Treatment of snoring: A new approach for primary care providers   

Let's say you snore and you mention this to your doctor during your annual physical. Chances are he/she will brush aside your complaint with a recommendation that you lose weight or cut down on alcohol before bedtime. For a few people, that's good advice.

But you persist: you snore AND you feel tired all the time. Your physician will, we hope, probe further for signs of obstructive sleep apnea (maybe not... this potentially lethal condition remains widely undiagnosed). Your doctor may then recommend a sleep study, known as a polysomnogram, which will be conducted overnight at a sleep clinic. Based on the results, your doctor or otolaryngologist may recommend treatment for your OSA or snoring, which may include use of a CPAP system or surgery to reduce or stiffen your throat tissue.

There are at least two problems with this scenario. One is time: most sleep clinics have long waiting lists. The other is money: sleep studies are expensive (the writer of this newsletter, who has pretty good health insurance, paid about $300 out of pocket for his polysomnogram and related consultations.) Wouldn't it be better if your primary care physician was able to provide a more immediate analysis and treatment of your snoring condition?

That's the basis for a new model for primary care management of snorers proposed by researchers at Christchurch School of Medicine and Health Science in New Zealand. The authors identify two basic metrics that can be performed from the doctor's office. First is your daytime sleepiness, assessed by giving you an 8-question test called the Epworth Sleepiness Scale (ESS). Second is a measurement of the pattern of how much oxygen is in your blood while you sleep. This is measured on a small pulse oximeter you can take home. You only need to sleep with one sensor on your finger, rather than the many sensors (and the associated leads) over your head and body when using polysomnography.

The next day, your doctor could easily download the oxygen data onto a PC and count how many times the oxygen levels 'dipped' during the night. The analysis process can be performed automatically within minutes. Each dip corresponds to a short period of choking or 'apnea'. Armed with your ESS score and oxygen desaturation index (the average number of times your oxygen dipped per hour), your doctor can use the chart above to quickly tell whether your snoring is serious enough to warrant immediate treatment such as CPAP or surgery or whether you have time to investigate less invasive snoring remedies. If you are in Group B, for example, you're both sleepy and have many dips per hour and you need urgent attention from a sleep specialist. Snorers in Group D -- not sleepy, with normal oxygen levels -- can be directed to other snoring treatments and do not need to be referred for polysomnography.

What does this mean for patients? Simply that your primary physician can make a rational decision on how to treat your snoring condition. And remember, you should never ignore your snoring. Apart from the social impact on your roommate or bed partner, even light snoring has been associated with increased blood pressure.

Source: Assessment of Snorers in Primary Care. Sparks, Bartle and Beckert, New Zealand Medical Journal, June 2002, Vol 115, No 1155

Find more information on our website: sleep apnea, polysomnography, Epworth Sleepiness Scale.  And remember, information provided by PutanEndtoSnoring does not substitute for the advice of your physician. 

  Feature article:  Touched by an Angel

 A new product is generating a lot of sales and some controversy: it's called Sleep Angel and is a headgear device that keeps your mouth closed while you sleep and also keeps your jaw forward, preventing your tongue falling back in your throat. The controversy arises from the implication that it can treat apnea; OSA treatments need FDA approval. Certainly, we at PutanEndtoSnoring believe that anyone with the Not-So-Silent Killer snoring type should not risk their lives with untested products but should head straight for their doctor. But in principle, Sleep Angel might prevent snoring and mild apnea, because, like dental mouthpieces, it repositions the jaw, helping keep the airways open at night.

One Sleep Angel enthusiast is Joe Stamler, who has contributed this first person account:

I'm a 60-year-old graphic designer and I love the work I do; it's a job that demands that I function at my best as to both my imagination and my technical skills. The first apnea symptom I was aware of and that began to concern me was when I began falling asleep in my chair almost every time I sat down at the computer to work. I was afraid to get behind the wheel. A few days later, I was using an X-Acto knife to trim a poster, something I had done hundreds of times before without any problem; but this time I accidentally slashed my index finger, requiring nine stitches. I consider myself very lucky to have had that progressive wake-up call.

My doctor suggested a sleep study to see if I need a CPAP system, but I dreaded the thought of having to go to sleep every night having oxygen forced into me through an intrusive mask. And I certainly didn't want to undergo surgery. That was when someone forwarded
me an inventor's personal account of how he came to design what he called the "Sleep Angel", described as a non-intrusive and inexpensive aid one could wear at night and which would prevent obstructive sleep apnea by keeping the lower jaw from sliding back into the position that allows for the obstructive sleep apnea. The timing certainly couldn't have been more perfect.

When my Sleep Angel arrived, I tried it on, crossed my fingers and wore it to bed for the first time. The next morning, my wife told me she definitely had noticed a big difference; the apnea wasn't completely gone, but the episodes were much less often and less intense; she said my snoring was also much quieter. Over the next few nights, as I experimented with the position and tightness of the Sleep Angel, my wife happily reported that not only could she not hear a trace of the apnea during the night, but my legs had stopped thrashing while I slept.

That was more than three months ago. I am definitely getting more and better sleep now at night, and I really feel the difference during the day, both in my work and in my enjoyment of life.

Joseph Stamler's company, Visual Transformations, provides logos and visual identity services for small businesses and professionals. Joe invites readers to join his Yahoo newsgroup for Sleep Angel users, http://groups.yahoo.com/group/SleepAngelZMail.

Send me your experiences with this or other snoring cures and we'll use it in this slot.

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This section features a current posting to our forum.   We welcome all readers experiences with snoring remedies of all types.

Says LK, on September 10:

Last year I underwent an LAUP procedure. It didn't work, was not covered by insurance and was the worst pain I have had which lasted for two weeks. Instead of surgery, lose the weight!

Good advice, LK, but not that easy for most of us!

Add your comments!

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