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Snoring & Sleeping Apnea


Management of Snoring & Sleep Apnea at STAR Hospitals, Hyderabad


Centre of excellence in the management of snoring and sleep apnea:
What is Sleep apnea?


Top ENT Specialist in Hyderabad - Sleep Apnea


Sleep apnea is a common disorder in which a person has one or more pauses in breathing or shallow breaths while sleeping. Breathing pauses can last from few seconds to minutes. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. Sleep apnea usually is a chronic (ongoing) condition that disrupts one’s sleep. When one’s breathing pauses or becomes shallow, they will often move out of deep sleep and into light sleep. As a result, the quality of sleep is poor, which makes them tired during the day. Sleep apnea is considered as one of the leading cause of excessive daytime sleepiness.


What are the symptoms of sleep apnea?


Symptoms of obstructive sleep apnea include- 



  • Excessive daytime sleepiness (hypersomnia)

  • Loud snoring

  • Episodes of breathing cessation during sleep witnessed by another person

  • Abrupt awakenings accompanied by shortness of breath, which more likely indicate central sleep apnea

  • Awakening with a dry mouth or sore throat

  • Morning headache

  • Attention problems

  • Memory loss

  • Irritability/ depression


 


What are risk factors in sleep apnea?


Risk factors for sleep apnea include:



  • Gender-Men are more prone to have sleep apnea over women

  • Weight- Patients with overweight are at higher risk

  • Age- Patient above the age of 40 years are at higher risk

  • Neck size- Having a large neck size (17 inches or greater in men and 16 inches or greater in women) are more prone

  • Having large tonsils, a large tongue, or a small jaw bone

  •  Having a family history of sleep apnea

  • Nasal problems- Having any nasal obstruction due to a deviated septum, allergies, or sinus problems make you more prone to sleep apnea


How are sleep apnea patients evaluated?
After a physical evaluation, sleep study is done to evaluate the severity of obstruction during sleep. It gives us an idea about, how many times the person is choking per hour at night and how much is the oxygen saturation falling down from the normal level.
The ENT surgeon then performs a sleep endoscopy, a technique performed in operation theatre under sedation to simulate the pattern of obstruction in a particular person during sleep using the stryker flexible endoscope. This makes the road map for the surgeon as to what are the structures that need surgical correction to prevent the snoring problem. This is a day care procedure. The person can go home within average two hours.
What are the treatments available for sleep apnea?
Sleep apnea is treated in various ways based on the cause. Few treatments include-


1) Lifestyle changes
If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.



  • Avoid alcohol and medicines that make you sleepy

  • Lose weight if you’re overweight or obese.

  • Sleep on your side instead of your back to help keep your throat open

  • Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed

  • If you smoke, quit


2) Breathing devices
CPAP (Continuous Positive Airway Pressure) is one of the treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat so that the pressure from the air helps keep your airway open while you sleep. The biggest drawback of breathing devices is compliance and adherence of patients.


3) Dental devices
Devices like Mandibular Repositioning Devices hold the lower jaw and tongue forward making more space to breathe and prevent snoring. If the patient is a ‘tongue base snorer’ , consultant would recommend this device.


4) Surgery
Obstructive sleep apnea patient who cannot tolerate CPAP Machine can go for surgery. Based on the findings in sleep endoscopy, surgeon decides the steps of this surgery depending on individual patient’s scenario. Usually it involves multi-levels surgeries including nasal surgery (Septo-turbinoplasty), Palatal procedures (Expansion sphincteroplasty, Dorsalpalatoplasty, Zeta palatoplasty etc), Tongue base procedure and rarely epiglottic surgery. For few patients, surgeon may recommend bony surgeries like advancement palatoplasty, advancement genioplasty, Maxillo-mandibular advancement etc. sleep surgeries


Expertise at Department of ENT at STAR Hospitals, Hyderabad
Department of ENT at STAR Hospitals, Hyderabad, is headed by Dr. Srinivas Kishore. With over 13 years of experience, he is regarded as one of the top sleep apnea surgeons in India. He has performed over 100 surgeries giving relief to these patients from sleep apnea. Sleep surgery’s success not only depends on the equipment and technique used, but also on the surgeon’s decision making ability to customize the surgery for resolving the exact problematic areas. Such customization requires deep expertise and experience in handling sleep surgeries.
– People who snore loudly are often the target of bad jokes and middle of the night elbow thrusts; but snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.
– Snoring Is Not Necessarily Sleep Apnea
– Everyone has heard stories of men and women whose snoring can be heard rooms away from where they are sleeping.
– Snoring of this magnitude can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one’s own snoring. But, snoring does not always equal OSA; sometimes it is only a social inconvenience.


Some non-medical treatments that may alleviate snoring include:
– Weight loss — as little as 10 pounds may be enough to make a difference.
– Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.
– Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.
Avoid sedatives — which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.


Your doctor has other treatment options, including the following:
– Radio Frequency (RF) of the Soft Palate uses radio waves to shrink the tissue in the throat or tongue, thereby increasing the space in the throat and making airway obstruction less likely. Over the course of several treatments the inner tissue shrinks while the outer tissue remains unharmed. Several treatments may be required, but the long-term success of this procedure has not as yet been determined.
– Laser-Assisted Uvuloplasty (LAUP) is a surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed in the Oral and Maxillofacial Surgeon’s office with local or general anesthesia.


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