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MESSAGES TO
Sleep & Snoring

Sleep & Snoring

A DxD Session with Dr Kenny Pang


Ended on Fri Nov 30 2018
Ended
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Top Answers


I understand. It is a common complaint from my patients that I see in my practice. It is likely that you might have poor sleep quality. 

The commonest cause for excessive daytime sleepiness is Obstructive Sleep Apnea (OSA). This occurs when the patient has a very narrow airway and this narrow airway closes in and collapses during sleep when the muscles are all relaxed and paralyzed during dream sleep. This results in stoppages of breathing and low oxygen at night with resultant increased heart rate and high blood pressure. Therefore, the patient is actually not resting and will wake up in the morning very tired. 

Other symptoms include nighttime loud snoring , gasping for air at night, choking sensation at night and frequent urination. Daytime symptoms include excessive daytime sleepiness, irritability, moody, forgetful and poor concentration. 

10 Oct 2018

Thanks for the D2D. Snoring is due to the excessive soft tissues in the airway, including swollen sinus turbinates, deviated nose septum, swollen adenoids, a thick long floppy palate or uvula, thick side walls of the mouth, and/or a big bulky tongue.

A blocked nose will cause the patient to open the mouth to breathe (survival instinct) and this would cause the tongue to fall back further with resultant blockage of the airway. 

Snoring is the “alarm” for a possible sleep disorder called Obstructive Sleep Apnea. 

6 Nov 2018

Thanks for the D2D. Yes. Snoring is due to an anatomical floppiness of the soft tissue and vibration in the upper airway. Studies have shown that most snoring originates from the vibration of the soft palate, other areas include the side walls of the mouth, the tongue base and / or epiglottis.

Snoring can be aggravated by a blocked nose, as this results in mouth breathing and mouth breathing worsens snoring. 

You would need a sleep specialist to examine your upper airway with a flexible Nasoendoscope. This will enable the sleep specialist to determine where exactly is the area that vibrates during your Snoring. 

The key to a successful snoring surgery is selecting the correct surgical procedure to perform for that individual patient (as every patient is different). 

6 Nov 2018

Thanks for the D2D. The reason why you might “automatically” open your mouth at night is because your nose is blocked, hence it’s a survival instinct to open your mouth to breathe.

Please do not use the Chin Strap until you have seen a sleep specialist or nose doctor who will examine your nose and perhaps shrink your sinus turbinates and/or remove any obvious obstructions in the nasal passages. 

6 Nov 2018

Hello,

Thanks for the D2D. This is very discerning of you. Yes. There are a lot of scientific evidence that CPAP is not useful in a real life setting. 

CPAP is only effective as long as you keep the mask on your face. There are many issues and problems with CPAP, like compliance , mask air leak, inadequate pressures, or even too high pressures. 

  1. Scientific studies show that CPAP may not be as efficacious as surgery. Weaver et al (2004) compared 18,000 CPAP users and 2,000 OSA patients who had surgery done and followed up for 6 years. They found that CPAP users had died faster than those OSA patients who had surgery. Implication: OSA patients who had surgery lived longer.                                                       
  2. Recent study from Adelaide (2016) published in the New England Journal of Medicine, compared 1300 OSA patients on CPAP and 1300 OSA patients who had no treatment. They found that after 8 years both groups with or without CPAP treatment had the same incidence of strokes, heart attacks or heart failure. Implication: CPAP treatment was as good as no treatment.          

  3. Most recent study from Korea (published in Sleep Medicine journal, 2018) compared 22,000 OSA patients who had surgery and 170,000 patients who were not treated. After 7 years, they found that the 22,000 OSA patients who had surgery survived longer and had less heart failure than the 170,000 patients who were not treated. Implication: OSA patients who had surgery had less risk of cardiovascular complications. 

6 Nov 2018

Hello,

Thanks for the D2D. Absolutely. You are a fairly young gentleman to have high blood pressure (hypertension). This could be also be due to a strong family history of hypertension, a high salt diet and certainly aggravated by Obstructive Sleep Apnea.

Scientific studies have shown that a young gentleman (below 50 years of age) who snores badly and has hypertension, would likely have a 80% chance of having Obstructive Sleep Apnea. It might be wise to see a Sleep specialist.  

6 Nov 2018

Hello,

Thanks for the D2D. Yes. It is likely that he might have Obstructive Sleep Apnea. He seems like he has stoppages in breathing at night and he might have nose congestion which explains his mouth opening during sleep. 

Because of the stoppages in breathing at night, his brain does not get enough oxygen at night, hence this affects his daytime concentration, he has a short attention span and poorer memory with poorer academic performance. 

In children, because of the sympathetic overdrive, they are hyperactive during the day and cannot focus on any task. 

Might be prudent to consult a Sleep Specialist as soon as possible. 

6 Nov 2018

This sounds like your son might have allergic rhinitis and likely swollen sinus turbinates and adenoids. He is snoring because of his blocked nasal passages and narrow airway.

He is likely a mouth breather that would aggravate the situation and narrow the airway further.

This can lead to obstructive sleep apnea and lack of oxygen at night, which in turn can lead to poor quality sleep, disruptive sleep and daytime tiredness, poor concentration and poorer school results. He would need an ENT consult and assessment soon.

20 Dec 2018

Top Questions


My 5 year old snores. He went for a scope recently and was diagnosed with enlarged turbinates, andenoids and tonsils. The doctor has suggested surgery to reduce them but we are a little hesitant given his young age. What is the recommended age for a child to have surgery for snoring, and what is the likelihood of the problem recurring (ie. enlarged turbinates again when he gets older) if he were to go for surgery?

My 5 year old son has a stuffy nose and snoring issues and we brought him for a scope recently. He was diagnosed with enlarged turbinates, adenoids and tonsils. The doctor recommended surgery. Are there alternatives to surgery, and how effective are these options?