Snoring and Sleep Apnoea
If there is obstruction at any point of the respiratory tract, from the nose to the voicebox, then, during sleep, when the muscular walls of the pharynx relax, the characteristic sound of snoring is produced. Snoring is unpleasant to the spouse, but does not necessarily denote a pathological condition. Most adults snore when they lie down supine, or if they go to sleep immediately after a heavy meal, or if they smoke and drink heavily before sleep.
However, loud snoring may be a symptom of a severe condition named Sleep Apnoea. In sleep apnoea, there is complete obstruction in the respiratory tract and oxygen supply is interrupted. The heart makes a hard effort to send oxygen to the tissues (palpitations), and blood pressure is raised, to increase the blood supply (hypertension). When carbon dioxide is raised to a certain level, the brain is aroused. The patient wakes up, the pharyngeal walls are contracted, the respiratory tract is opened and oxygen flows in. When enough air is inspired, the patient falls asleep again, to wake up again in a few minutes, when the brain seeks for more oxygen. This vicious cycle may happen more than 500 times in 6 hours of sleep. The patient wakes up tired in the morning, and has an annoying sleepiness all day. This interferes with his/her work and regular day activities, and may be even dangerous when driving or handling machinery. Furtherfore, since the heart and vessels are stressed every night, after some time, conditions such as hypertension or even heart failure may develop.
Increased body weight leads to accumulation of fat under the walls of the throat, and this results in narrowing of the respiratory tract in some individuals. Snoring or sleep apnoea can be induced or worsened. For this reason, we always put obese or overweighted snoring patients on special diet, aiming at returning them to normal weight, as an important part of their overall management.
Ear, Nose, and Throat examination is needed in every case of snoring. It can reveal obstruction in the respiratory path and treatment will be discussed, when necessary. A blocked nose may need correction of the deviated septum, and/or surgcial reduction of the enlarged turbinates. If there is hyperthrophy of the soft tissues of the throat, a pharyngoplasty may be indicated.
In cases where snoring is associated with day sleepiness or there are other possible indications of sleep apnoea, the patient must undergo a Sleep Study. If the study is positive for sleep apnoea, then a consultation with a Chest Physician will be arranged, and a positive pressure air breathing device (C-PAP) will be probably prescribed.
It must be underlined that, common surgical procedures such as septum surgery, turbinate reduction and palatoplasty are quite useful for snoring, but have shown poor results in the treatment of sleep apnoea. Of course, common sense does apply. In this regard, an apnoeic patient with huge tonsils and hypertrophic palate will almost certainly benefit from a palatoplasty, although he/she will probably need to continue using the positive pressure device after the operation.
Every case of snoring must be carefully evaluated by a specialist. Often co-operation of two or more medical and surgical specialties will be needed for appropriate management, which may include both medical and surgical treatment. In cases with abnormal sleep study, use of a C-PAP device will be necessary.