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Snoring and Sleep Apnea
Snoring is a very common problem, caused by obstruction and vibration of the tissues in the mouth and throat. The cause of snoring can be an elongated soft palate and uvula, large tonsils, a large or floppy tongue, obstructed nasal airways, or collapse of tissues lower in the throat. While simple snoring is an annoying and socially disruptive problem, it can be a sign of obstructive sleep apnea (OSA), a significant medical problem that can lead to daytime sleepiness, morning headaches, interrupted sleep, and even significant heart and lung disease. Patients with OSA may have a higher risk of premature death, especially if they are under 40 years old, have significant heart or lung disease, or are more than 100 pounds overweight. The initial steps in diagnosis are an exam by a head and neck surgeon, as well as an overnight sleep study (polysomnogram) in a sleep laboratory. These tests will help locate the source of obstruction and indicate the severity of the apnea. Click here to take a survey to help determine if you may have sleep apnea.
Continuous Positive Airway Pressure or "CPAP": By wearing a mask connected to a machine that blows air into the nose and/or mouth, OSA can be effectively treated 99% of the time. It is a safe, painless, and effective treatment. However, many people do not tolerate or like wearing a mask while sleeping, and long-term use rates remain poor.
Dental appliances: By wearing a mouthpiece at night, usually fit by a dentist or orthodontist, the tongue and mouth tissues are held open. This is a safe but less effective option, with success rates ranging between 50-60%. Some people have significant problems with jaw joint pain due to appliance use.
Surgery: There are several different procedures that are commonly done for OSA and snoring.
Surgical therapy can be very effective in certain cases of sleep apnea when there is a clear site of upper airway obstruction. Snoring can be eliminated or significantly improved in 80-85% of patients. Apnea can be eliminated or significantly improved in up to 75% patients; however, long-term results (5 years or longer) reveal significant improvement in 50-55% of patients. The obvious benefit of surgical therapy is a reasonable chance for improved sleep without the need for any machines or appliances.
Preoperative Instructions: Once your doctor has determined that surgical treatment for sleep apnea is indicated, our staff will arrange the surgical date. You may not have anything to eat or drink after midnight prior to your surgery or your procedure may be cancelled. Plan on at least an overnight stay in the hospital for UPPP and/or tongue suspension.
Postoperative Instructions: The majority of patients can be safely discharged to home the day after surgery for OSA. Your surgeon will give you prescriptions for liquid pain medicine, antibiotics, and possibly steroids. The major difficulty after surgery is pain-throat pain, difficulty swallowing, and pain radiating to the ears is very common. This pain can be very severe, but with regular doses of pain medication and plenty of fluids, it can be controlled. The pain usually lasts at least 10-14 days, but occasionally will last longer.
It is crucial to drink
plenty of fluids after surgery. Water, Gatorade, Popsicles, and clear juices are
the best. Avoid drinks with caffeine or alcohol, as they will dehydrate you.
While most people begin taking soft foods within 24-48 hours after surgery, most
find they lose a few pounds before being able to resume a normal diet by about
two weeks after surgery. Bleeding is a rare
complication after surgery. Occasionally, when healing tissue in the mouth or
palate sloughs off, bleeding from the incisions can occur. The majority of the
time, this is easily controlled in the office or, if after hours, in the
If the palate and uvula are trimmed, initially you may notice a nasal quality to your voice, or have liquids accidentally reflux into your nose while swallowing. This is a problem that very rarely is a long-term problem and improves as the palate heals. In the rare patient where this is persistent, treatments ranging from speech exercises to corrective surgery are available. If tongue suspension is performed, expect some amount of swelling under the tongue that will resolve over one week. Over correction of tongue collapse can cause swallowing problems. Cutting the suture in the office can easily reverse this. Depending on the procedure, plan on 2 weeks for recovery. You likely will be seen 2-4 weeks in the office after the procedure for follow up. Many surgeons will also repeat your sleep study 3 to 6 months after surgery to evaluate results.