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Snoring

August 21, 1998

SnoringBy KATE COLEMAN / Staff Writer

photo: RIC DUGAN / staff photographer [enlarge]




"We've been married for 27 years, and for 27 years I haven't slept," says Maryann Fisher.

She doesn't have insomnia.

She has a husband, Bob Fisher, who snores.

Snoring frequently has been an easy way for comics to get a laugh.

"It's funny sometimes," says Dr. Shaheen Iqbal, a Hagerstown physician whose specialties include sleep medicine.

But sometimes it's not so funny.

--cont. from lifestyle--

Bob Fisher's snoring turned out to be more than an annoyance to his wife.

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After being tested at The Sleep-Breathing Disorders Center of Hagerstown, the resident of Chambersburg, Pa., learned that he had severe sleep apnea, a serious potentially life-threatening condition that occurs when air cannot flow into or out of the person's nose or mouth, according to information on the Web site of National Heath, Lung and Blood Institute of National Institutes of Health at www.nhlbi.nih.gov/nhlbi/sleep/gp/sleepapn.htm.

People with sleep apnea stop breathing. They usually snore between apnea episodes, but not everyone who snores has sleep apnea.

It's in the throat




So what is snoring?

Snoring is a throat problem rather than a nose problem, says Dr. Michael J. Saylor, a physician specializing in treatment of the ear, nose and throat. Snoring is caused by turbulence and vibration in the throat. A deviated septum, nasal polyps or stuffiness can make snoring worse, but the source of the problem is in the throat.

Although it may not be as easy for women to admit, women do snore, Iqbal says. But snoring is more common in men.

Most people don't even know they snore, he says.

Bob Fisher was in that group. "He had no idea," Maryann Fisher says.

Before he spent the night at The Sleep-Breathing Disorders Center attached to devices that monitored bodily functions as he slept, Bob Fisher had to fill out a sleep survey form. Maryann Fisher, his sleeping partner, was asked to complete the same form. Their answers were very different.

Possible solutions




One treatment recommended for sleep apnea is continuous positive airway pressure or CPAP. The patient wears a mask over the nose during sleep, and an air blower forces air through the nasal passages keeping the throat from collapsing. Bob Fisher didn't think he could tolerate that, so he opted for uvulopalatopharyngoplasty (UPPP), the surgical removal of excess tissue from the throat.

UPPP also can be a solution for snoring. If the patient still has tonsils, they are removed along with the uvula, "the dingus" that hangs down from the back of the throat, Saylor says. Excess tissue of the soft palate or roof of the mouth also is cut away.

The surgery is performed under general anesthesia. There is no dotted line in the throat showing the surgeon where to cut, Saylor says. There is a small risk of bleeding.

If the surgeon doesn't take enough tissue, the procedure may need to be repeated.

If the surgeon takes too much tissue, the patient temporarily may have water come out of the nose when drinking or may sound like he or she is talking through the nose for a while, Saylor says.

These are rare occurrences, according to Saylor, but he says he has to tell his patients about any possibilities.

Laser-assisted uvulopalatoplasty also is performed for snoring. The patient is awake for the procedure, which usually is performed in stages, sometimes taking four or five treatments. Tissue is removed with lasers; the soft palate stiffens and heals. The process is repeated until a sufficient amount of tissue has been taken.

From a practical point of view, Saylor prefers the UPPP to the laser procedure. He'd rather see a patient go through hurting and healing one time, instead of several, which may be necessary with the laser procedure.

Next month Saylor will take a course on somnoplasty, a new procedure that uses radio frequency waves to shrink tissue. He compares the process to microwaving meat.

Bob Fisher had his surgery a month ago. He says his physician, Dr. Andrew R. Cukier, one of Saylor's associates, prepared him well. It hurt "real bad," but there were no surprises.

It's a little early to tell, but Bob Fisher says he feels a little better every day.

He spent the first couple of nights after the surgery sleeping upright in a recliner.

Maryann Fisher noticed a difference the first night her husband slept in their bed.

"I didn't sleep because he was too quiet," she says.

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