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"Here's How the Snorers Amoung Us Can Get Help"
Ft. Worth Star Telegram, February 2008
The typical patient at a sleep clinic is older than 35, weighs about 235, is on medication for high blood pressure, is more irritable and moody than usual and may have a history of heart disease. He finally makes an appointment with a sleep specialist at the urging of his wife who said all his snorting, whistling and rattling may not be keeping him awake at night, but it's playing havoc with her sanity.
Sleep apnea is a serious sleep disorder that occurs when tissues in the upper throat collapse and block the airway. It increases the risk of heart attack, angina, stroke and hypertension. "Sleep disorders can wreak havoc on people's lives. Poor sleep not only affects performance and behavior at school, work and home, but it also has been tied to health issues such as obesity and high blood pressure," said Dr. Nilesh Dave, medical director of UT Southwestern Medical Center's new Sleep and Breathing Disorders Center in Dallas. "There is a growing body of research that shows if you have been snoring for a long time, it tends to cause memory problems; patients feel they can't think clearly. Even without sleep apnea, snoring can cause chronic sleep deprivation, which can make it difficult to go about your daily business. You can't focus, can't remember things," Dave said.
And a study published in the January 2008 issue of Journal of the American Geriatrics Society found that older women with sleep apnea are more likely to show cognitive impairment. The greater the severity of apnea in these otherwise healthy older women living at home, the greater the likelihood of impairment.
We asked the sleep experts about snoring:
What is snoring?
Snoring is a rough and hoarse breathing sound made in the upper airway of your throat as you sleep. Air enters through the mouth and nose and causes vibrations and noise as it flows over relaxed throat muscles, adenoids, uvula (the soft flap of tissue hanging from the back of the mouth), soft palate and other tissue in the throat, on its way to the lungs.
Who snores?
At least 30 percent of adults snore on a regular basis; up to 50 percent snore at least occasionally. Men out-snore women by about 2 to1, and the risk of snoring increases with age and weight. Allergies, asthma, colds and sinus infections increase the risk, as does smoking, alcohol, sleeping flat on your back and taking certain medications, including muscle relaxers.
What can I do to stop snoring?
Anything that increases airway resistance can provoke snoring, so anything that decreases resistance can help. First, try clearing your nasal passages by blowing your nose, taking a decongestant or using saline nose nasal spray just before falling asleep.
Also, lose weight (excess tissue in the mouth, nose and throat increases with weight gain), stop smoking and sleep on your side. (Try the tennis ball trick where you safety pin a sock containing a tennis ball to the back of your pajamas so that it is uncomfortable to sleep on your back.). Some experts suggest elevating the head of your bed about four 4 inches and sleeping without a pillow.
Breathe Right external nasal dilators, spring-loaded strips that hold the nasal passages open, work for some people. (To test, look in the mirror, inhale through your nose and watch what happens inside. If the walls of your nose collapse and the air passages narrow, nasal strips probably will likely help.)
What are the medical treatments?
Mandibular advancement devices, which look like mouth guards worn by athletes, are the best accepted and most often used devices to treat snoring that disrupts sleep but is not linked to apnea. These "oral appliances" are fitted by a dentist or orthodontist and can be very effective in reducing snoring, Watenpaugh said. The advantage is they are simple devices that are not connected to any machine and do not require a mask over the face. They help open airways by bringing your lower jaw or tongue forward during sleep. Most dental devices are acrylic and cost between $500 and $1,000.
Pressurized masks, designed to treat obstructive sleep apnea, also keep your airway open and can be used to relieve snoring, although insurance usually will not pay for them except to treat apnea. A Continuous Positive Airway Pressure (CPAP) mask worn over the nose and mouth delivers pressurized air from a machine at the bedside. (Think of your nose, mouth and throat as a deflated balloon. The positive airway pressure reinflates the balloon and prevents it from collapsing on itself.) The machines cost between $200 and $400, and masks with replaceable cushions average $50 to $60.
Surgery can increase the size of your airway by removing tissue or correcting abnormalities. Surgeons remove polyps, tonsils, adenoids, and excess tissue at the back of the throat or inside the nose or reconstruct the jaw in severe cases. Laser surgery and thermal ablation are sometimes used. Surgery costs vary widely.
Also the "Pillar Procedure," minimally invasive surgery to implant small plastic rods into the soft palate using a syringe-like instrument, is sometimes used to stiffen the soft palate and prevent snoring. The rods are implanted in a doctor's office under local anesthesia in a procedure that takes 20 to 30 minutes and costs $1,500 to $2,000.
TESTING COSTS
Specialists in pulmonary medicine, otolaryngology and dentistry are most involved in the treatment of sleep disorders, including snoring, sleep apnea, insomnia, restless leg syndrome, narcolepsy and other sleep problems, but most insurers, including Medicare, require diagnosis through an over-night test at a sleep lab, which costs about $1,500.
Now Medicare is considering a change in regulations to allow payment for diagnosing and treating obstructive sleep apnea through at-home testing, which costs about $500. Final approval is expected in March, and if Medicare begins paying for treatment based on the at-home test, private insurance is expected to follow suit.
WHERE TO FIND HELP
Most patients see a medical or dental sleep specialist at the suggestion of their primary care physician after first trying home remedies and over-the-counter antihistamines and decongestants to relieve snoring. Most insurance will not pay over for treatment for snoring unless sleep apnea is diagnosed through an over-night "polysomnography" (PSG) test at a sleep clinic.
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