Dr. Robert Bodlaj | Practice for Ears-Nose-Throat Medicine
Snoring / Sleep apnoea
As age increases, on average, one out of every two men and one out of every four women snores. But snoring is much more than a common disorder that many people just laugh about. The disturbing noise in the night can rapidly turn into a serious risk factor for one’s general health.
On the following pages you will learn about the different forms of snoring and when snoring becomes dangerous.
We will also inform you about modern diagnosis and treatment options in the practice of Dr. Robert Bodlaj. These options promise quiet and well-being and can make sure that you, too, will soon start your days well-rested and recovered.
How does snoring start?
Body and mind regenerate during sleep.
While our brains process the events of the day and transfer what we have learned into our long-term memory, our musculature relaxes. The relaxation of muscle tension that occurs when we sleep also relaxes the musculature of the soft palate, throat and tongue also relax. They keep the upper respiratory pathways open. If the upper respiratory pathways constrict, this generates the snoring noise. The causes are vibrations from the soft palate, base of the tongue or even the throat walls and epiglottis, caused by the flow of breath.
Often the real fault lies with the soft palate. This is the pink layer of mucous tissue in the throat that keeps food and beverages from getting into your nose. If it is too long or too loose, it moves in the airflow caused by respiration. This generates the snoring noise. But the base of the tongue can also be responsible for the nightly background noise, because it relaxes when we sleep and can slide backwards. The most frequent causes of snoring are therefore:
- A vibrating soft palate
- A vibrating base of the tongue
In extreme cases, where the upper respiratory pathways become completely closed off, resulting in choking fits, one speaks of Obstructive Sleep Apnoea (OSA). These choking fits last around 30 to 45 seconds and can occur up to 60 times in a single hour.
What are the different kinds of snoring?
- ‘Harmless’ snoring – which ‘only’ generates annoying noise and does not interrupt breathing
- UARS (Upper Airway Resistance Syndrome) – constriction of the airways without complete closure
- OSAS (Obstructive Sleep Apnoea Syndrome) – Dangerous interruption in breathing
Vibration in the soft palate and/or the base of the tongue generates the snoring noise. As such this is not dangerous, just annoying, especially for your spouse!
Upper Airway Resistance Syndrome (UARS):
Constriction of the upper airways without complete closure. Breathing resistance increases, the brain registers the risk of suffocation and waking reactions occur repeatedly. Sleep is constantly interrupted. This expresses itself e.g. in constant fatigue and inability to concentrate.
Obstructive Sleep Apnoea (OSAS):
Complete closure of the upper respiratory pathways. When we sleep, the soft tissues in the throat sink down because the muscle tension in the neck is released and this displaces the upper respiratory pathways. The oxygen concentration in the blood drops, the brain receives too little oxygen and it triggers a waking reaction. Without reaching full consciousness, the sleeper sinks back into the next deep-sleep phase and the mechanism starts all over again.
This form of sleep apnoea is also seen in children, e.g. in cases of very enlarged tonsils!
When does snoring become dangerous?
As soon as the collapse of the airways leads to nightly interruptions in breathing, one refers to it as sleep apnoea. Then it becomes dangerous for the person affected. The body must work very hard because of the elevated breathing resistance. The body reacts to the insufficient oxygen supply when breathing is interrupted by waking. One wakes up, gets one’s breath, and then falls asleep again.
According to estimates there are more than 1.2 million people in Germany who suffer from sleep apnoea. Of them, though, only 5% have received any treatment to date. That means that 95% of sleep apnoea patients don’t even know that they are affected and are consequently not receiving any treatment.
This is a considerable cause for concern in light of the consequences that these nocturnal interruptions in breathing can have. Possible consequences are:
- Fatigue and despondency in the morning and even after long sleep
- Listlessness and a decrease in performance
- Sexual dysfunctions
- Nightly nosebleeds
- Nightly bedwetting among children
- as well as momentary nodding off while driving, which is dangerous.
