To snore no more - possible solutions

Nation's Business, May, 1995 by Edward Tomkin

Managing well includes managing your own health; here is advice to help you do that better.

In the U.S. alone, there are 25 million chronic snorers--people who nightly produce enough noise to waken others or to keep them from falling asleep at all. Most snorers are men, many are overweight, and the condition usually gets worse with age.

While the snoring spouse is a cliche, snoring can affect the efficiency of business as well. Among business travelers sharing a transcontinental flight or hotel accommodations, snoring can keep a colleague awake for hours.

But it's not just the nonsnoring companion who suffers: Studies have shown that snorers themselves don't sleep soundly either. They are disturbed by their own nocturnal noise. Loud snoring can also indicate a more serious medical problem.

Sleep apnea is a condition in which the snorer actually stops breathing for a short time, again and again, throughout the night. At irregular intervals, struggling for breath while his airway is obstructed, the snorer may waken briefly and be deprived of an uninterrupted night's sleep. Over time, sleep apnea can lead to hypertension or even cardiac arrest So, snoring can be of real medical concern.

Fortunately, both snoring and sleep apnea--but especially snoring--may be lessened if you take some, or all, of the following measures:

* Lose weight.

* Avoid alcohol, tranquilizers, and sleeping pills; they relax the soft-palate muscle, blocking the airway and creating noise.

* Don't sleep on your back.

* Tilt the bed with bricks, for example-to raise your head about four inches.

If snoring persists, surgery may be in order. Traditional surgical treatment, called a uvulopalatoplasty, is not undertaken lightly. It's a resection of the soft palate, uvula, tonsils, and, often, other tissues at the back of the throat. The procedure is performed under anesthesia and requires a hospital stay of a day or two; recovery takes about two weeks.

But now there's a relatively inexpensive and often highly effective alternative.

Because snoring occurs most often when the soft palate and the uvula (the tissue that looks like a bell clapper at the back of the threat) are so enlarged that they fall into the airway and vibrate loudly as air travels past, an effective treatment requires a reduction in the size of both.

That is precisely what happens in the new procedure: a laser-assisted uvuloplasty (LAUP). A trained otolaryngologist uses a laser to vaporize the excess tissue, reshape the uvula and palate (which can be up to three times larger than normal), and eliminate the obstruction of air.

Laser surgery for snoring was developed in Paris by Dr. Yves Victor Kamami. The use of various kinds of lasers for many different outpatient procedures has become more prevalent as the technology has progressed. There are now lasers for almost every surgical procedure involving the ear, nose, or throat.

The new technique to alleviate snoring is performed in steps and typically requires three to five sessions, with a four-week recovery period between each session. Because only local anesthesia is used, there is no hospital stay. It's an outpatient procedure performed in the physician's office.

And because only a small amount of tissue is "vaporized" each time, the surgery is usually no more painful than a trip to the dentist. And it's cost-effective. The outpatient procedure not only eliminates a hospital stay but also requires no time away from work. Business people and other professionals are usually very happy about that aspect of the treatment.

Unfortunately, if the snoring professional has a severe case of sleep apnea, laser-assisted treatment alone may not be enough (although the snoring will be reduced), and the traditional surgical treatment may be required. But for those with ordinary though chronic snoring or even mild sleep apnea, laser-assisted treatment can be effective.

Says dentist Robert Solomon, one of my patients who underwent the treatment: "My practice is so thoroughly demanding that the LAUP which I completed in just three sessions--was ideal. The discomfort level was about what I'd expect from a tonsillectomy. That is, I took a mild painkiller between sessions. But I continued with my normal routine of seeing patients."

In his case, each session required between 15 and 20 minutes from beginning to end, including the injection of a local anesthetic and the wait for the anesthetic to take effect. Since the surgery, he reports being less tired, probably because he now sleeps more soundly.

The busy professional or business executive--or someone intent on climbing higher on the corporate ladder--may need to take snoring into account. Traveling colleagues will, after all, be grateful. The chronic snorer will be more alert and better rested, too.

Dr. Edward Tomkin is a board-certified otolaryngologist in private practice in Allentown and Bethlehem, Pa. He specializes in laser-assisted treatment for snoring.