Snore Warzzzzzzz

The Daily Herald, Arlington Heights, Illinois
October 30, 2000

By Amy Carr
Daily Herald Staff Writer

Bedroom buzz saws keep millions of Americans awake at night, but snoring is more than a nuisance, it's a health hazard - and it's treatable.

It doesn't take a doctor to diagnose the 50-year-old Barrington Hills resident's problem. The pain, no doubt, comes from the firm elbow thrusts his wife delivers each time his obnoxious snoring interrupts her slumber.

Schubert recognizes that a few elbow jabs are nothing compared to what his wife has endured night after night. His snoring is serious business.

"I think it can be disastrous to a marriage," he says. "Both parties aren't sleeping well and that can lead to impatience."

Forty million other men and women feel his pain. About 45 percent of normal adults snore at least occasionally and 25 percent are habitual snorers.

Dr. William Gatti, a Libertyville ear nose and throat specialist, injects a sclerosing agent into the palate of Bob Levin, 54, of Buffalo Grove. Doctors hope the new, experimental procedure will provide a painless, inexpensive solution to snoring. (Daily Herald Photo/Paul Beaty)

Though it makes for an easy punch line, snoring is no laughing matter. It can wreak havoc on relationships and serve as a precursor to serious medical problems like hypertension, heart trouble and stroke.

In five out of every 100 people, it also signals sleep apnea, a potentially life-threatening condition in which patients stop breathing frequently during sleep for 10 seconds or more at a time.

The social stigma associated with snoring often kept patients from seeking medical help in the past, but doctors say that's changing, thanks to an increased awareness of the risks associated with snoring and a promising array of new treatment options.

Using radio waves, lasers or something as innocuous as a needle, doctors now are able to treat snoring with some degree of success and, depending on the procedure, limited pain.

After years of prodding, Schubert finally decided to see a doctor about his snoring.

"It was a social thing," Schubert says of his decision to seek medical advice. "It was probably half my wife's influence and half my sympathy for her getting a good night's sleep."

Dr. William Gatti, a Libertyville ear, nose and throat specialist, initially recommended a laser-assisted uvulapalatoplasty, a procedure that involves using a laser to vaporize the uvula and a portion of the palate in an attempt to open up the airway and eliminate snoring. It would cost $1,500 and insurance probably wouldn't cover it, but Schubert had another concern.

"I work with lasers and I know what it does to a steel plate," he says. "I envisioned that would be very painful."

Desperate, he had agreed to go ahead with the procedure, when his wife caught a report on "Good Morning America" about a painless new treatment for snoring.

According to the report, doctors at Walter Reed Army Medical Center in Washington, D.C., were eliminating snoring in patients with a simple, inexpensive needle stick. Dr. Eric Mair and Dr. Scott Brietzke found injecting sotrodecol, a sclerosing agent typically used to treat varicose veins, into the palate caused the roof of the mouth to stiffen. The stiffening stopped the fluttering of the palate that creates the snoring noise.

According to Mair, the procedure eliminated snoring for 25 of 27 patients who received the treatment.

"The beauty of it is it's effective and it's low cost," Mair says. "The materials for this procedure cost about $40 and it's painless. There's a little discomfort, but all the patients go right back to work. It's a marked difference from the other procedures we do."

The technique sounded like a winner to Schubert, who quickly called Gatti to see if he knew anything about it. Coincidentally, Gatti had just heard Brietzke and Mair give a presentation on the treatment, called injection snoreplasty, at a national meeting of otolaryngologists.

The doctors aren't recommending the procedure until after the study results have been published in a peer-reviewed journal, which likely will take at least six months. Brietzke also notes that while the Food and Drug Administration says its safe to use sotrodecol in the mouth, its use in the treatment of snoring still is considered experimental.

Even so, the procedure seemed so simple, so safe and so promising that Gatti felt comfortable giving it a try anyway.

Earlier this month, he performed injection snoreplasty on Schubert and another snoring patient, 54-year-old Bob Levin of Buffalo Grove. Gatti charges $375 for the procedure and it probably will not be covered by insurance.

The results have been encouraging, but not exactly amazing.

Both patients say they experienced no pain other than a minor sore throat on the day of the procedure. Recovery from laser surgery is so painful, patients typically lose 8 to 12 pounds. Levin, on the other hand, ate steak the day after receiving injection snoreplasty.

Gatti says Schubert was not an "ideal" candidate for the procedure because only 64 percent of his snoring comes from the palate, but there already has been some improvement.

"After two weeks, my estimate is that I'm halfway there," says Schubert. "Half of my problem has gone away. There is still snoring going on, but my wife is very pleased."

Levin hasn't noticed any significant change yet, but he's still optimistic.

"I'm still very excited about it," he said, noting that he plans to have the procedure a second time in a few weeks. An additional dose should increase the stiffening in the palate, Gatti says.

The long-term effects of the procedure remain unknown, but Mair says he knows of no reason why the procedure can't be repeated time and time again if necessary.

Harriett Schubert begged her husband, John, to do something about his snoring because she was concerned about his health and, quite frankly, she wanted to sleep with him again.

"I'm always kicking him and telling him to get out of the room," she says. "It does create a problem if I want to sleep with him. I would love to stay in the same room with him at night."

Doctors say a complaining spouse is the primary reason patients come to see them about snoring. More often than not, that spouse is a woman, but make no mistake: Women snore, too.

Among younger adults, the ratio of male snorers versus women is 2 to 1. Between the ages of 55 and 65, the numbers even out due, in part, to changes in the airway caused by menopause, according to Dr. Regina Walker, associate professor of otolaryngology at Loyola University and a leading authority on snoring.

