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Snoring & Sleep Apnea 2

Snoring Sleep Apnea

Sleep Apnea Treatment

iStock_000000917558XSmallPeople with sleep apnea stop breathing while they sleep, sometimes hundreds of times per night, and sometimes for a minute or longer. Sleep apnea affects about 18 million people of all ages in the U.S. and takes three forms: obstructive, central and mixed. Obstructive sleep apnea (OSA), the most common form, occurs when the soft tissue at the back of the throat closes, blocking (obstructing) the person’s airway. The airway remains open in central sleep apnea, but the brain does not send signals to the muscles involved in breathing. Mixed sleep apnea combines aspects of the obstructive and central types. A common warning sign of sleep apnea is snoring (especially snoring interspersed with gasps or lack of breathing), although snoring does not always occur as a result of sleep apnea.

Because sufferers are roused from sleep briefly to resume proper breathing, disrupting and lowering the quality of a person’s rest, sleep apnea can cause a number of problems. If left untreated, it can result in high blood pressure, cardiovascular disease, stroke, memory problems, weight gain, impotency, headaches, and daytime fatigue leading to job impairment and motor vehicle crashes.

Treatments for sleep apnea include:

Sedated Functional Sleep Endoscopy Uvulopalatopharyngoplasty (UPPP)
In-Home Sleep Testing with CPAP Titration Hyoid Suspension
Turbinate Reduction / Coblation Turbinoplasty Mandibular Advancement Device
  Sedated Functional Sleep Endoscopy

Sleep Endoscopy refers to a procedure performed under sedation in our Los Angeles area office which allows for an assessment of a patient’s airway adequacy (as well as any vibration or associated sounds made during respiration). By coming as close to a natural sleep state as possible, this assessment provides invaluable information in cases of suspected sleep apnea or disruptive snoring, which is often not gathered during a completely awake office visit. The specialist is also able to alter head and neck position, and provide airway support during the endoscopy, allowing for effective nonsurgical remedy of the sleep-associated airway narrowing. In cases where airway surgery is found to be indicated, this can often be performed at the same time as the diagnostic endoscopy.

In-Home Sleep Testing with CPAP Titration

In-Home Sleep Testing with CPAP Titration enables patients to undergo sleep studies from the comfort of their own bedroom for a more accurate diagnosis. Your doctor may recommend a sleep study if he suspects you are suffering from obstructive sleep apnea. To perform the in-home sleep testing, the patient will receive a portable monitor that measures activity while they are sleeping, and a CPAP (continuous positive airway pressure) device. The CPAP device is connected to the mouth, and it will automatically titrate, or adjust the amount of air pressure needed to breathe during sleep without causing apnea. For accurate test results, you must sleep for at least two hours on the night of your sleep testing. The next day, you return the monitor and the CPAP device to your doctor, who will interpret the results and create a customized treatment plan for your individual condition.

Turbinate Reduction / Coblation Turbinoplasty

Coblation turbinoplasty is an effective treatment for snoring that painlessly removes the tissue that causes nasal obstruction with radiofrequency technology. Patients who suffer from loud snoring have enlarged turbinates that affect their breathing and block the nasal passage. This procedure can also be used to treat chronic nasal congestion, facial pressure and nasal drainage.

During the procedure, local anesthetic will be applied to the nose to minimize any discomfort. A special wand is inserted into each turbinate to carefully remove excess tissue, instantaneously reducing the size of the turbinate. The wand then applies coblation therapy to the area to create a channel within the turbinate. After the coblation procedure, the channel in the turbinate will shrink, relieving nasal obstruction and restoring normal breathing. This will help effectively relieve snoring and other breathing problems.


p-istock_000002292426smallA tonsillectomy is the surgical removal of the tonsils (two oval-shaped pads located in the back of the throat on each side), performed for patients with recurring episodes of tonsillitis (inflammation of the tonsils) or for an infection that has not gotten better with other treatment. In some cases, a tonsillectomy may be performed if enlarged tonsils block normal breathing. This can lead to problems such as sleep apnea and difficulty eating. Occasionally, a tonsillectomy may be performed to treat cancer. A tonsillectomy is much more common for children than for adults. The surgery is most often an outpatient procedure in our Los Angeles area office and uses a general anesthetic.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure that treats sleep apnea by removing excess tissue in the throat and, as a result, widens the airway. This allows air to move through the throat more easily when you breathe, effectively reducing the symptoms of snoring and sleep apnea.

UPPP is recommended for patients with excess tissue in the nose, mouth or throat that blocks the airways and causes breathing abnormalities during sleep. It can also be used after lifestyle changes and conservative treatment methods have failed. In addition to widening the airway, UPPP also aims to improve the movement of the soft palate and help the airway remain open during sleep.

During the UPPP procedure, tissue may be removed from the uvula, soft palate and throat, depending on the location and severity of each patient’s individual condition. If the tonsils and adenoids are still intact, they will also be removed during UPPP. This procedure can also be performed using laser energy for more precise, less invasive results. 

Hyoid Suspension

p-istock_000004874725xsmallHyoid suspension is a surgical procedure performed to treat obstructive sleep apnea by securing the hyoid bone, the U-shaped bone in the neck, in place instead of allowing it to move around freely. Movement of the hyoid bone increases the risk of airway blockage during sleep and causes symptoms of sleep apnea.

Hyoid suspension involves creating an incision in the neck (within the natural crease) and detaching two of the upper tendons on the hyoid bone and advancing to a proper position before stabilizing the hyoid bone in place by attaching it to the thyroid cartilage with stitches. This procedure takes less than an hour to perform and does not cause any long-term voice changes or other complications in most cases.

Mandibular Advancement Device

A mandibular advancement device, or MAD, is the most popular mouthpiece used for treating sleep apnea, and is very similar to mouthpieces worn during sports. The MAD attaches to both the upper and lower dental arches, and is hinged to promote jaw movement. In many cases, this is an excellent alternative to surgery for treating sleep apnea. Talk to your doctor to see if you can benefit from a mandibular advancement device.

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