Transcription:
Snoring: It's More Common Than You Think

Melanie Cole: Do you snore? Of course, you don’t. Only other people snore, but if somebody told you that you do snore and you're not really sure what to do about it, my guest today is Dr. Ruwanthi Campano. She's an ENT and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show. What is snoring? Of course, none of us snore. It’s only other people that snore and we don’t even know what snoring is.

Dr. Ruwanthi Campano, MD: We purr actually. We don’t actually snore, at least women. What is snoring? Snoring is air that’s coming in and hitting tissue and then it causing it to vibrate. Snoring is what we call multifactorial. It can be caused by a variety of things that could vibrate in our upper respiratory system.

Melanie: We don’t always know if we snore, although some people can wake themselves up by snoring and you hear yourself and then you fall back asleep, but it’s really the partner who notices your snoring. One of my first questions here, is snoring the same as sleep apnea, because we've heard about sleep apnea?

Dr. Campano: No. A lot of people snore but not everybody has sleep apnea. Sleep apnea is a medical condition which is quite serious and has severe cardiovascular ramifications, but snoring is basically just loud, it’s going to bother your spouse, it’s going to bother the people on the plane, but you're probably happily sleeping and you don’t know. Sleep apnea is where you wake yourself up, you actually stop breathing at night and it triggers other things in your body and that has the medical complications. It’s really important to differentiate. If patients tell me and based on their anatomy when I'm examining them, I ask them about sleep apnea questions, which would be if you're very tired, you get eight hours of sleep and you still wake up really tired, if they are falling asleep at the wheel or they're having trouble concentrating or even high blood pressure. Certain medical issues are correlated with sleep apnea; obesity lends itself to sleep apnea, but if the tongue and a lot of the lower airway is floppy, that can give you sleep apnea. I've had patients weight 99 pounds who have sleep apnea based on their anatomy.

Melanie: Snoring is not really considered a medical condition. Is it something that needs treatment or is it something that you just push your partner and say ‘cut it out’?

Dr. Campano: It just depends on how extreme it actually is. There's heroic snoring where you can hear them through the door. I personally, and I'm sure my parents don’t appreciate me saying this, both of my parents snored heroically all of my life and the dog probably snored the most. If you are actually bothering your spouse, your spouse is not getting sleep and that’s going to cause big problems. They actually make houses with two master bedrooms because of how significant snoring is and a lot of times that spouse is banished to the sofa where they really don’t get any sleep. People wear earplugs and other things, so it is a significant marital issue a lot of times.

Melanie: What do we do about it? What would you say if some couple comes to you and the woman is saying his snoring is keeping me up at night and it’s making me want to divorce this man? What would you say would be the first best line of defense?

Dr. Campano: I usually do an exam and see what potential places where they have obstructions. I always say snoring is multifactorial. Air is coming and hitting tissue that vibrates, so I start with the nasal anatomy and if their nose is clogged and congested. Basically, if you can't breathe through your nose, you're going to open up your mouth and everyone would snore. There's a lot of different things you can do to open up the nose, you can use those Breathe Right strips, if you have allergies and congestion, there are medicated nasal sprays that are safe for you to use, there's allergy treatment, if your septum is deviated and you're very obstructed, I can open that up. I once prescribed a patient medicated nasal spray and his wife loves me, brought me chocolate for a while because she was so grateful that she was getting sleep at night. We then want to go further down, you can examine the palate – the thing that dangles from the back of your throat, the uvula, your soft palate – that can go and obstruct the airway. Air is coming in, hitting that tissue and it's going to vibrate. There are various procedures that can be done. I've done pretty much everything over the last 20 years that is possible; you can trim the uvula, you can use radiofrequency, you can use lasers to stiffen up the palate a lot of times so that does loosen up. My favorite treatment is the pillar implant. If your palate is the problem, it's made of PTFE, which is heart sensitive.  I implant it into the soft palate at the junction of the heart and the soft palate so it’s not like your palate is shaking in the wind anymore. They’ve done studies between three and five implants can be used across the entire palate.