Certain factors do contribute to snoring, including age, obesity, the presence of a large uvula and alcohol or drug use.

Alcohol and drugs relax the muscles in the tongue and throat. The tongue then falls backward, blocking the airway. Heavier people have a greater amount of air resistance in the throat, thus increasing the likelihood of snoring. Children with large tonsils or adenoids often snore as well.

Determining whether you snore or not generally isn't too difficult. Deciding whether a doctor is warranted is a bit trickier.

According to Walker, "benign" snoring typically means that a patient or spouse reports snoring with absolutely no other symptoms.

"Heroic" and "irregular" snoring typically are associated with apnea. The heroic snorer shakes the walls with his or her loud snoring and the irregular snorer starts and stops throughout the night.

Patients who suffer from sleep apnea should definitely seek medical treatment, Walker says. Apnea might cause a variety of problems ranging from depression, irritability, sexual dysfunction, memory difficulties and daytime sleepiness to serious health concerns like high blood pressure and a higher risk of heart attack and stroke.

According to physicians, most insurance companies do cover treatment for apnea.

You might want to see a doctor if:

Your bed partner notices you stop breathing or gasp for breath at night.

You wake up tired and never feel rested.

You wake up with a headache that goes away within the first hour of waking up, suggesting that you suffer from low oxygen levels during the night.

You are hypertensive and you snore.

As a rule, Walker also says, "If you are significantly overweight and you snore and you are male and you are tired, you have apnea until otherwise diagnosed."

Anatomy of a Snore

Many treatment options for snoring are painful, awkward and expensive, but the problem can be so detrimental to a person's health and well-being that many patients are willing to overlook the down sides.

"People are desperate," says Dr. Byron Eisenstein, ear, nose and throat surgery section chief for Northwest Community Hospital in Arlington Heights. "I say, 'I'll take your uvula out (a surgical treatment for snoring) and it will hurt,' and people will say, 'OK. When?'"

The fact that there are more than 300 patented devices for the treatment of snoring suggests that many people would love to find an easy answer to this problem. Unfortunately, it's not that simple.

"There are a lot of devices," Eisenstein says. "Obviously if any one of them worked, we'd all be out of business. We're all looking for that answer."

Some low-tech solutions - like sewing a tennis ball into the back of your pajamas or placing nasal strips over the nose at bedtime - do work for some patients, according to Eisenstein. More often than not, however, a cure is more elusive.

For apnea patients, major surgery might be the best option. This could include a tonsillectomy or adenoidectomy or something more extreme, such as an operation that corrects a jaw deformity by lengthening the jaw bone.

Another procedure, called a uvulopalatopharyngoplasty involves surgically trimming and tightening the throat tissues. The surgery costs about $3,000 and has only a 30 percent to 50 percent success rate.

Doctors are seeing more promising results from Somnoplasty, a relatively new treatment that uses radio waves to reduce the size of the uvula in the back of the throat. The procedure, which costs about $2,500, is relatively painless and can be conducted on an outpatient basis in the doctor's office.

A study conducted by Stanford University found the technology resulted in a 77 percent reduction of snoring, but the long-term results were slightly less encouraging. In a recently released study tracking 22 Somnoplasty patients, university researchers reported that 59 percent reported no relapse in snoring, while 41 percent said their snoring returned.

There are, of course, non-surgical options. Trouble is, no one wants to hear much about them.

For starters, snorers can try to make behavioral adjustments. For many people, however, that just isn't a desirable solution, Walker says.

"We'll do a sleep study that only shows snoring (with no signs of apnea) and tell them they can lose weight, drink less, get more sleep or sleep with the head of the bed elevated 6 inches. We'll tell them that and 80 percent say, 'I don't want to do any of that,'" she says. "The other 20 percent have false hopes. I see them six months later. They cannot help themselves and they want the surgery."

Perhaps the only 100 percent effective cure, aside from a tracheotomy, is Continuous Positive Airway Pressure .

Nasal CPAP delivers air through a specially designed mask or pillow. A tube connected to the mask delivers a constant stream of air, creating enough pressure to keep the airway open.

It is extremely effective as a snoring treatment, but few people want to sleep with a mask on every night for the rest of their lives.

"That (CPAP) is why I'm in business," Walker says. "I have people who come in and just laugh at it. They think it's the joke of all time."

Gatti has seen the same frustration from patients. He hopes injection snoreplasty will finally give doctors a palatable solution to offer patients.

"If this procedure can solve the whole thing with less pain and in a shorter period of time with less expense, that'd be great," he says.

Treatment Options A host of surgical and non-surgical options can treat snoring and sleep apnea. They include:
	Uvulopalatopharyngoplasty (UPPP):  Surgically trimming and tightening the throat tissues. A major surgical procedure in which the palate is folded over on itself and stitched into place. Cost: $3,000
	Tonsillectomy or Adenoidectomy:  Removal of tonsils or adenoids. Cost: $1,000
	Laser-Assisted Uvulopalatoplasty (LAUP):  Uses a laser to vaporize the uvula (the dangling tissue in the back of the mouth) and a portion of the palate. Cost: $1,500
	Somnoplasty:  A relatively painless, outpatient procedure in which a needle inserted into the uvula delivers low-temperature radio waves that reduce the size of the uvula on the back of the throat. Cost: $2,500
	Injection Snoreplasty:  Sotradecol, a sclerosing agent typically used to treat varicose veins, is injected into the palate, creating a scar that stiffens and stops the vibration that causes snoring. The procedure is new and might not be available in many doctor's offices. Cost: $375
	Continuous Positive Airway Pressure:  Nasal CPAP delivers air to the airway through a mask or pillow. Mask creates enough pressure to keep the airway open during sleep. Cost: $1,250