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Snoring and Sleep Apnea
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Program Director:
Rawnsley, Jeffrey D. M.D., M.S. http://www.drrawnsley.com
Calcaterra, Thomas M.D., F.A.C.S.
Castro, Dan J. M.D., F.A.C.S
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Description of Clinical Program
Snoring and Sleep Apnea Center
Sleep disorders can range from mild to severe snoring, to times when breathing may actually stop (apnea). Severe snoring may be sign of the potentially serious obstructive sleep apnea syndrome (OSAS). There are a variety of treatments for each disorder. At the UCLA Division of Head and Neck Surgery, we specialize in providing the very best treatments for both kinds of sleep disorders.
Snoring
It is estimated that 40 million Americans snore at some time or another. Even more people are affected if you consider the bed partners of those who habitually snore. Significant snoring is sometimes described as "heroic" snoring, in which the snoring may be heard more than two bedrooms away. Such snoring may cause several problems:
- Marital discord
- Sleep disturbances (from spousal prodding)
- Waking episodes (from one's own snoring)
- Frequent sleep apnea (OSAS) episodes
Snoring is not sleep apnea, and sleep apnea is not snoring. Snoring is a social problem, which may involve considerable sleep disturbance, waking episodes, etc., without obstructive sleep apnea. However, many patients with loud snoring, may also have obstructive sleep apnea.
Most loud snorers should have an overnight sleep test in a sleep laboratory to determine if they suffer from sleep apnea. In addition to recording the number and length of possible apneic episodes, body position, heart rhythm (EKG) and blood oxygen levels are evaluated during the sleep study.
Treatment decisions are based on whether significant apnea exists. For snorers, treatment can include non-surgical or surgical approaches. Non-surgical options include weight loss and positional changes (keeping snorer off his/her back). Surgical methods include Laser-Assisted Uvulopalatoplasty (LAUP) or the new minimally invasive Coblation Channeling treatment.
Treatment options for patients with OSAS include weight loss, positional changes while sleeping, Continuous Positive Airway Pressure (CPAP), LAUP, or Uvulopalatopharyngoplasty (UPPP or UP3).
Obstructive Sleep Apnea Syndrome
Obstructive Sleep Apnea Syndrome (OSAS) is characterized by frequent breathing interruptions (airway obstructions) during the night. When breathing stops, there may be a significant decrease in blood oxygen levels and cardiac arrhythmia (irregularities in the heart's normal beating pattern) may occur. In extreme cases, the result can be death. OSAS is a serious disorder, which can become a major health risk. Long-term effects can include both lung and heart problems. On a less drastic level, these disturbances may prevent the brain from entering the restorative REM sleep stage, leading to mood, memory and concentration problems.
Loud snorers should be aware of the association between snoring and sleep apnea. Their bed partners can help by monitoring the snorer's sleep patterns. Danger signs are apneic episodes lasting more than 10-20 seconds. If this occurs, wake the snorer immediately.
Sleep apnea symptoms can include:
- Excessive daytime tiredness
- Napping during work hours
- Falling asleep while driving
- Sore throat
- Headache
CPAP
Continuous Positive Airway Pressure or CPAP is the only non-surgical treatment for OSAS. With CPAP, pressurized air is administered using a facemask, which is worn while sleeping. The pressure of the air actually maintains a clear airway. CPAP is effective in reducing the number of apneic episodes. Many patients find that while wearing this device, they experience a much improved sleep pattern with an overall better night's sleep. For others however, the CPAP device is cumbersome and difficult to use. Some patients, use CPAP for a while, and then choose surgical therapy because of the difficulty in consistently using the device.
LAUP
LAUP is a surgical method used to treat mild-to-heroic snorers and those with very mild OSAS. This procedure utilizes a laser beam to remove and tighten floppy soft palate tissue in the back of the mouth, thereby reducing the amount that these tissues contribute to snoring. This procedure, although surgical, can be performed in an outpatient setting. Most patients find that postoperative discomfort is mild, equivalent to a few days' worth of a sore throat. Many people find that their snoring is significantly reduced and sometimes eliminated through the LAUP. Some patients do however require multiple LAUP treatments to effectively eliminate severe snoring.
Coblation-Channeling
Coblation-Channeling is a new surgical therapy for snoring. The treatment is performed in our office under local anesthesia. Treatment time is about ninety seconds, a fraction of the time needed by other radiofrequency techniques. Coblation-Channeling is a minimally invasive treatment which may result in less postoperative pain than traditional surgical snoring therapies.
Coblation-Channeling reduces snoring in two important ways: firstly, by removing a small amount of tissue via a patented process of molecular disintegration; and secondly, by heating tissue to cause controlled shrinkage and stiffening of the soft palate. Laser therapies, while similar in aim, are very different in their method of action.
Laser snoring therapies involve cutting into the soft palate. With Coblation-Chaneling, there is no cutting, only molecular disintegration and tissue shrinkage.
The UCLA Medical Center is one of a number of national centers where this technology is undergoing continuing clinical evaluation.
UPPP
UPPP has been the mainstay in the surgical treatment of severe snoring and OSAS. Thousands of patients have been effectively treated with this technique. While UPPP does not cure all OSAS, it will significantly reduce the degree of OSAS in over 50-60% of patients, and usually eliminates or significantly reduces snoring. Those patients who do not experience a significant correction of the OSAS may need to undergo other surgical treatment. Most people do, however, experience an improvement in their sleep patterns and overall quality of life.
The UPPP is performed in the main operating rooms at the UCLA Medical Center, under general anesthesia, and typically requires an overnight hospital stay for observation.
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