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Don’t Ignore the Snore

Those snorts, chokes and gasps are not good snooze and may signal other health issues

By Jackie Carr   |   February 28, 2019

It’s 2:36 a.m. You’re lying in bed awake listening to your partner snore. The roar is deafening. And while it sounds like a joke, it’s not. Because what you’re hearing is your loved one having genuine difficulty breathing. You’re impacted too, definitely sleep deprived, and maybe a bit resentful. Fortunately, there are treatments for snoring that don’t involve separate bedrooms.

Atul Malhotra

Atul Malhotra, MD, director of sleep medicine at UC San Diego Health.

“Snoring is an issue when it is habitual — when the sleep disruption occurs every night,” said Atul Malhotra, MD, professor of medicine at UC San Diego School of Medicine and director of sleep medicine at UC San Diego Health. “Snoring can be caused by a range of issues. But the louder the snoring is, the more likely the diagnosis is sleep apnea, a condition that causes breathing to stop repeatedly throughout the night.”

Sleep apnea affects more than 10 percent of adults in the United States. The telltale pauses in breathing are caused by a blocked airway or abnormal collapses of the pharynx, the membrane-lined cavity behind the nose and mouth that connects them to the esophagus and trachea. The associated sounds of snorting, choking or gasping for breath are indications of a larger medical issue.

“Long-term impacts from sleep apnea may include neurocognitive and cardiovascular disease,” said Malhotra. “Theoretically, snoring can cause a harmful vibration in the carotid arteries that can lead to cerebrovascular injuries. These microscopic injuries, over time, may, at least in theory, result in stroke or other brain disorders.”

Malhotra advises seeking help from your primary care physician or a sleep medicine specialist. These experts will ask you questions about daytime sleepiness, metabolic disease and high blood pressure.

“I have seen cases where spouses report needing to sleep in a different bed or where neighbors complain of the noise through walls. If the volume is loud enough to disrupt others, it is not a minor problem,” said Malhotra. “The best thing to do is to have a conversation with your doctor. There are both conservative and aggressive approaches to treating snoring, many of which can be done at home.

“Depending on what you report, your doctor may order a sleep test. There are options that can be conducted at home or in an overnight sleep lab. Either is fine for an initial evaluation. Patients should find out what insurance covers first before proceeding.”

INSPIRE device

If the diagnosis is sleep apnea, continuous positive airway pressure or CPAP is the first line of treatment. CPAP involves wearing a mask to keep the airway open with a constant flow of air. The CPAP mask takes time to adjust to, said Malhotra. There are multiple versions available depending on the patient’s shape and size.

“Sometimes patients are initially resistant to the mask. Granted, it feels odd and takes practice wearing, but with the right combination of everyday practice, calibrating how the air pressure is delivered and ongoing education, we see excellent results.”

If the patient has snoring without sleep apnea, there are a variety of tactics that a patient can try to get rest. “I recommend trying something as simple as side sleeping or a nasal decongestant,” said Malhotra. “The nasal spray reduces inflammation and may enable snoreless sleeping. There are also oral appliances that hold the tongue and jaw in a better place to facilitate easier breathing.”

Malhotra said being overweight also factors into snoring.

“Many patients, with diet and exercise, can reduce weight and eliminate snoring. It’s not an easy solution, but one that can produce good results that stop snoring and improve long-term health.”

In patients where CPAP and other conservative measures have failed, surgery may be an option. Depending upon the patient’s anatomy and the specific cause of snoring, both weight loss surgery and an implantable device may be considered.

“In patients with a BMI over 35, weight loss surgery can help with snoring,” said Garth Jacobsen, MD, bariatric surgeon at UC San Diego Health. “Of course, the first issue at hand is treating the obesity. But by reducing weight, other issues, such as snoring, diabetes and high blood pressure, may resolve, too.”

A relatively new implantable device, called Inspire, is available to patients who are snoring and have sleep apnea, but who are not overly obese.

Paul Schalch

Paul Schalch, MD, head and neck surgeon at UC San Diego Health.

“This implantable therapy has given many patients relief,” said Paul Schalch, MD, head and neck surgeon at UC San Diego Health. “The device is implanted under the skin of the neck and chest through three small incisions during an outpatient procedure. Based on the patient’s breathing patterns, the system delivers stimulation to the hypoglossal nerve, which controls the movement of the tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.”

The device is controlled by a small handheld sleep remote. The remote allows you to turn the therapy on before bed and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed. After the device is implanted, Schalch said patients see a 78 percent reduction in sleep apnea events per hour.

“When sleep apnea is not an issue, other options to enable better breathing include office-based procedures to open the nasal passages,” said Schlach. “Radiofrequency energy can be used to shrink the size of obstructing tissue. Re-absorbable implants can be used to hold nasal tissue apart.”

“What’s important is for patients to ask their doctor about all of their options. Snoring is a marker of a disease with real consequences. Good sleep medicine in not just important for the patient, but for the couple,” Schalch said. “Fortunately, if you seek medical advice, you will be on the path to reducing daytime sleepiness, improved diabetes control and overall feeling better with quiet nights.”

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