To treat snoring and obstructive sleep apnea, Yale physicians are using a radiofrequency technology called somnoplasty to shrink extra tissues in the nose and throat, and oral appliances to move the lower jaw forward during sleep.
"We've found this new approach effective in minimizing snoring and upper airway obstruction, which affects millions of Americans," said Douglas Ross, associate professor of surgery/otolaryngology at Yale. "These techniques can be done on an outpatient basis without significant morbidity."
Snoring occurs when floppy tissue in the back of the nose and throat airway relaxes during sleep and vibrates. Most snoring is caused by an enlarged soft palate and uvula at the back of the mouth. Somnoplasty treats snoring by reducing the volume of the soft palate tissue and stiffening it. Since snoring is primarily caused by the vibrating of the soft palate and uvula, this has the effect of reducing or eliminating snoring.
Yale physicians also use somnoplasty to treat obstructive sleep apnea syndrome, a disorder that causes people to stop breathing temporarily during sleep for 10 seconds or more at least five times per hour of sleep. Sleep apnea mainly affects middle-aged, overweight males. Symptoms include frequent and regular episodes of obstructed breathing during sleep. Somnoplasty is used to shrink the upper airway, including the base of the tongue, that is the source of the obstruction. Ross points out that somnoplasty may not be useful to treat apnea in some patients.
"In sleep, the body's muscles relax, causing excess tissue to collapse into the upper airway back of the mouth, nose and throat-and block breathing," said Ross. "When breathing is obstructed, the body reacts by waking enough to start breathing again. These arousals can occur hundreds of times each night. The person is never fully awakened by the loud snoring, choking and gasping for air that is typically associated with obstructive sleep apnea."
Ross said somnoplasty can also reduce nasal congestion and stuffiness by reducing the volume of the tissue of the nasal turbinate, a small bone in the nasal passage. When turbinates are enlarged, the tissue obstructs the nasal airways, causing stuffiness and chronic nasal congestion.
Somnoplasty cuts down on the bleeding and pain associated with other types of treatments and is performed in less than 10 minutes under local anesthesia in a doctor's office. Ross said there is no discomfort during the procedure and the somnoplasty device generates low-level radiofrequency that is closely controlled to protect the delicate surface of the tissue. After three to six weeks, the treated tissue is naturally "sloughed off" and reabsorbed by the body, and the tissue volume is reduced.
"The treatment also makes the tissue contract and stiffen, which lifts up the uvula," said Ross. "The reduction in snoring is due to both the reduction and tightening of the obstructive tissue."
In addition to somnoplasty, physicians also use conventional treatments at the Yale Center for Sleep Medicine. Directed by Vahid Mohsenin, M.D., the center provides comprehensive evaluation and treatment for sleep-related breathing disorders such as snoring and sleep apnea.
Yale Center for Sleep Medicine will host the 15th Annual Meeting of the Northeastern Sleep Society on March 30-31 at the Omni Hotel. The theme of the meeting is "Health Consequences of Sleep Disorders."
"Snorers, especially those who have loud habitual snoring and patients with sleep apnea, are particularly at risk for developing hypertension and other cardiovascular complications," said Mohsenin.