Snorers without Significant Sleep Apnea
Patients in this category are NOT covered for surgical treatment of the throat (soft palate and base of tongue) by their medical insurance company as they are considered to have a socially significant but not a medically important problem. Medical treatment of snoring consists of avoidance of alcohol before going to sleep as this substance is a muscle relaxant that exacerbates snoring. Weight loss, if indicated, is helpful in some patients. A trial of nasal decongestants and dilators of the nasal valve (sinus cones and breathe-rite strips) is indicated. Please also see section on septoplasty/turbinoplasty and nasal valve surgery. Avoidance of sleeping on one’s back decreases snoring in many individuals as the tendency of the tongue to fall back and thus obstruct the airway is diminished. Medical devices such as CPAP (continuous positive airway pressure) and custom dental appliances may also be very effective for overcoming snoring. Other non-prescription (OTC) devices such as throat lubricants and neck pillows have been proven not to work.
Dr. Zemplenyi advises surgical treatment if conservative measures are not satisfactory. Nasal surgery, described under the section of septoplasty/turbinoplasty & nasal valve surgery, is beneficial for those patient who have decreased snoring with nasal decongestion with Afrin (oxymetazoline). In this case nasal surgery is covered by medical insurance while the snoring throat surgery is not covered by insurance. Dr. Zemplenyi performs a palatoplasty in patients who are found on examination to have a low-lying, prominent, soft palate and a long uvula (favorable anatomy). The goal of soft palate surgery (palatoplasty) is to stiffen the soft palate and thus to dampen the vibrations to reduce or to eliminate snoring. Stiffening of the soft palate can be achieved in a single procedure under local anesthesia by insertion of three Dacron pillars made by Restore Medical. The beauty of this procedure is its relative simplicity, reversibility and a relatively short duration pain and discomfort in most patients (usually less than three days following the procedure). Patients usually do not lose time from work. The success rate for reduction of snoring exceeds 80% in properly selected patients. At times Dr. Zemplenyi recommends a combination of pillar insertion along with shortening of the uvula. Additional stiffening of the soft tissues may be achieved with a radio-frequency devices and plasma coblation device (Arthrocare) that induces internal scarring and further stiffening of the tissues. This is similar but not the same technique as Somnoplasty. Same radio-frequency and coblation devices may also be utilized for volumetric reduction of the base of tongue thus further improving the patency of throat airway. Dr. Zemplenyi feels that laser-assisted palatoplasty produces too much post-operative pain and thus he does not use.