Snoring and Apnea

We recognize that snoring is very common and by itself does not represent a problem. If the bed-partner is a light sleeper, this noisy breathing may lead to discord.

Snoring may also be a part of a larger picture. Upper airway noise, such as snoring, may occur along with breath holding known as apnea. If associated with long periods of silence and then gasping and choking, Obstructive Sleep Apnea (OSA) may exist and it should be further studied and treated.

Reliance on an observer is critical. If that party can identify apnea, further study with split-night oximetry is needed. If there is no observer, a screening oximetry may be undertaken in the home. Therefore, a history of snoring and apnea as well as an office exam of the mouth, bite, tonsils, uvula and palate, tongue base and lower throat is necessary. A fiberoptic exam of the larynx and tongue base is helpful, especially if there is increased gagging.

If apnea is minor, and there is no hypoxia below a normal level (FIO2 of 90%), we feel that upper airway treatments to reduce nasal and/or oral obstructions are indicated. Specifically, repair of nasal obstructions such as deviated septum with septoplasty, removal of polyps, reduction of turbinates with Somnoplasty, sinus surgery with  endoscopic sinus surgery (FESS) and removal of excessive soft palate tissue with Somnoplasty are procedures we recommend and perform.

Once we make the diagnosis of apnea, and the severity of obstruction is noted, we feel that normalization of the heart and lung physiology is most important. This means that use of tracheotomy or pressure machines such as CPAP or BiPAP are necessary and almost mandatory. Once stabilized, other options are considered such as mandibular repositioning, hyoid advancement, and Somnoplasty of the Tongue Base.

We would be happy to have you visit our office, perform a regionally pertinent history and examination and then recommend further evaluation and treatment for your simple snoring, mixed snoring and apnea or severe apnea problems.

William S. Halsey, M.D., F.A.C.S.