Chronic Snorer

I liked the title of my last column: “ In search of peaceful sleep”! That, of course, is everybody’s dream! Can we make that dream a reality?

As you may recollect, the last column discussed snoring and obstructive sleep apnea. We learnt that there is a fair amount of uncertainty about this disorder. Today, we will talk about treatment.

It is commonly claimed that obstructive sleep apnea is associated with premature death and illnesses of the lungs and heart. But we know that this has not been proven.

So, one would wonder, is it necessary to seek treatment for this condition? If yes, then what sort of treatment is available?

Treatment of snoring is required if a person snores to the extent that the marital relationship may be threatened. Then the choices are either you snore alone in the basement of your house or few miles away in an isolated barn! Or get help!

Treatment is also required if the sleep disorder affects daytime sleepiness and alters the function of the heart and the lungs.

The goals of treatment are to abolish snoring and eliminate disruption of sleep due to upper-airway obstruction. This will establish adequate oxygen level in the blood and adequate ventilation system.

Treatment strategies are divided into three general categories:

-Behavioural modification
-Medical treatment
-Surgical treatment

Counselling for behavioural changes includes losing weight, avoidance of alcohol and sedatives. Most patients snore sleeping on their back. These patients should be asked to train themselves to sleep exclusively on their side.

Medical management of sleep apnea revolves around positive airway pressure, dental appliance and medications. There is no good medication to help sleep apnea so we won’t discuss that here. Sometimes oxygen therapy helps.

The positive airway pressure (PAP) is delivered through a mask to be worn when a sleep. The machine that creates PAP weighs two kilograms. The cost of the system may run into couple of thousand dollars. PAP keeps the upper airway open during sleep.

Compliance of this method of treatment is not hundred percent. One study demonstrated 46 percent of patients used PAP for more than four hours per night for more than 70 percent of the observed nights. Some people may find system difficult to use. Others have adapted quite nicely. Some studies have shown improved survival in patients who use PAP.

Oral appliance has been promoted as a useful alternative to PAP. There are varieties of appliances. The appliances are worn only during sleep and are generally well tolerated. Not all patients have clinically proven response. It is considered as a second line of treatment compared to PAP.

Surgical treatment for snoring and obstructive sleep apnea has become quite popular recently. Probably due to the inconvenience of PAP and oral appliance. Several surgical procedures are available, each one with advantages and disadvantages. These procedures are done by Otolaryngologists (specialists in ear, nose and throat surgeries).

Not all snorers require major surgery involving the palate. Fixing simple problems in the nose and throat can make a significant difference. Major surgical procedure involving the palate and pharynx is successful in abolishing snoring in about two thirds of selected patients. There is some amount of complications associated with surgical procedures – failure and pain.

There isn’t one solution to the problem of snoring and obstructive sleep apnea. So, Mr. Snorer, and all other snores, if you don’t want to snort with the pigs in the barn then seek help. Some thing may work for you. Besides, you have to help yourself first before anybody can help you!

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