Snoring and sleep apnea are part of a spectrum of upper airway blockage that can disrupt the normal sleep cycle.  They are two different problems that may be related and often coexist.  However, snoring and sleep apnea are not the same thing.  Snoring is a loud disruptive sound that usually keeps your bed partner awake.  Sleep apnea is a serious medical condition that causes reduced oxygen flow to the lungs and needs to be treated in order to avoid long term complications.  

Sleep apnea basically refers to any sleep disorder that leads to a significant reduction of airflow to the lungs.  There are three types:

1.  Central sleep apnea describes a lack of respiratory effort.  Basically, there is a problem initiating the breathing mechanism.  The diaphragm doesn’t move, the chest doesn’t expand, and air is not “sucked in” to fill the lungs. Central sleep apnea is a nervous system problem, not a blockage problem.

2.  Obstructive sleep apnea, describes conditions in which there is respiratory effort but obstruction in the upper airway blocks the air from moving into the lungs.  Technically, this blockage can occur at any level from the nasal and oral opening down to the trachea.  However, most commonly, the obstruction is at the level of the throat just behind the tongue.

3.  Mixed sleep apnea is a complicated combination of central and obstructive sleep apnea. 

Since obstructive sleep apnea (OSA) is the most common type of sleep apnea encountered, the remainder of this section will focus on OSA.

Obstructive Sleep Apnea

A major problem with the human throat is that the tongue and palate are not firmly fixed in position.  Therefore, when lying down to sleep, gravity pulls these relaxed muscles back into the throat causing various levels of blockage.  If the obstruction is mild, light snoring will occur.  If there is a major obstruction, breathing will actually stop leading to OSA.  This is an improtant concept to understand because many people that come in for evaluation of snoring and sleep apnea want to discuss nasal surgery.  While nasal surgery can help with nasal breathing all the time, it is not very effective by itself in improving snoring and sleep apnea.  Whether you chose surgical or non-surgical therapy, the goal must be to change the interaction between the tongue, palate, and throat...not just the nose.

Treatment For Snoring

Treatment for snoring is optional and often times requested by the person's bed partner.  The noise level can keep others from getting a full nights sleep and lead to tension in relationships.  The main point of treatment is to change the point of friction between the tongue and soft palate so that air flows more freely.  Various techniques are available for this including jaw realignment with oral devices, implantable materials that stiffen the palate, and minor surgery which can reshape and tighten the upper airway.  The specific technique and exact treatment plan depends of personal preference and the patients anatomy.

Treatment for Obstructive Sleep Apnea

Treatment for obstructive sleep apnea is essential.  There are serious health risks that can result from prolonged obstructed breathing and lack of oxygen delivery to major organs.  Like many other aspects of medicine, treatment is divided into surgical and non-surgical categories.

CPAP-Continuous Positive Airway Pressure is a nonsurgical way of expanding the airway while you sleep.  This is done by wearing a mask, nasal pillow or other device that allows delivery of high pressure air to the upper airway.  This pressue will reduce the collapse of the tongue and palate relieving obstructive sleep apnea.  The main operation utilized is termed uvulopalatopharyngoplasty.  This can be done in combination with septoplasty and turbinate reduction to widen the nasal airway, and/or in combination with tongue base reduction to widen the lower throat airway.

Oral Appliances-Sometimes, the tongue and lower jaw can be moved forward with an oral appliance.  These are put in place during sleep.  With the tongue locked in a more foreward position, the upper airway is open and air can pass more easily.

Palatal Implants - Implants can be placed into the soft palate to maket it tighter and more stiff over time.  This will reduce the vibration of the palate as air moves past and can relieve mild cases of OSA.

Oropharyngeal Surgery - The oropharynx is the section of throat that contains the soft palate, tonsils, tongue base, and the back of the sidewalls of the throat.  Several operations have been developed with the goal of changing the size and position of the various components of the oropharynx.  The hope is to achieve a permanent opening of the airway to eliminate OSA.

Facial Bone Surgery - This involves acutally breaking and repositioning the upper and lower jaw to move the entire comples of tongue and palate forward.  The procedure is termed mandibulomaxillary advancement and is one of the most major operations that can be performed for obstructive sleep apnea.