neurologic disorders
Snoring
Treatment of Snoring
Treatment of snoring associated with other conditions, such as chronic Treatment and Overall, treatment includes general measures to manage risk factors plus physical methods to open the airways and/or stiffen the involved structures. Several general measures can be used for primary snoring. Their efficacy has not been well-evaluated, primarily because perception of snoring is highly subjective; However, particular patients may benefit. Measures include Avoiding alcohol and sedating drugs for several hours before bedtime Sleeping with the head elevated (best accomplished by using bed- or body-positioning devices such as wedges) or sleeping in the lateral decubitus position Losing weight Treating any nasal congestion (eg, with decongestant and/or corticosteroid sprays) Bed partners may benefit from using earplugs or white-noise machines. Sometimes alternate sleeping arrangements (eg, separate rooms) are necessary. Oral appliances are worn only during sleep; they include Mandibular advancement devices Tongue-retaining devices These appliances should be fitted by specially trained dentists. They are helpful for patients with OSA and are generally regarded as effective for simple snoring, although studies in this area are scant. Adverse effects include temporomandibular joint (TMJ) discomfort, dental misalignment, and excessive salivation, but most patients tolerate the devices well. Mandibular advancement devicesare most commonly used. These devices move the mandible and tongue forward relative to the maxilla and thus increase airway caliber during sleep. These devices can be adjusted incrementally after the initial fitting to optimize results. Tongue-retaining devicesuse suction to maintain the tongue in an anterior position. Tongue-retaining devices are more uncomfortable than mandibular advancement devices. A recently developed, removabletongue muscle stimulatoris designed to be used during the day and to improve tongue muscle function in patients with snoring or OSA. However, more data are needed to confirm effectiveness. Treatment maintain a constant positive pressure in the upper airway via a small mask applied to the nose or nose and mouth. By increasing the caliber of the upper airway, CPAP prevents narrowing or collapse of the upper airway during sleep. It thus is very effective for OSA and is effective for primary snoring. However, patients may have difficulty tolerating CPAP, and its use in primary snoring is limited because third-party reimbursement for this use is lacking. Although patients are often willing to use a CPAP device nightly to avoid the significant symptoms and long-term consequences of OSA, they are less willing to use the device to manage primary snoring, whose consequences are primarily social. Because reduced nasal patency promotes snoring, surgically correcting specific causes of airway compromise (eg, nasal polyps, hypertrophied tonsils, deviated septum) may be a reasonable way to decrease snoring. However, studies have not yet substantiated this theory. Various pharyngeal surgical procedures that alter the structure of the palate and sometimes the uvula have been developed for obstructive sleep apnea. Some are also useful for nonapneic snoring. Uvulopalatopharyngoplastyinvolves remodeling the uvula, palate, and pharyngeal walls to increase the size of the airway. It can be effective for snoring, although effects may not last beyond a few years. It is an inpatient procedure requiring general anesthesia; thus, its usefulness for snoring alone is limited. Therefore, a number of outpatient palate-altering procedures requiring only a local anesthetic have been developed: Laser-assisted uvuloplastyis less invasive than uvulopalatopharyngoplasty. Although some patients report benefit, its usefulness in treating snoring has not been proved. Forinjection snoreplasty, a sclerotherapeutic agent is injected into the submucosa of the soft palate to stiffen it and the uvula. Its usefulness for snoring alone requires further study. Forradiofrequency ablation, a probe is used to introduce thermal energy into the soft palate. Studies have shown its usefulness for snoring, but further study is needed. Palatal implants, made of polyethylene, can be placed into the soft palate to stiffen it. Three small implants are used. Their usefulness for snoring alone has not been proved, and the implants can extrude. 