But other, sometimes severe illnesses, can also be caused by sleep apnoea. These include, among others:
- High blood pressure
- Cardiac disease ranging up to heart attacks and sudden cardiac death
All told, untreated sleep apnoea damages quality of life and shortens life expectancy on average by eight years. The mortality rate increases up to more than 50 percent within 10 years, if there are 30 or more breathing brakes per hour.
What diagnostic options are available in Dr. Bodlaj’s practice?
Dr. Robert Bodlaj’s practice has the most modern medical technology available, so that we can reach a precise, targeted diagnosis:
- Video-nasopharyngoscopy provides high-resolution images of the nose and nasal sinuses
- With a very-low-radiation 3-D digital volume tomograph (DVT) we can image the finest structures of the nose and the nasal sinuses – the images that the DVT provides are, when necessary, also directly put into use for nasal sinus navigation.
- An out-patient sleep laboratory is available for our patients, with technology for recording brainwaves (SOMNOmedics or WatchPAT);
- with rhinomanometry we can obtain precise findings
But the core of diagnostics is EEG-guided sleep endoscopy.
Snoring – what can I do about it?
In every case when snoring is so loud that it wakes you or disturbs those around you, you should go to the doctor in order to rule out an obstruction of the airways or have it treated, if necessary. You should consult a doctor especially if the complaints listed above raise the suspicion of sleep apnoea.
This is especially true for children also, since in their case enlarged pharyngeal or palatal tonsils are often a cause of snoring.
There are many treatment options depending on what form of snoring you suffer from. Thanks to the very newest technological developments, there are now in many cases surgical alternatives to the previous standard, which was nightly overpressure ventilation using a so-called nCPAP mask. Of course we offer this on request in our practice. We will be glad to inform you about a possible CPAP Alternative.
Before we being with a treatment in our practice, we complete a detailed diagnostic procedure in order to identify the cause of the snoring, i.e. the location of the greatest constriction in the pharynx. The anatomy of the individual patient plays a significant role.
Our practice’s number one goal is to develop an individual treatment concept that promises maximum success with the least possible risk. We begin first with treatment based on medication. Only if it does not lead to the desired result are surgical methods such as a sleep apnoea operation even considered.
Nasal surgery without packing
To the extent that a surgical intervention is necessary, it should be carried out so that it is as unnoticed by you, our patient, as possible and so that you are already fully recovered the next day. Uncomfortable side effects such as continued bleeding and complications are things of the past thanks to Dr. Bodlaj’s minimally invasive surgical technique.
In Dr. Bodlaj’s practice, every nasal or nasal sinus surgery is carried out without the nasal packing that so many patients fear.
Only after careful diagnostics is it possible to decide whether and in what scope a surgical procedure, such as e.g. a sleep apnoea surgery, can be taken into consideration.
Also included among the factors that are favourable to the development of snoring are
- Consumption of sedatives, alcohol, sleeping pills, tranquilisers and psychopharmaceuticals
- sleeping on one’s back
For that reason it can even be helpful to observe good sleep hygiene. This includes, among other things, avoiding alcohol, going to bed early and maintain a healthy climate in the room. Weight loss can also help obese patients.
Changing one’s sleeping position often reduces the disturbing night-time noises. The switch from sleeping on the back to sleeping on the side leads to the respiratory pathways being less constricted when the overall muscle tensions relaxes. Side-sleeper pillows help to prevent a return to the back position.
But if there is an actual case of Upper Airway Resistance Syndrome or Obstructive Sleep Apnoea, healthy sleep hygiene will not be enough.
Are there alternatives to CPAP?
We have many options in todays’ modern ENT treatment as alternatives to nCPAP, the so-called breathing mask. In our practice we use only minimally invasive surgical methods that are gentle on the tissues.
Dr. Bodlaj has a broad spectrum of the most modern treatment procedures, including, among others
- The Pillar procedure (soft palate implants)
- Coblation (plasma field surgery)
- ReVENT implants
- Inspire hypoglossus stimulation (tongue ground pacemaker)
- Radiofrequency therapy
All procedures we use almost completely exclude complications and subsequent bleeding and make nasal surgery without packing possible.