Snoring Homeopathic Cure

Exercises To Completely Cure Snoring

Christan Goodman is an expert on many topics and he will teach you how you can stop snoring and sleep apnea for good. He has this program that treats the root cause of the problem and by doing that, you will finally have the freedom and the happiness you always wanted. The program will give you a quick diagnosis on your case of snoring along with an explanation of how the snoring starts to develop in the first place. Additionally, you will be given the one way that everyone can fix their apnea. The program has corrective exercises and breathing techniques that take as little as three minutes per day. The power of the stop snoring program is that it can fix your snoring literally the very day you start doing these exercises. Although one day will not permanently stop the sleep apnea and snoring, a few days of the three minutes per day program sure will. After that, you will finally be able to experience the joy of sleeping with your partner without having to annoy them or wake them up at night. Anyone can do this program since it has easy language and directions that you can't get lost in, all of this is done so you can finally have your first peaceful night today. More here...

Exercises To Completely Cure Snoring Summary


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Associated Medical Findings

The physical examination in a patient with a suspected sleep disorder focuses on several features. To assess for physical abnormalities associated with obstructive sleep apnea, particular attention is directed toward examination of height, weight, and blood pressure. Abnormalities of the upper airway, including enlarged tonsils, tongue, or low palate, can indicate possible airway obstruction. A reddened uvula and palate may be associated with loud snoring. Retrognathia and a small pharyngeal opening may also be seen in patients with sleep apnea.

Basic Principles and Technique

Disorders of sleep are common and often respond well to treatment. Polysomnography is important in diagnosing and characterizing such disorders. It involves recording the EEG on two or a few channels to characterize the stage of sleep while recordings are also made of eye movements, mentalis muscle activity (chin EMG), electrocardiogram, respiration, and oxygen saturation. Respiratory movements are recorded by measurement of air flow through the nasal passages and the mouth using thermistors and by recording thoracoabdominal excursions with surface electrodes. Oxygen saturation is measured using an ear oximeter. A microphone can be taped to the face to record snoring.

And Preoperative Evaluation

UPPP can reduce or eliminate the snoring sound of the so-called velum snorer. But it is not that easy to recognize with certainty the velum snorer. Clinically, the velum snorer displays characteristic anatomic traits of the soft palate, such as The velum snorer is especially distinguished by a snoring sound characterized by a base frequency of 25-50 Hz and a multitude of overtones, which results in a regular and harmonic sound pattern 30 . UPPP has no effect in the case of a tongue base snorer, whose nighttime respiratory sounds are characterized by loud, hard, metallic, nonharmonic snoring with frequency between 1,100 and 1,700 Hz. Examination of patients with possible velum snoring 29 involves the following history-taking with standardized or validated questionnaires for profiling risk symptoms and daytime sleepiness otorhinolaryn-gological status including orthodontic status of occlusion situation, staging after Friedman et al. 8 for ton sils and tongue position testing the...

Postoperative Care

Intraoperatively an intravenous single-shot antibiotic with 2 g cefazolin is administered otherwise, antibiotics are only used in cases of relevant inflammatory complications. In patients with a history of oral aphthous ulcers, a virostatic is applied. The severe pain occurring in almost all of the patients in the first postoperative days is treated with diclofenac suppositories, and later with tablets. Apart from aspirin, there is no significant increased risk of postoperative bleeding for nonsteroidal anti-inflammatory drugs, as recently published in a meta-analysis 23 . In most cases, postoperatively, there is a remarkable edema of the uvula stump which can even enhance postoperative snoring. The patient should know this. During the first postoperative day, the patients are fed via infusion, and take in tea and ice cream, as in the case of a tonsillectomy. Most patients are also able to swallow liquids, albeit under pain. From the second day, they receive a special tonsillectomy...

Upper airway resistance syndrome UARS

The UARS affects males and females equally frequently. UARS is more frequent in the non-obese than OSA and it is uncertain whether it is simply a phase which occurs between simple snoring and the appearance of sleep apnoeas or whether it is a separate 'variant' of abnormal upper airway behaviour which does not change despite, for instance, increasing age or weight.

