Snoring And Sleep Apnoea

Snoring And Sleep Apnoea is a combined breathing disorder involving obstruction of the upper airway leading to symptoms of noisy breathing and blockage of the airway. Airway blockage can cause sleep apnoea (apnoea means cassation of breathing).

The blockage typically occurs in the region of the nose, soft palate, tongue base and tonsil. The noise of snoring is generally by vibration of the soft palate against the back of the throat and in itself does not cause airway obstruction.

More severe collapse of the airway while breathing in can cause complete obstruction of the airway. This usually only occurs during sleep when the muscles breathing are relaxed. While most people don’t completely wake up during these “apnoeas” (short periods of obstruction of the airway), the drop in blood oxygen levels that occur during this process causes a significant level of arousal with the end result that people with this problem never get a good quality deep sleep. This is reflected in chronic tiredness, often times headache, lack of concentration and falling asleep during the day inappropriately (e.g. while stopped at a red traffic light). In very severe cases it can increase resistance to blood flow through the lung and cause heart failure. This is uncommon however, in all but the most severe cases.

Obstruction of the airway can be due to many factors, in fact can occur in any part of the normal airway i.e. nose and mouth down the trachea (windpipe). This obstruction can be made significantly worse in people who are overweight or who take sedatives (including alcohol) at night. These patients may be helped considerably by serious attempts at weight loss and avoidance of these sedatives.

Treatments and Studies

However a significant number of people will still require some form of treatment for the snoring, or sleep apnoea or both. Snoring alone (without associated sleep apnoea) is usually helped by removing the cause of the blockage (e.g. nasal decongestants or nasal surgery for nasal obstruction), and or the surgical removal of the vibrating tissue causing the snoring noise. This typically involves removal of the excess floppy part of the soft palate. In those patients who have not had their tonsils removed, the tonsils are usually removed also. The surgery is typically done using a laser for reduction of the soft palate.

Patients suffering obstructive sleep apnoea are generally recommended to try a CPAP (Continuous Positive Pressure Ventilation). This has the affect of applying a positive pressure to the inspired air while asleep via a specially worn facemask and in effect, inflating those parts of the airway that collapse during sleep. If the nose is blocked, corrective nasal surgery may be recommended to enhance the affect of CPAP.

Whether the patient is suffering from true sleep apnoea or merely snoring can often be determined by the patient’s symptoms, however this is usually confirmed by performing a sleep study. This involves an overnight observation (in hospital) during which the blood oxygen level and sometimes the level of arousal (EEG) and videotaping are performed while the patient sleeps. From this it can be determined fairly accurately both whether the patient is suffering sleep apnoea and also how severe it is.

The Surgery

The operation (as is removal of the tonsils in an adult) is painful; most patients need to remain in hospital at least 2 days before swallowing is comfortable. The operation requires a general anaesthetic and takes about 40 minutes. It may be combined with nasal corrective surgery if nasal obstruction is also complicating the problem.

Possible Complications and Risks

Complications although uncommon can include pain postoperatively, post operative bleeding, problems with nasal regurgitation when swallowing and recurrence of the snoring or breathing problems.

Instructions for Surgery

You may also refer to the Preparing for Surgery patient information sheet.

FASTING: (food & liquid) from midnight for a morning operation and from 7.30am for an afternoon operation, a light breakfast of tea and toast is OK prior to 7.30am.  Children under 14 may have clear fluids only up until 10.30am, (NO MILK) but definitely nothing after 10.30am.

FORMS: Hospital admission forms and anaesthetic forms should be completed and returned to the hospital at least 3 days prior to the date of your operation.  If you have any queries regarding your operation please do not hesitate to contact Dr Nicholson’s rooms.

No Aspirin Or Aspirin Containing Pain Killers To Be Taken 2 Weeks Prior To Surgery 

Post Operative Care for Surgery

Dr Nicholson will provide you with specific instructions for post operative care.

*These notes are an outline only and should be expanded on in discussion with Dr Nicholson.