Sleep Disorders & Snoring



Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep. More than 100 different disorders of sleeping and waking have been identified. Sleep disturbances produced by abnormal breathing patterns are termed sleep-disordered breathing (SDB). Snoring, sleep apnea and other sleep-related breathing disorders represent the most common sleep disorders seen in the outpatient setting.

Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea. Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of apnea (cessation of breath).

Various methods are used to alleviate primary snoring. They include behavior modification (such as weight loss), surgical and non-surgical treatments, and dental devices. Surgical treatments include: laser assisted uvulopalatoplasty (LAUP), an outpatient treatment for primary snoring and mild OSA that involves use of a laser under local anesthesia to make vertical incisions in the upper palate, shortening the uvula and lessening airway obstruction; and radiofrequency volumetric reduction of the palate, a relatively new procedure performed in an otolaryngologist’s office that utilizes targeted radio waves to heat and shrink tissue in the upper palate. If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or "CPAP". An oral appliance may also be an effective treatment option for people who prefer it to CPAP.

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur hundreds of times in one night. Most people with OSA snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens.The result is a fragmented quality of sleep that often produces an excessive level of daytime sleepiness. After many years with this disorder, elevated blood pressure and heart enlargement may occur, leading to heart attack, stroke, and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, weight gain, poor performance at work, failing personal relationships, and increased risk for accidents, including motor vehicle accidents.

Obstructive sleep apnea must first be diagnosed at a sleep center or lab during an overnight sleep study, or "polysomnogram." Our office refers to several sleep centers in the Northern Virginia area for your convenience.

CPAP is the standard treatment option for moderate to severe cases of OSA and a good option for mild sleep apnea. This airflow keeps the airway open, preventing pauses in breathing and restoring normal oxygen levels.

An oral appliance is an effective treatment option for people with mild to moderate OSA who are unable to successfully comply with CPAP therapy. Oral appliances look much like sports mouth guards, and they help maintain an open and unobstructed airway by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. Some are designed specifically for snoring, and others are intended to treat both snoring and sleep apnea. They should always be fitted by dentists who are trained in sleep medicine.

Surgery is a treatment option for OSA when noninvasive treatments such as CPAP or oral appliances have not been unsuccessful. It is most effective when there is an obvious anatomic deformity that can be corrected to alleviate the breathing problem. Otherwise, surgical options most often address the problem by reducing or removing tissue from the nasal passage, soft palate, uvula, tonsils, adenoids or tongue. More complex surgery may be performed to adjust craniofacial bone structures. Surgical options may require multiple operations, and positive results may not be permanent.

One of the most common surgical methods is uvulopalatopharyngoplasty (UPPP), which trims the size of the soft palate and may involve the removal of the tonsils and uvula. Adenotonsillectomy, the surgical removal of the tonsils and adenoids, is the most common treatment option for children with OSA. Other children with sleep apnea may benefit from CPAP.

Our Offices: Fairfax · Reston · Chantilly Phone: (703)383-8130 Fax: (703)383-7350