And Objective Symptom Elimination

Subjective success is based on comparative improvement in snoring level, daytime sleepiness, and overall well-being. Patients who underwent ZPP were compared with patients who had previously undergone UPPP for the treatment of OSAHS. The results achieved were far superior with ZPP, particularly with adjunctive TBRF. Quality-of-life scores improved significantly more often after ZPP than after UPPP 4 . When focusing on objective success, ZPP showed considerable improvement over UPPP. Objective cure rates for stage II patients treated with ZPP and TBRF were close to 70 , compared with about 30 for classic UPPP with TBRF. The treatment, like any other, may fail. Failure can be defined as a persistence of symptoms, which demands additional treatment. Failure also occurs when symptoms of snoring and daytime sleepiness are eliminated, but polysomnography scores still indicate persistent disease. Typically, patients who fail will show a pattern of elimination of apneas, with persistent...

Natural history of obstructive sleep apnoeas in adults

OSA is usually preceded by many years of stable snoring which then worsens gradually or sometimes quite rapidly before the symptoms of OSA become prominent. Weight gain may accelerate the deterioration at the time that OSA is evolving from simple snoring. Snoring which can be reliably dated to childhood and which is still a problem in adult life is often due to enlarged tonsils or a skeletal abnormality of the face or mandible. Occasionally, OSA arises suddenly in adult life, in which case it is usually due to an identifiable event such as a stroke or facial injury, or to the development of a contributory disorder such as hypothyroidism. Nocturia, early morning headaches due to hypercapnia, and features of right heart failure develop late in the natural history of OSA.

Obstructive sleep apnoeas and gender

Obstructive sleep apnoeas, upper airway resistance syndrome and snoring are all at least twice as common in men as in women. The risk in women is five times greater after the menopause and twice as great while taking hormone replacement treatment, compared to before the menopause.

Indications and Contraindications

We recommend an extensive clinical evaluation pre-operatively with the help of rigid endoscopy and polysomnography. We see no primary indication for the hyoid suspension for primary snoring except in cases where the snoring problem is severe or an alternative operation did not succeed or in cases with an en-doscopic diagnosed retrolaryngeal stenosis.

Obstructive sleep apnoeas in children

The most common clinical features are snoring-like noises during sleep associated with observation by the parents or carers that the child stops breathing and is a restless sleeper 31 . Unusual sleeping positions may be adopted and there may be enuresis. Excessive daytime sleepiness is unusual, but behavioural disturbances during the day are frequent, and include irritability, hyperactivity, aggression, poor school performance with problems with reading and visual attention, and rapid mood changes. Impulsivity may be sufficient to lead to an initial diagnosis of attention deficit hyperactivity disorder (ADHD). There is often

Obstructive sleep apnoeas in the elderly

Snoring is less commonly reported in the elderly, possibly because of the partner's deteriorating hearing, because the partner is in a separate bed or bedroom, or because the snorer lives alone. Obstructive sleep apnoeas, however, appear to become progressively more common in older age, although over the age of 60 the gender difference between males and females is less than in younger adults and obesity is less important. The familial association of OSA persists into old age. In women there is an increased prevalence of OSA after the menopause.

Sleeping on the side rather than in the supine position

'Postural' or 'positional' treatment is difficult to maintain 34 . This type of treatment is said to lead to a conditioned reflex whereby the lateral position is maintained, but there is little evidence for this. Sleeping with a pillow wedged under the shoulders to prevent returning to the supine position is preferable to fixing a ball, foam or similar object into the back of the nightclothes since this causes arousals from sleep each time the supine position occurs 35 . Equipment which delivers an electric shock when it detects a snoring sound works on similar principles and has similar disadvantages.

Clinical features

The complaint of snoring almost invariably comes from a listener, usually the bed partner of the patient (Table 10.6). The complaint usually reflects the degree of sleep disruption or dissatisfaction of the partner and varies according to the partner's arousability from sleep by the noise and the presence of any insomnia. Snoring can lead to significant sleep disruption with excessive daytime sleepiness and frustration and anger in the partner. This may be expressed by repetitive physical attempts to wake the snorer who may then become secondarily sleep deprived and feel guilty about the sleep disruption that the snoring is causing to the partner. There is no evidence that snoring causes noise-induced deafness either in the patient or in the partner. The volume of the snoring varies considerably between patients and during any one night. The pitch of snoring generated at different levels in the upper airway can be recognized by the experienced listener. A stridor-like sound usually...

