, pharyngeal mucosa and finally your upper and lower jaws.
The complete lines of treatment are available in our facility to address all degree of disease
A) Sleep test or polysomnogram
B) Hormonal and weight reduction program
C) CPAP
D) Mandibular repositioning device
E) Radiofrequency
F) Laser treatment
G) Soft tissue surgery i.e. palatal plasty, uvula plasty, tongue plasty.
H) Mandibular surgery, maxillomandibular or bimaxillary advancement
I) Injection
J) Palatal implant (pillar)
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