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Snoring and sleep apnea

Definition/symptoms: for snoring, a loud noise is made while one is sleeping, disturbing not the patient, but one's partner (spouse) trying to sleep next to the one snoring. So snoring is the spouse's problem, not a problem to the patient. Sleep apnea is much different.  One who has sleep apnea, almost always is a snorer, but now the patient stops breathing while he or she sleeps, the oxygenation level falls below normal and the person stops breathing during sleep.  The patient will be tired in the morning on awakening, be tired during the day and may fall asleep during the day, and will awaken at night 3 or more times per night.  The patient with sleep apnea never gets into REM sleep, called rapid eye movement sleep, where one has to spend 20-25% of sleep to get a good nights rest. Sleep apnea is the patient’s problem and it has to be addressed.

Causes/treatment: most snoring is due to being overweight.  This excess weight causes fat to accumulate in the back of the tongue, narrowing the throat while one is sleeping in the flat position.  With this narrowing, the uvula, which comes off the soft palate, vibrates, causing the snoring. In sleep apnea, the tongue is large; it blocks the back of the throat, causing the patient to stop breathing. Sleep apnea is dangerous. After a careful exam and almost certainly a sleep study is needed to evaluate this problem to determine if there is just snoring or snoring and sleep apnea. After finding out just snoring is present and not sleep apnea, the first treatment recommended is to lose weight.  A second treatment is to sleep on one's side, by putting a golf ball in the night shirt, so one will not sleep on their back.  A third treatment is to be fitted with a dental night guard, that pulls the chin forward, giving more room to the back of the throat by pulling the tongue forward so the throat is not narrowed, thereby stopping the snoring.  A fourth treatment is to inject a scaring agent into the soft palate, causing the palate not to move and therefore stopping the snoring. The last treatment is to cut off the lower part of the soft palate, that includes the uvula, thereby stopping snoring by giving more room in the back of the throat and removing the uvula, which vibrates and causes the snoring.

The treatment of sleep apnea is more urgent and difficult. After a sleep study finds sleep apnea, the fitting of a mask on the nose/mouth, that forces air under pressure into the nose, that forces air past the blockage from the back of the tongue being too big and the tongue is continuously pushed forward in the throat by this pressurized air to keep the throat open while the patient is sleeping, thereby controlling the sleep apnea, but not curing it.  Weight loss is strongly advised.  If the patient does not lose weight, the patient will need to use this mask, called CPAP, indefinitely. So excess weight is the cause of most, but not all problems of snoring and sleep apnea.

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