Treatment of the patient

These are similar in principle to those for OSA, but upper airway surgery is usually more effective because the site of snoring is often more localized than the site of obstruction in OSA. Mandibular advancement devices may be useful, but nasal CPAP is less frequently required than in OSA and wakefulness promoting drugs are not indicated. Upper airway surgery. It is essential that a sleep study is performed before surgery is contemplated to assess whether OSA are sufficiently frequent to be a contraindication to surgery. Localization techniques may also be useful. Surgery should not be recommended unless first-line treatments, in particular weight loss, have been attempted and is only indicated if snoring is sufficiently troublesome to the listener or has the potential to be so for a future partner. The snorer should be aware that there will be no direct personal benefit from surgery and there are risks with all the procedures. These include Palatal surgery is initially effective in...

Children from 4 to 10 Years

Children who start to snore or get worse between 4 and 10 years of age usually have large tonsils as a result of subclinical or clinical infections or owing to a genetically narrow airway and a normal physiological hypertrophy of Waldeyer's ring. The adenoid is still present, but usually diminishes in size before the age of 10 years. Primary enuresis and oral motor dysfunction can be the symptoms, in addition to the snoring and sleep disturbance. At the age of 4 years, there can be bite aberrations which can be related to the oral posture 17 . The earlier the condition is relieved the better is the prognosis for maxillofacial development 8 .

Determination of Obstruction Level

Determining the level of obstruction is the most important key factor in the success of the surgical treatment of OSA. UPPP and more aggressive modifications cured snoring in most patients, but polysom-nographic data showed that a few of them still had higher apnea scores. Studies aimed at defining factors that influence the outcome of palatal surgery in order to eliminate the nonresponder group preoperatively. These studies showed that the main reason for failure after UPPP is the presence of obstructive anatomy other than at the retropalatal level, mainly the tongue base. Fujita 13 introduced a classification of the pre-operative physical examination according to the level of obstruction and proposed that patients with type III (hypopharyngeal only) obstruction were poor re-sponders to UPPP. Muller's maneuver was proposed as a more reliable method of evaluation by simulating the collapse of the upper airway, but later results showed lower sensitivity and specificity 23 .

Evaluation of Polysomnography

Surgical techniques for OSA aim to correct airway obstruction in two main sites retropalatal and or ret-rolingual. Success rates of UPPP alone in all patients are significantly lower than those of tracheotomy or CPAP. Early modifications of UPPP with aggressive tissue resection were suggested to achieve better results, but these were associated with increased complication rates instead of success 53 . Electrosur-gery, laser-assisted uvulopalatoplasty, radiofrequency and use of chemical agents were suggested for palate operations, as consequences of advanced technology 5, 21, 28, 39 . Instead of providing better results than UPPP, most of them tried to attain the success of UPPP, and have been recommended for snoring and mild OSAS only. It appears that multilevel and staged surgery provides the best surgical results in patients with OSA 40 .

Technique of Sedated Endoscopy

Sedation is gradually initiated. With the onset of snoring, the rhinolaryngoscope is inserted. This usually results in mild arousal which quickly reverts back to a sleep state. At this point mechanisms and locations of snoring may be observed. Placement of the endoscope is best in the smaller nostril if possible to allow the placement of the nasal airway into the larger nostril in step 5.

Indications and Contraindications for Isolated UPPP

Velum snorer with airway obstruction at the level of the soft palate by redundant tissue Velum snorer on the basis of analyzing snoring noises None or minor daytime sleepiness Primary snoring, mild OSA AHI 25 For moderate or severe OSA as part of a multilevel surgery concept Contraindications are Chronic heart and or lung diseases Neurological psychiatric illnesses in need of treatment

Long Term Effectiveness of UPPP for SDB

Eight groups of authors reported on long-term results after UPPP for primary snoring in 868 patients with follow-ups between 1.5 and 10 years 12 . No snoring was found in 29.8 of patients, reduced snoring in 43.1 , no change in 29.4 and worse snoring in 8.1 . Combining the values for snoring reduced and no snoring results in a long-term success rate of 73 for isolated UPPP in the treatment of primary snoring. But these data have to be considered with caution, owing to the fact that the diverse evaluation criteria are extremely heterogeneous. Accordingly, the success rates vary in the cited studies between 44 and 91 . Six of the eight studies were retrospective, one evidence-based medicine (EBM) grade II-2 and one EBM grade II-3.