You then want to address further down. The tongue is another component of the airway, and so that’s going to obstruct the airway. There are actually dental devices that will bring your jaw forward, which brings your tongue attached to it forward and that can also be used to help with snoring. Simple things – you can change your sleep position. If your tongue is obstructing the airway, you can sleep on your side. If you're overweight, there's a lot of extra tissue in the back of your throat, so losing weight can help. Avoiding things that'll make the palate floppy such as alcohol products and alcohol can also make the nose a little more congested. Getting good sleep hygiene. If you're someone who has erratic sleep patterns, get back to standard sleep patterns that would be of benefit. You can adjust your pillow. If you're elevated more, the flatter you are, your nose, your tissues and inferior turbinates will become more congested. Your tongue may occlude your airway, so if you elevate yourself, that can help. Overall, just staying hydrated and just being a healthy person would be of benefit.

Melanie: The pillow, you could elevate yourself a little bit more and that would help, so even if we see some of these beds on the market that elevate a little bit, that could actually help.

Dr. Campano: Absolutely. Those are fancy beds. I wish I had one.

Melanie: What else? Are there any medications? Is this something that once you’ve done some of these procedures that you’ve discussed, is this a permanent solution, or if someone snores on and off with some of these solutions, it could come back?

Dr. Campano: I think that most people who snore is going to be variable. I remember when I was dating my husband, he says it’s cute I purr sometimes and I apparently after we got married, he said when I have a cold, I snore. Luckily, it’s not every day so if my nose is congested when I had a cold or my allergies are acting up, then I'm more apt to snore because my nose is obstructed. I think that for most people, the snoring is intermittent. It’s going to be when you have a cold, when you're obstructed and those things, but there's a good majority of people and I say the percentage is about 45% of bed partners do complain that at some point in time, the partners do sleep. Some of the procedure may be a permanent procedure. Obviously, weight loss would be of benefit. The pillar implant would also be a permanent solution because it’s an implantable device and it doesn't dissolve. The dental device, if you use it, it’ll bring your tongue forward. Those are more permanent solutions. There are also surgical interventions. Sometimes, however, a lot of the things that we used to use a long time ago, injecting the palate with things that'll stiffen it up, that does loosen up with time. Those things were more of a temporary measure versus some of the implants and other things are more permanent. It’s just going to depend on you and your spouse. From personal experience, I know with my family that I always ask them ‘do you have sleep apnea’ and we did tests when they were younger, but no, they just snored really loudly, which was bothersome when we went on a trip because you knew you had to share a room. It depends on the family and it depends on your anatomy. I think the anatomy is really key. When patients come in, I have to do a really good head and neck exam so that I can see what's going on. If they have huge tonsils, they're more apt to snore, but they're also possibly more apt to have sleep apnea. The big thing is snoring is what we consider a cosmetic problem. It bothers your bed partners and other people, but it does not medically significant, except for irritation, and you might get poked. The sleep apnea is the serious thing, so there's ever a question, I always say ‘have a sleep study’ so we know the difference.

Melanie: Wrap it up for us with your best advice about sleep hygiene and snoring solutions and why they should come to Palmdale Regional Medical Center for their care.

Dr. Campano: Palmdale is an excellent hospital. It’s a beautiful brand new hospital. As far as why they should treat their snoring here is basically if you want to make your spouse happy a lot of times, you want to keep them happy, a happy wife, a happy life and the same thing with the husband, I think you'd probably want to treat the snoring. You want to address three basic sites; the nasal congestion obstruction, your palate – the thing that’s dangling in the back of the throat, the floppy area – as well as your tongue. Sometimes you just only need to address one thing as the cause of your snoring problems, but a lot of times, it’s all three sites. If you address those in a systematic fashion, you can go have a really good head and neck exam from an ear, nose and throat doctor and have that treated systematically. I think your spouse will be happier.

Melanie: Thank you so much for being with us today. What really great and such important information for listeners to hear. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.