Obstructive Sleep Apnea and Snoring

Sleep-disordered breathing includes a spectrum of disorders ranging from upper airway resistance syndrome or just snoring to obstructive sleep apnea (loud snoring, periods of breath holding, and daytime somnolence and chronic fatigue). Our goal is to identify the causes of the breathing disorder and then tailor an individualized treatment plan to address each patient's needs.

Over the past 30 years, as more and more has been discovered about sleep-disordered breathing, people who snore or experience apnea (breath holding) have been able to find relief. We now know that successful treatment of many diseases, including hypertension, diabetes, coronary artery disease, depression, obesity and even Alzheimer's require management of the patient's sleep abnormalities.

It is important to recognize that sleep disorder breathing is typically a multifactorial process. Good sleep hygiene and a healthy lifestyle, as well as stress management, are an integral part of optimizing one's sleep patterns. Specifically, if it is identified that there is an upper airway resistance and/or obstruction that is leading to your sleep issues, that also is often multifactorial and requires a comprehensive evaluation to develop management strategies.

One of the leading causes of Adult Obstructive Sleep Apnea (OSA) is obesity. Obtaining and maintaining a healthy body weight can drastically reduce and often eliminate OSA.

Anatomical factors that can lead to upper airway resistance and obstruction include:

Nasal airway blockage from nasal septal deviation and inferior turbinate hypertrophy (where the bony structures inside of the nose become swollen. )
Large/long Uvula
Redundant/flaccid palate
Enlarged tonsils
Large base of tongue
Small/retruded mandible (sunken jaw)
Neck soft tissue excess

Essentially upper airway obstruction can be anywhere from the nose to the neck. Often time it is in more than one location and to have good results multiple areas of obstruction will need to be addressed.

It is very important for you to have a comprehensive evaluation by Dr. Parhizkar if you are concerned about snoring and obstructive sleep apnea. Dr. P works very closely with sleep specialists and pulmonologists in the community to identify and treat the issues for optimal results.

If a surgical option is deemed appropriate for you, typically it is done in conjunction with other therapies to optimize your sleep. This may include weight-loss, changes in sleep habits and hygiene, as well as need for continued use of CPAP despite surgical intervention. Some patients will need breathing assistance using CPAP even after surgery.

We use a variety of methods, both surgical and medical, to treat patients with sleep apnea. For patients with snoring or mild apnea, we offer in-office procedures such as the Pillar Implant or somnoplasty to reduce airway obstruction and improve breathing. While many patients with sleep apnea are treated with use of CPAP (continuous positive airway pressure) via a mask, many are intolerant of CPAP. We therefore often use upper airway surgery to improve tolerance to CPAP and, for some patients, to eliminate difficult nasal breathing, snoring, or sleep apnea.

Scope of Surgical Options for Obstructive Sleep Apnea:

Nasal Airway blockage: Septoplasty (a surgical procedure done to straighten the nasal septum) and inferior turbinate submucosal resection (The inferior turbinate is a large structure that runs the length of the nasal airway and when enlarged can obstruct breathing)
Oropharyngeal: Pillar procedure (an in-office procedure to stiffen the soft palate and reduce the flutter that can cause snoring and sleep apnea)
Uvulopalatopharyngoplasty ("UPPP"—a surgical procedure used to remove tissue in the throat), tonsillectomy, tongue base reduction

The bottom line: Adult sleep apnea rarely has a simple solution. It is often a process that we need to work on together. Dr. Parhizkar can assure you though that she will work with you to improve your sleep, your health, and your quality of life.