Training Upper Airway Sleep

Locations Upper Airway Mass

Snoring OSA osa OSA Nasal surgery seldom affects the severity of OSA and is of use only in those patients with primary snoring 25 . Nevertheless nasal surgery is indicated as adjuvant therapy especially to facilitate a nasal ventilation therapy. The following procedures should be limited to simple snorers as up to now there are no published data available documenting any efficiency in the treatment of OSA laser-assisted uvulopalatoplasty, palatal implants, cautery-assisted palatal stiffening operation, and injection snoreplasty. As well, there are no sleep studies showing a reduction in AHI after radiofrequency treatment of the tonsils. Admittedly, a substantial reduction of the tonsillar volume has been documented. From knowledge that tonsillecto-my is an effective treatment for OSA, there might be enough evidence to assume that radiofrequnency surgery of the tonsils is effective also. - Desire for treatment in simple snorers In the case of pediatric SDB both conditions, namely, OSA...

How to Examine a Child with Suspected OSA

Of breathing obstruction, although a genetic-component most often also exists. Look at the accompanying parents and ask about their snoring history in childhood and later. However, if the history suggests severe disease or you do not find large tonsils or an occluding adenoid pad, partial polysomnography is necessary to verify the condition. In some cases, the sleep study is therapeutic as you can calm the parents that the child's breathing is normal despite some snoring. In all cases where preoperative polysomnography has demonstrated apneas hypopneas and or oxygen desaturation, a control postoperative polysomnography should be performed. All parents should also be informed that during further growth and development of the child, snoring and apnea may reoccur and in that case the

Sleep Disorders Classification

Sleep disorders within the isolated symptoms category include long sleeping, short sleeping, snoring, sleeptalking, sleep starts (hypnic jerks), benign sleep myoc-lonus of infancy, hypnangogic foot tremor and alternating leg muscle activation during sleep, propriospinal myoclonus at sleep onset, and excessive fragmentary myoclonus. Sleep disorders that cannot be classified elsewhere are assigned to the final category, other sleep disorders. These include physiological (organic) sleep disorders and environmental sleep disorders.

Nasal continuous positive airway pressure CPAP and bilevel pressure support

Some autotitrating CPAP systems sense vibrations similar to those which lead to snoring. Others detect airflow limitation from a flattening of the pressure profile, or using a forced oscillation technique in which small pressure oscillations are applied to the mouth and any increase in impedance indicates narrowing of the airway. All these techniques have limitations and may lead to inaccuracies associated with the subject being awake rather than asleep at night, mouth leaks, central sleep apnoeas or the presence of significant lung disease or cardiac failure. Symptoms. Symptoms both during the night and during the day improve within one or two nights and the improvement is virtually complete within around two weeks. Excessive daytime sleepiness improves both subjectively and objectively. The reduction in snoring and nocturnal restlessness often improves the partner's sleepiness as well. Mood changes, difficulty in concentrating and other cognitive problems usually resolve. The risk...

Neurological Examination

Specific attention to pontine cranial nerve function (trigeminal, abducens, facial, and vestibulocochlear) are essential. Bulbar dysfunction in the form of dysphagia, hoarseness, and dyspnea can occur in neuromuscular disorders and myopathies. In checking for the gag reflex, the upper airway can be examined, and a reddened palate and uvula are suggestive of snoring.

Indications and Patient Selection

Medical evaluation of disorders that may include symptoms of snoring, excessive sleepiness, or nocturnal choking To better treat current and future patients, prior surgical techniques should be evaluated. Errors may be in diagnostic assessment or in surgical technique. Procedures that create a scar will improve snoring but may do so at the expense of narrowing the airway and worsening sleep apnea. Stenosis is an almost certain result of excessive removal of pharyngeal mucosa. Current experience indicates a larger more open airway requires more mucosa not less to remain patent. Technical failure may also be intrinsic to the proce Accurate diagnosis is important in selecting additional surgery. Endoscopy during nonsedated sleep, sedated sleep, and quantitative sedated sleep has been used as both clinical and research tools 8 . Improved surgical success rates have not been associated with many of the subjective methods described to predict success of palatal surgery for sleep apnea....

Mandibular advancement or positioning devices

These devices rarely completely abolish snoring, but may significantly improve mild to moderate obstructive sleep apnoeas. A reduction of the apnoea-hypopnoea index to less than 10 per hour is usually taken as a successful outcome. A reduction of around 50 of the number of sleep apnoeas is achievable in around 50 of those with sleep apnoeas. Improvements in daytime sleepiness, memory and ability to learn have been demonstrated with mandibular advancement devices. Localization techniques, such as sleep nasendoscopy, have been used as a predictor of response to this type of treatment, but there is little evidence regarding their value.

