Snoring: Treatment Philosophy
Once you are determined not to have significant obstructive sleep apnea (via a formal sleep study or a take home screening study), treatment for snoring can begin. Similar to the approach for obstructive sleep apnea, the entire airway from the tip of the nose to the voice box must be addressed. If you have any degree of nasal obstruction for whatever reason, this must be addressed first. Sometimes nasal congestion can aggravate snoring, by causing a vacuum effect in your throat, creating forces that tend to collapse the palate, thus aggravating snoring.
If you have very large tonsils, removing them may help as well, as they cause a narrowing in the area surrounding the soft palate.
Although the main focus of snoring treatments center on the soft palate, one must never ignore any degree of nasal congestion or possible tongue collapse. An examination in the office will reveal exactly where the sites of obstruction may exist.
There are various ways of stiffening the soft palate:
LAUP procedure (laser assisted uvulopalato-plasty): must be performed 2-3 times, 4-6 weeks apart. Due to the higher levels of pain and discomfort, as well as the time factor, it is not performed as much anymore.
Cautery Assisted Palatal Stiffening Operation (CAPSO): Electrical cautery (or similar device is used to remove the uvula and a small portion of the mucous membrane of the soft palate. Usually, only one procedure is needed, and it is somewhat painful.
Injection Snoreplasty: The soft palate mucous membrane is injected with a stiffening agent. Most people need 2-3 treatments, 4-6 weeks apart.
Radiofreqeuncy Thermal Ablation (Somnoplasty): A needle electrode is placed in the muscles of the soft palate and the tissues heated gently, causing scarring and tightening. Most people need 2-3 treatments, 4-6 weeks apart.
Pillar Implants: Three thin braided polyesters rods are inserted into the soft palate. This causes an inflammatory response, eventually causing stiffening. Most people need 1 treatment. This procedure was recently FDA approved for mild obstructive sleep apnea.
For people with significant tongue collapse, a mandibular advancement device may also be a good option. This may alleviate mild obstructive sleep apnea, as well as UARS.
All these procedures have up to 90% success, in terms of patient satisfaction. Long-term follow-up studies (one year or more) reveals that for the most part, the results last at least this long.
If the procedure does not work, it either means:
• there is another site of obstruction (nose, tongue)
• the treatment was not strong enough
• there is underlying obstructive sleep apnea.
In general, remember that treating the snoring does not treat obstructive sleep apnea. This is why routine follow-up and monitoring are so important.
Steven Y. Park, M.D.
Otolaryngology – Head & Neck Surgery
(212) 315-9058
