Dr David Lowinger MBBS FRACS Ear Nose & Throat Specialist Surgeon
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Snoring & Sleep Apnoea

Snoring :: Sleep Apnea

Snoring

Snoring is a sound produced by the vibrations of the tissues of the nose and throat on breathing during sleep. Snoring is more common in men than women, and may increase with advancing age.

Normally when we breathe, air flows in and out in a steady flow from nose or mouth to lungs. But during sleep the area at the back of the throat, nose or mouth may get narrowed and when the air passes through this narrow opening the surrounding tissues vibrate producing sounds of snoring.

The most common cause of snoring is nasal passage obstruction caused from nasal septum deviation, allergies, sinus infections, swollen turbinates (nasal concha) and enlarged tonsils. It may also be seen in children who breathe through their mouth.

Certain medications and alcohol increase the relaxation of the muscles of the palate, tongue, neck, and pharynx leading to smaller airway and greater tissue vibration resulting in snoring. Snoring can also be a sign of sleep disorders or other sleep related breathing problems.

Your doctor evaluates snoring by taking a completed medical history and by physical examination. You may be asked about your snoring and sleep pattern and sleep problems. Body mass index (BMI) and neck circumference are estimated. Physician may examine throat, nasal and oral cavities to determine narrow oral and nasal passages. If sleeping problem is suspected then a sleep study can be performed.

Treatment options for snoring include non-surgical and surgical treatment.

Non-surgical treatment:

  • Behavioral changes: This therapy includes losing weight if overweight, avoiding alcohol or sedative medications, stop smoking, and changing sleeping positions.

  • Dental devices: Dental devices hold the jaw forward and these devices may be used for mild snoring and in people who have not responded from behavioral changes.

  • Nasal devices and medications: Adhesive nasal strips are available which can be placed over the nose. These will help in widening the nostrils and makes breathing easy. Nasal steroid sprays may be used to decrease the inflammation in the nasal passages. Decongestants nasal sprays and drops are prescribed to relieve the stuffy nose. These medicines shrink the swollen blood vessels in the lining of the nose and help to improve snoring resulting from nasal congestion.

  • Nasal continuous positive airway pressure: Nasal continuous positive airway pressure (CPAP) is a device that prevents narrowing of the airway during inspiration and expiration by providing a persistent increased pressure.

Surgical treatment

The goal of the nasal surgery is to improve the narrow nasal passage. Surgery may be needed to correct the anatomic abnormalities. Deviated nasal septum may be surgically corrected with a septoplasty procedure. Polypectomy is done to remove the nasal polyps.


Sleep Apnea

Sleep apnea is a common sleep disorder where patients have abnormal breathing pattern during sleep i.e. they pause during breathing or breathing gets very shallow. Breathing pauses last between 10 to 20 seconds or more. Apnea causes sleep disruption as a result of reduced oxygen level in the blood.

The types of sleep apnea include:

  • Central sleep apnea: This type of apnea occurs with interrupted brain signals to the muscles involved inbreathing, and there is no effort of the muscles in breathing

  • Obstructive sleep apnea: This is the most common type of sleep apnea and occurs because of obstruction in the airway preventing sufficient flow of air. In this condition the brain signals are not interrupted however the muscular efforts will be unsuccessful

  • Mixed sleep apnea: It is a combination of both central sleep apnea and obstructive sleep apnea

The common symptoms of sleep apnea include daytime sleepiness, weakness, repeated naps, headaches, irritation, sleeplessness (insomnia), poor memory and concentration, and snoring.

The most common cause of snoring is nasal passage obstruction caused from nasal septum deviation, allergies, sinus infections, swollen turbinates (nasal concha) and enlarged tonsils.
Risk of obstructive sleep apnea increase with age and is more in men, obese individuals, and people with heart diseases.

Obstructive sleep apnea if left untreated may lead to complications such as hypertension, heart failure, heart rhythm disturbances, atherosclerotic heart disease, pulmonary hypertension, insulin resistance and even death.

Sleep apnea may be treated by:

  • Behavioral changes: This therapy includes losing weight if overweight, avoiding alcohol or sedative medications, stop smoking, and changing sleeping positions.

  • Dental devices: Dental devices hold the jaw forward and these devices may be used for mild snoring and in people who have not responded from behavioral changes.

  • Nasal devices and medications: Adhesive nasal strips are available which can be placed over the nose. These will help in widening the nostrils and makes breathing easy. Nasal steroid sprays may be used to decrease the inflammation in the nasal passages. Decongestants nasal sprays and drops are prescribed to relieve the stuffy nose. These medicines shrink the swollen blood vessels in the lining of the nose and help to improve snoring resulting from nasal congestion.

    Medications such as provigil and armodafinil may be used to increase daytime wakefulness in people with sleep apnea.

  • Nasal continuous positive airway pressure: Nasal continuous positive airway pressure (CPAP) is a device that prevents narrowing of the airway during inspiration and expiration by providing a persistent increased pressure.

  • Surgery: Surgery may be needed to correct the anatomic abnormalities. Deviated nasal septum may be surgically corrected with a septoplasty procedure. Polypectomy is done to remove the nasal polyps.
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