The Goal of Surgery in Children with OSA and the Methods Used

The goal of surgery in children with OSA is to increase the diameter of the upper airway in order to decrease the tissue collapse by the Bernoulli effect and thereby resolve snoring and other obstructive symptoms. The surgery should always allow for normal future growth and development. 1. Snoring and sleep apnea in children may primarily be caused by Stuffed nose (infections, allergy, foreign body) 9. Different combinations of all the above conditions Snoring and sleep apnea may cause

Noisy breathing in sleep

Sleep apnoeas usually follow many years of loud snoring and are associated with a change in the pattern of the noise. At the end of the apnoea the airway snaps open with a loud snorting or similar noise. The variety of irregular snoring noises indicates how many different patterns of hypopnoea, apnoea and arousal can occur. Acoustic frequency analysis of these noises shows them to be distinct from simple snoring, and a stridor-like character suggests that the obstruction is arising at laryngeal level. Noisy breathing during sleep can be confused with asthma or stridor, and in children with grunting.

Normal Sleep Architecture And Sleep Stages

An individual's sleep can be recorded via an overnight polysomnogram (PSG). Some of the most commonly measured variables include electroencephalography (EEG), electrooculography (EOG), electromyography (EMG), electrocardiography, respiration, oxygen saturation, snoring, and body position (Fig. 2). To score the various stages of sleep, an epoch of sleep, or a 30-second

Upper Pharyngeal Airway Surgery

Redundant Tonsillar Pillar

Ment of patients with OSAHS has an overall success rate of approximately 40 40 . For patients with primary snoring, the success rate is higher, although snoring may to some degree recur over time 27, 50 . An uvulopalatal flap was considered as an alternative procedure to pharyngeal reconstruction to reduce the risk of nasopharyngeal insufficiency and postoperative pharyngeal pain 41 . Patients with a long uvula or a thick palate are not good candidates for this technique. Transpalatal advancement pharyngoplasty has been proposed as an alternative to UPPP 57 . minimal and the results for snoring and OSAHS were shown to be similar to those for other procedures 22 . TCRVF is now frequently called radiofrequency interstitial thermotherapy technique (RFITT), eliminating the notion of true volumetric tissue reduction, which is difficult to demonstrate in MRI studies. A randomized, placebo-controlled trial on radio-frequency surgery of the soft palate in the treatment of snoring showed that...

Treatment of the partner

It is important that the partner is aware that the snorer is not generating the noise voluntarily and reassurance about the absence of health risks to the snorer may be of help. The partner may be able to sleep better if he or she falls asleep before the snorer, and protection in the form of ear plugs or similar equipment may be useful. If these measures are ineffective and the snoring cannot be treated, an alternative is for the snorer and partner to sleep in separate bedrooms. Hypnotic drugs are occasionally taken by the partner to minimize the sleep disruption caused by the snoring, but are inadvisable as long-term treatment.

For Sleep Related Breathing Disorders

Isolated use of hyoid suspension is rare since it is almost always performed as part of the multilevel surgery concept for patients with OSA. Currently, no published data exist in regard to its usefulness for primary snoring. Only Riley et al. 8 presented their results after an isolated hyoid suspension. In a group of 15 patients with diagnosed OSA, they found a reduction of the AHI from 46.9 to 21.3 postoperatively with a success rate of 53.3 . In another study we evaluated the discomfort and side effects associated with this surgical concept 1 . Between November 2001 and June 2004, 102 patients with OSA and or with laryngeal stenosis, who were all treated with a hyoid suspension in combination with surgeries at the base of tongue, the soft palate or the nose, were included in this study. Patients completed a questionnaire concerning their discomfort and snoring sensation at 1 month postoperative-ly. A reduction in snoring to a level which was tolerated by the bed partner was...

Location of sleep

The environment in space reduces the gravitational effect on the structures in the upper airway. This reduces the upper airway resistance during sleep. Snoring and sleep-disordered breathing are less likely and there are fewer respiratory arousals during sleep as a result. There is also a reduction in respiratory frequency and heart rate before sleep and in the latter during stages 3 and 4 NREM sleep. The extent of excessive daytime sleepiness is approximately proportional to the barometric pressure, especially at depths greater than 200-300 m. The increased gas density leads to a sensation of nasal blockage which causes awakenings from sleep. Snoring and obstructive sleep apnoeas are more common than at sea level. There is also an initial polyuria which interrupts sleep and is due to haemodynamic changes.


