April 8, 2004 -- Who says you and your snoring sleepmate can't snooze together in peace? While snoring can turn nighttime into a nightmare, doctors now have several new treatments to help quiet the bedtime bulldozer.
At one time or another, snoring affects an estimated quarter to half of Americans. Besides fitful sleep for bed partners and the potential for marital discord, snoring can disrupt sleep even for the snorer and is often associated with the more severe condition known as obstructive sleep apnea, where the airway is obstructed at night.
For snorers like Daniel Nixon of New York City, various home solutions tried over the years yielded little to no success. Nixon told ABCNEWS' Good Morning America about some of the remedies he'd tried: "Some sprays and some washes, … some strips that help you breathe at night that you put across your nose. None of it did that much good."
Much of the frustration lies in pinpointing the exact cause of the snoring. Many people often assume the cause is a floppy soft palate that vibrates at night when breathing through the mouth. But other common causes include obstructive sleep apnea, an enlarged tongue base or tonsils, or simple allergies.
That's why Dr. Peter Catalano, chair of the department of otolaryngology at Lahey Clinic in Burlington, Mass., says it's so important to get a thorough evaluation by a trained specialist to help decide which treatment approach will be most effective.
Treatment for a floppy palate won't help if the cause is something else. "I'd say 60 percent of my patients have one of these other causes," Catalano says.
New Treatments for Floppy Palates
If other causes are ruled out, then those with a floppy palate may be candidates for new treatments to help reduce vibration of the palate or other tissues in the airway, like the tongue, throat muscles, and uvula which visibly hangs from the palate's back end.
In the past, one of the most common medical treatments for floppy tissue has been laser-assisted uvulopalatoplasty or LAUP.
In this surgical procedure, a doctor uses a laser to cut away excess tissue and tighten up the anatomy. Doctors have reported varied results and post-procedure pain can be significant.
Alternative to Laser
A newer way to treat loose tissue, but with less pain, is radiofrequency-assisted uvulopalatoplasty or RAUP. Instead of a laser, thermal energy is used under local anesthesia to scar and shrink the soft tissue in the back of the throat.
"A needle is applied to the palate and through the needle a form of microwave energy is applied to create scar tissue in the palate," explains Dr. Jeffrey Ahn, who treats Nixon and is director of sleep disorder surgery at Columbia University Medical Center in New York. "With scar tissue, the palate stiffens and vibrates less."
Often referred to as a somnoplasty procedure, RAUP can be performed in an outpatient setting and is associated with less discomfort during recovery than LAUP. But Catalano says patients may need as many as three separate treatments before the snoring problem is corrected. He says total costs can range from $1,800 to $2,700.
If you're not crazy about having the back of your throat cut or burned, then you may want to consider palatal implants. These are three small polyester inserts placed in the soft palate under local anesthesia to stiffen the anatomy.
Called the pillar system, these 18mm by 2mm inserts are embedded into the palate using a special instrument.
"They are very easy to place and it is a well-tolerated procedure," Catalano says. He notes patients are often able to return to work right after the procedure.
In fact, Catalano says this is the first procedure to focus on stabilizing the front of the palate located under the nasal passages, rather than the free end towards the back of the throat. It's also reversible.
"Although it's an implant procedure, if there are any side effects or if the patient is not happy with it, the implants can be removed," Ahn says, who plans to use the procedure on Nixon.
All three implants can be placed at once and costs range from $1,000 to $2,500.
The least invasive new treatment involves injecting a substance into the palate to chemically scar the tissue. It may be the quickest way to get in and out of the doctor's office. But the injected agent, called Sotradecol, is not often available from suppliers due to extremely low production.
"In the Northeast at least, we can't find it," says Catalano. While he offers to do the procedure with an alternative compound also considered effective, he says most patients shy away when they hear the original agent will not be used.
Catalano says patients often will require more than one injection, up to three, at a cost of $300 a piece separated by one or two months each.
Deciding on Treatment
Both Ahn and Catalano stress the importance of a thorough evaluation by a sleep disorder specialist to decide which procedure may be right for your snoring problem. They say stiffening the palate won't help a thing if that's not the cause of your snoring.
And since insurance companies don't cover any of these procedures for a simple snoring problem, it's important to choose wisely. Depending on diagnosis, your doctor may even recommend a more conventional treatment that he or she is more experienced with.
"I also recommend a sleep study, to make sure the patients don't have more severe obstruction, or obstructive sleep apnea," says Ahn.
Snoring caused by sleep apnea may require different types of treatment to correct the underlying problem, including a specialized breathing mask at night or removable oral appliances designed to keep the airway open.
Dr. Harold Smith is a dentist in Indianapolis who uses these appliances on patients referred to him by sleep disorder specialists.
"Oral appliances have been around for the last 20 years, but they've been perfected in the last five to seven years," Smith says.
Ranging in cost from $1,000 to $1,500, Smith says oral appliances are a viable option for snoring due to sleep apnea in patients not wanting surgery of any kind.
As for Nixon, he's looking forward to his pillar implants and peaceful nights ahead.
"I hope it stops the snoring, or diminishes it enough to make a difference."
Good Morning America's Alexa Pozniak contributed to this report.