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Paging Dr. Shapiro: Sleep Problems

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Sleep is ever so important to our health. When we have problems during our sleep we often have difficulties elsewhere in our lives.
Snoring is a medical problem that plagues many of us. In fact, almost 50% of the adult population exhibit occasional snoring, and about 25% are habitual snorers. The problem is seen more often as we age, but young children can also be involved. Men are almost twice as likely to snore as women. The heavier we are the more likely we are to snore and have sleeping troubles. Marital problems, depression, and divorce have been noted for the snorer’s bed-partners.
There are a number of reasons why we snore. The most common is a relaxation of the muscles in the back of the throat. Enlarged tonsils and adenoids can block the passage of airflow. A deformed nose, including septal deviations and enlargement of the turbinates that act as nasal radiators, can contribute to snoring. If snoring progresses to cause airway problems then sleep apnea, or cessation of breathing, can occur. The airways will close with relaxation of the muscles and only open again when the person awakes. This cycle can be repeated hundreds of times each night.
Sleep apnea is believed to be a culprit in the cause of high blood pressure, heart disease, strokes and blood clot formation. In addition, sleep deprivation from sleep apnea can contribute to poor concentration, diminished alertness, and severe fatigue. Many motor vehicle and heavy machinery accidents, along with poor school grades and work performance, are a result of sleep apnea.
In the past, treatments for snoring were dismissed as trivial and not medically important. Now, a number of possible options exist for those who suffer from snoring and sleep apnea. Weight loss, avoidance of alcohol, caffeine and sedatives are crucial. Dental devices to reposition the oral airway have had some success. An air compressor can be used to blow air through the nose and mouth via a mask to keep the airways open. Often, a more permanent solution is sought. Many times the correction of a nasal deformity and removal of any tonsil and adenoid tissue can be curative.
Since 1980, a procedure called a uvulopalatopharyngoplasty, or UPPP, has dramatically helped snorers and sleep apnea patients by removing a portion of the soft palate and uvula. Beginning in 1996, a revolutionary procedure called somnoplasty was devised to decrease the swelling in the soft palate, base of the tongue, nose and tonsils with a radiofrequency probe. This can be performed in the office under local anesthesia without any cutting or tissue removal. Excellent results have been seen with a number of these options which are performed by otolaryngologists.
Snoring is not a laughing matter. It can be treated. Anyone who snores or who knows someone who does should be evaluated. Avoiding the medical problems which can result from undiagnosed sleep apnea will be one of the major goals of 21st century medicine.

Paging Dr. Shapiro is written by Dr. Adam M. Shapiro, an ear, nose and throat physician in practice on St. Thomas and on staff at the Roy L. Schnieder Hospital. More information is available at the Virgin Islands Ear, Nose & Throat Web site. In writing this column, Dr. Shapiro made frequent reference to material published on the American Academy of Otolaryngology Web site.

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