Population surveys have indicated that EDS is associated with sleep deprivation, snoring and hypnotic use, and is commonest in young adults, shift workers and the elderly. Excessive daytime sleepiness has been documented to occur in around 5 of the adult population in developed countries, but the prevalence varies according to its definition.


Powell et al. 12 reported that the UPF procedure provided the same anatomical and clinical results as UPPP. Postoperative snoring determined by subjective measurement was similar in both procedures. A positive correlation between improved snoring and repositioned tissue was evident. UPF was performed as a one-stage surgery for snoring. In one study 10 , the UPF success rate for snoring was 88 (49 of 56 patients). This demonstrated a significant improvement in the snoring index (245.8 versus 42.5 events per hour) and the percentage of sleep time spent in loud snoring (10.2 versus 3.8 ). It also appeared that the changes in both parameters correlated significantly with changes in the subjective perception of the disease.

Results Outcome

There have been a handful of articles showing fairly good results achieved with this procedure. Brietz-ke and Mair 1 first described this technique in 27 patients, using the sclerosant Sotradecol (STS). Twenty-five (92 ) of the 27 patients reported a subjective decrease in their snoring and were satisfied. There were no significant complications documented. Levin-son 5 demonstrated similar results with this procedure. Lon- term results up to 19 months were evaluated by Brietzke and Mair 2 , who showed that the subjective reduction in snoring decreased from 92 at 3 months to 75 at 19 months, and the snoring relapse rate was 18 . Other sclerosants were also investigated by Brietzke and Mair 3 , including ethanol, doxy-cycline and hypertonic saline. They observed that the There is one nonrandomized prospective study that was done on 70 simple snorers comparing the efficacy of radiofrequency ablation versus injection snoreplasty 4 . A subjective improvement was reported in 87.5 of the...

Sleeping position

The effect of position on OSA is most apparent in younger adults with mild or moderately severe OSA. It is less important in obesity, presumably because the excess fatty tissue surrounds the airway and causes apnoeas in any position. Neck flexion and opening of the mouth also increase the upper airway resistance and contribute to apnoeas and snoring.


5 What is the cause of any upper airway obstruction Has the subject gained weight or increased their collar size Are there symptoms of nasal obstruction Does the subject smoke, drink alcohol, take any medication and are there any problems with sleep hygiene leading to sleep deprivation Is there any significant medical history, for instance, of facial or nasal injury, or of a neuromuscular disorder which might induce laryngeal obstruction Has previous surgery for snoring been carried out on the upper airway Snoring and snorting at night, usually with observation

Sleep study

Low clinical probability for OSA Excessive daytime sleepiness, but with no known snoring or risk factors such as obesity, is an example. A simple screening study such as oximetry, possibly with monitoring of chest wall movements or the pulse transit time, may be sufficient to exclude OSA and to suggest whether or not there is a non-respiratory cause for excessive daytime sleepiness. Intermediate and high clinical probability for OSA Snoring with observed apnoeas and excessive daytime sleepiness is an example. Confirmation of apnoeas or paradoxical rib cage and abdominal movements, or desaturations, is required. Oximetry, ideally with a chest wall movement detector and airflow sensor, provides this information. The frequency of arousals can be assessed either from heart rate or from pulse transit time variations. Excessive daytime sleepiness with snoring plus symptoms of the restless legs syndrome is an example. Polysomnography is advisable to evaluate the relative contributions of...


Nearly all patients tolerated the discomfort and side effects of hyoid suspension in the context of multilevel surgery for the treatment of OSA. The majority of the patients reported reduction of their snoring, and despite the associated discomfort and temporary speech difficulties they would consider undergoing this procedure if they had to start all over again. Further studies are needed to estimate long-term success rates of hyoid suspension used alone or in the context of multilevel surgery. 4. H rmann K, Maurer JT, Baisch A. (2004) Snoring sleep apnea - The success of surgery in German . HNO 52 807813. 5. Li KK. (2003) Hyoid suspension advancement. In Fairbanks DNF, Mickelson SA, Woodson BT (Eds). Snoring and obstructive sleep apnea. Lippincott Williams & Wilkins, Philadelphia 3rd edition pp. 178-182.


