Laser snoring treatments and help with sleep apnoea

What causes snoring?

 

The cause of snoring is sound production at the back of the throat due to turbulent (ie noisy) airflow. This occurs at night due to loss of muscle tone in sleep, with collapse and narrowing of breathing passages often already compromised by an underlying problem. We don’t snore whilst awake because muscle tone holds our airway open. Turbulent airflow occurs because the airway narrows or becomes blocked.

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The underlying problems that can precipitate snoring are:

• Nose blockage leading to mouth breathing/opening. This causes the tongue to slide back and obstruct the throat at the back of the tongue. Causes of nose blockage are a deviated nasal septum, large adenoids, large turbinates, nasal polyps, allergy, chronic sinusitis.

• A long and thick soft palate - which sits behind the tongue, compromising the airway at the back of the tongue, the key area in snoring.

• Large tonsils which block the back of the throat, again affecting the airway at the back of the tongue.

• Excessive weight on the neck, causing pressure on the airway when muscles relax in sleep.​

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The initial consultation is with a Consultant Ear, Nose and Throat Surgeon, as the cause of snoring and sleep apnoea is always found in the nose or throat.

 

A full history will be taken, your Epworth Sleepiness Score will be measured, as will your body mass index (BMI). Nose, throat and neck examination will be carried out, as will flexible endoscopy and the Muller manoeuvre. At this stage your doctor will have a pretty good idea as to what is causing your snoring / apnoea problem.

 

You will be advised as to what is the correct treatment for the cause of your problem, which may involve a number of different treatments: Nose unlocking surgery, tonsil reduction, palatoplasty, mandibular advancement device, CPAP (Continuous Positive Airway Pressure ventilation), weight loss, allergy testing etc.

 

A sleep study using overnight oximetry at home may be required pre and post treatment, to analyse the extent of any sleep apnoea, and to make sure treatment has been effective. This costs £450.

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Laser removal of snoring problems

Q: How can laser treatment alleviate snoring?

A: Laser treatment can work well, but it's not the only solution.

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The treatment of snoring is naturally focused on the cause of the problem – factors in the airway that precipitate obstruction to the breathing tube, and high velocity, turbulent, noisy breathing. The main procedures for this include nose unblocking surgery, laser palatal surgery and laser tonsillectomy or laser tonsillotomy. 

Weight loss can be vital in those whose body mass index is high. Always bear this in mind that it may be part of your treatment plan, without it any other treatment may be less effective. 

Mandibular advancement devices are common adjuncts to surgery, as they also work by unblocking the airway at the back of the tongue. You need good strong teeth for this, and a good orthodontist or someone very experienced in making them, as they are a real art. Mike Dilkes often starts with a Blue Pro device which is an adjustable plastic splint he can make himself. It is relatively cheap (£400), and gives a good idea as to whether a more expensive device will be tolerated and will be effective.

Continuous Positive Airway Pressure (CPAP) Ventilation is usually reserved for those who cannot tolerate surgery or a mandibular advancement device, and cannot lose weight. It involves having a ventilation mask strapped down tightly over the nose and/or mouth. This is connected to a ventilator which forces air into the lungs over a net positive pressure baseline. Very effective but often uncomfortable and the noise of the ventilator can keep patient and bed partner awake.

The treatment of snoring is usually multi-disciplinary - it means sometimes patients need more than one intervention - for example, nose unblocking surgery and a mandibular advancement device are often part of the same treatment plan.
 
Procedures performed to alleviate snoring:

1) Palatal surgery (LAUP) - laser palatoplasty

l perform this operation, almost always under local anaesthetic, when the patient clearly has an elongated and thickened soft palate and uvula (the hanging down tissue at the back of the mouth). It certainly helps snorers, it can also help in mild cases of sleep apnoea. Scientific evidence based on observation of the airway and correlation with sound analysis of the patient’s snoring suggests that if snoring is of a low pitched, rumbling nature, it comes from the soft palate area. LAUP effectively takes away the vibrating part of the airway responsible for a large proportion of the snoring sound, and causes scar tissue to build up, meaning the palate is shorter, lighter, stiffer and less likely to vibrate. Under local anaesthetic, this procedure costs £1,500.

 

2) Nose unblocking
Click here for nose unblocking information.

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3) Tonsil reduction / tonsillectomy (laser)

Click here for laser tonsillectomy information.