Children snore when their upper airways are too narrow with lower than usual negative pressures secondary to a Bernoulli effect. When these patients have sleep-related muscular hypotonia, the breathing will cause audible vibrations. As in adults, the most common anatomy that contributes to the snoring sound is the soft palate and uvula. The level of obstruction in patients with apneas is usually at the level of the base of the tongue. Children who snore at birth or before the age of 1 year usually have some congenital anatomical obstruction as a part of a congenital syndrome such as Pierre Robin syndrome, or are abnormally muscular hypotonic as in Down syndrome. When the snoring sound and apneas are produced in the laryngeal entrance, laryngomala-sia is included in the differential diagnosis. Snoring and apneas in an infant always requires special investigation including polysomnography.


Snoring in infants does not necessarily cause loud noise small children do not have the volume of muscles and size of the lungs which are necessary for strong sounds. The most prominent symptom is, however, snoring in combination with oral breathing. The open mouth posture may in the long run cause abnormal development of the maxilla and mandible owing to the muscular influence and bite aberrations, since the tongue in the closed mouth normally acts like a mold for facial development 20 . When snoring becomes an effort, the child usually also develops increased daytime sleepiness, which is very often noticed as an increased difficulty in concentration and hyperactivity. Primary and secondary enuresis is common, and for very small children, a noticeable failure to thrive (which means low increase of length and weight irrespective of eating habits) because of influenced output of growth hormone during the disturbed sleep. The children are usually also slow eaters and have a poor...


During this period, children who were adenoidecto-mized in early childhood may start to snore again. This often begins in connection with an acute throat infection (strep throat or mononucleosis), but they then continue to snore after the acute situation has been resolved. Recurrent infections are more common than among younger children and the obstruction OSA is usually a major problem only during these occasions. The parents are not bothered by the snoring as much since the youth sleeps alone. Daytime sleepiness is common, but may be related to several other reasons. Friends are commonly the ones who complain about the snoring during camp stays or stay-overs. The maxillofacial development progresses up to puberty. If an open mouth posture has existed up to that time, the bite aberrations may be severe 6 . It is important that the orthodontists who treat the children address the snoring and breathing problems and that they do not only try to correct the bite. Distraction or expansion...

Sleep Disorders

Sleep-related breathing disorders are the most common diagnoses made in sleep centers. Based on a random sample of 602 employed people between 30 and 60 years of age, Young et al. (1993) estimated that 4 of men and 2 of women meet diagnostic criteria for sleep apnea syndrome. Obesity, large neck circumference, and hypertension are associated with sleep apnea. Most patients are loud snorers and are sleepy during the day, although these complaints often come from family members rather than the patients themselves. The cause of sleep apnea appears to be susceptibility of the upper airway to collapse during inspiration when muscle tone decreases with sleep onset. The most common treatment for sleep-related breathing disorders is continuous positive airway pressure (CPAP) delivered by a mask over the nose. Patients are titrated during polysomnography for the minimum pressure that resolves apnea, eliminates snoring, and improves the sleep pattern. Regular use of CPAP usually improves...


Although the symptoms are resolved after surgery, the parents should be informed that there is a risk that the snoring, apneas and other symptoms may recur and if this occurs they should again contact a physician. If the original surgery has not accomplished transition to nasal breathing, there is risk that negative maxillofacial development continues with recurrence of symptoms, either in the teens or in adulthood. The child who continues to have predominantly oral breathing should be evaluated with respect to additional treatment of rhinological problems (allergy) or be referred to an orthodontist, even if the snoring and apneas have improved after primary surgery. After isolated adenoidectomy, hypertrophied tonsils may contribute to worsening snoring and disturbed sleep. This problem can partly be avoided if partial resection of the tonsils is performed routinely with adenoidectomy.


Cause decreased and disturbed sleep with suppression of REM sleep. Antipsychotic drugs with sedative effects can cause decreased sleep latency, increased total sleep time, and improved sleep continuity. Firstgeneration antihistamines (H1 antagonists) might produce daytime sleepiness and worsen OSA symptoms. This effect can be avoided by replacing them with second-generation antihistamines. Some anti-depressant drugs have sedative effects. Sedative and hypnotic drugs can worsen sleep apnea, as does alcohol consumption. -adrenergic blockers may cause daytime sleepiness owing to fragmentation of sleep, while a-adrenergic agonists, such as methyldopa and clonidine, may cause sedation. All stimulants, such as caffeine, theophylline, amphetamine, and cocaine, increase wakefulness and withdrawal of these agents may produce severe hypersomnia in chronic use. Alcohol consumption can increase snoring and worsen sleep apnea. It is also a major cause of sleep disruption. Always consider alcohol...

Patient Selection

Sleep or sedated endoscopy may allow the identification of obstruction and collapse during simulated sleep when muscle tone is decreased 5 . Although, this method has produced valuable information in the pathophysiology of SRBD, its clinical application in the selection of patients is more questionable especially for patients with primary snoring, but it may help in the decision-making for patients with OSAHS with multiple sites of airway obstruction. Clinical assessment and airway evaluation for the surgical treatment of patients with SRBD is thus evolving. The current algorithm on the general management of the SRBD patient is given in Fig 48.3.

Results Outcomes

It was first demonstrated in 12 patients with mild OSA (AHI 15), by Ho et al. 4 that palatal implants are safe and effective in reducing the snoring intensity and daytime sleepiness after 3 months after surgery. Nordgard et al. 7 showed in 35 patients that the mean subjective reduction in snoring intensity was 51 , with improvement in excessive daytime sleepiness as well. The longest follow-up in patients with the implants was documented at a 1-year follow-up period 6 . The authors found an encouraging reduction of snoring and daytime sleepiness however, there was a high extrusion rate of 25 (ten out of the 40 patients) 6 . Skjostad et al. 8 revealed that stiffer implants had no advantage over the regular implants used, and that stiffer implants had higher extrusion rates than the regular implants. The largest series was reported by Kuhnel et al. 3 , in which 106 primary snoring patients showed im- pressive subjective reduction in snoring intensity and daytime sleepiness. Previously,...

Sleep and obesity

Sleep disorders may affect the bed partner, family, friends, carers and even neighbours in addition to the patient. The partner may become concerned because of the implications of the sleep disorder, especially when the patient stops breathing, as in obstructive and central sleep apnoeas and Cheyne-Stokes respiration, appears to choke and makes sudden vigorous movements, as with epilepsy and REM sleep behaviour disorder, and if there is a possibility of injury while sleep walking. Snoring and abnormal movements during sleep due to, for instance, the restless legs and periodic limb movements may fragment the partner's sleep and cause a significant degree of excessive daytime sleepiness. Severe insomnia at night or sleep reversal can also put considerable strain on the family and carers, particularly if the patient also becomes confused at night and wanders from the bedroom. The presence of a bed partner can also modify the patient's sleep and sleep complaints. The partner's snoring,...

Physical examination

The weight and neck circumference, examination of the nose and pharynx and the presence of retro-gnathia are relevant to snoring and obstructive sleep apnoeas. Ground-down teeth are a feature of brux-ism, and evidence of physical injuries, which might be either the result of a motor abnormality in sleep or the cause of the sleep disorder, should be sought.


Snoring is due to vibration of the tissues of the upper airway, usually during inspiration but occasionally during expiration or both. Unlike OSA there is no interruption of airflow into the lungs since the closure of the airway is at most only momentary and is not sustained throughout one or more inspirations. The noise of snoring is generated by turbulent flow in the column of air in the upper airway. Vibration of the upper airway can occur at any level down to the larynx but usually involves the soft palate, base of the tongue and posterior pharyngeal wall. There is no cortical or autonomic arousal from sleep during simple snoring since the work of the inspiratory muscles does not progressively increase as in OSA and the upper airway resistance syndrome.


3 Why does the subject wake up What is it that he or she is aware of on waking Is there awareness of snoring, choking, vivid dreams, panicking, or symptoms such as headache, wheezing, a need to micturate, pain or discomfort What does the subject do after waking Are there any intrusive thoughts or does environmental noise prevent sleep from starting again How long does the awakening last

Sleep Apnea

Sleep apnea is a breathing disorder in which there are breathing interruptions during sleep. Apnea means want ofbreath in Greek. There are two types of sleep apnea central and obstructive. Central sleep apnea occurs when the brain fails to send the appropriate signals to the breathing muscles that cause you to breathe in and out. More common, however, is obstructive sleep apnea. This occurs when air cannot flow in or out of your nose or mouth. This can be linked to a growth or tumor in the neck or throat area such as a goiter (see Chapter 7) or a large thyroid nodule. In other people, apnea is the result of throat and tongue muscles relaxing during sleep, which can partially block airways. Obesity (see Chapter 16) can also lead to apnea, as an excess amount of tissue can narrow breathing airways. Signs that you may have sleep apnea are persistent loud snoring at night and daytime sleepiness. Frequent long pauses in breathing during sleep, followed by choking and gasping for breath,...

Quit Snoring Now

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