Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Surgery to treat snoring is designed to reduce obstruction or narrowing in
the anatomic area that is causing the snoring. Frequently, there is more than
one involved area, so surgery on only one of the narrowed areas may decrease
snoring but not eliminate it entirely.
Surgical treatment of snoring is generally focused on the nasal passages,
palate and uvula, and tongue. Most of the surgical procedures are performed in a
doctor's office. In general, individual insurance carriers determine what
medical conditions are covered as a benefit of the plan. Insurance is frequently
changing, and, therefore, coverage policies may vary. As always, it is important
to check with your own insurance carrier and pre-confirm the estimated cost and
coverage for any planned medical treatment or surgery.
It is prudent to undergo a formal sleep study (polysomnogram) prior to
performing surgery to assure that snoring is not a manifestation of obstructive
sleep apnea. If sleep apnea is the case, then more conservative CPAP needs to be
prescribed and attempted first. In addition, if snoring is related to
obstructive sleep apnea, then a surgical correction may mask the obvious symptom
of a potentially serious condition and leave sleep apnea undiagnosed.
Nasal surgery options for snoring
Nasal surgery to treat snoring is generally focused on improving a narrow
nasal passage.
Radio-frequency energy
In the doctor's office, radio-frequency energy can be used to
shrink the turbinates by creating scar tissue in them, resulting in a more open
nasal passage. The procedure takes about 15 minutes. Most of that time is spent
numbing the nasal tissue with topical and injectable medications.
The procedure is performed with a wand that is placed into the tissues.
Radio-frequency energy then is released into the tissues for about ten seconds.
Several applications are done on each side of the nose for maximal effect. The
procedure is successful when scar tissue forms. Therefore, it takes about three
months to see the full effect of the procedure. As the scar tissue softens over
time, however, the swelling and narrowing may recur. The procedure then can be
repeated as needed in the office.
Deviated septum
Several other anatomic problems can cause or worsen snoring. The nasal septum
is the "wall" in the center of the nose that separates the right and left nasal
passages. After trauma (including during birth), the septum can be deviated to
one side or may curve to both sides (one side by the front of the septum and the
other by the back of the septum). The septum deviation can be corrected by
removing the crooked cartilage. This surgery usually is performed in the
operating room under general anesthesia. After surgery, if the nasal obstruction
is improved, the snoring often improves.
Nasal polyps
Nasal polyps are mucosal "growths" in the nose that are usually caused by
allergies. As they continue to enlarge over time, they can cause nasal
obstruction. If the polyps are large enough, they will require surgery to remove
them. This surgery was previously performed in the doctor's office. However, it
is currently more usual to perform the surgery in the operating room under
general anesthesia. Removing the polyps reduces nasal obstruction, which may
improve snoring.
Oral surgery options for snoring
Snoring can also be caused by a long, floppy palate and uvula. There are
several procedures that involve the uvula and palate. Some procedures remove the
tissue whereas others try to stiffen the tissues.
Uvulectomy
Uvulectomy is the removal of the uvula. This can easily be performed under
local anesthesia in the doctor's office. A person usually does not miss having
the uvula. However, there is a period of one to two weeks of discomfort in the
throat after the procedure. Some people require strong pain medications for
several days, whereas others need only acetaminophen (Tylenol) or an
over-the-counter equivalent. Most people describe the pain as similar to a bad
viral sore throat that is worse when swallowing. The main risks of uvulectomy
are pain, bleeding, and altered speech (if you speak a language with guttural
fricatives like Hebrew or Farsi).
Laser assisted uvulopalatoplasty (LAUP)
Laser assisted uvulopalatoplasty (LAUP) involves trimming the palate with a
laser. It can be performed in the doctor's office under local anesthesia. Small
cuts are made in the palate on each side of the uvula with a laser. Several
procedures are usually needed for a maximal effect. The scarring caused by the
procedure stiffens the palate, decreasing the ability of the palate to vibrate
and pulls the palate sideways to tighten it. This procedure results in mild to
moderate pain for one to two weeks that is generally controlled with oral pain
medications.
Snoring due to a long, floppy palate can be treated with office procedures
that stiffen the palate. Like a sail on a sailboat, the air moving around the
palate can cause vibrations of the tissue. For a sailboat sail, battens are
placed to stiffen the sail and decrease vibration. Similarly, a stiffer palate
vibrates less. The palate can be stiffened by creating scar tissue (as discussed
previously) or with implants.
Radio-frequency ablation of the palate
Radio-frequency ablation of the palate can be performed under local
anesthesia in the doctor's office. Usually, three tunnels in the tissue are made
with a radiofrequency wand. The radiofrequency energy is applied for
approximately ten seconds with the wand in the palate muscle tissue. The tissue
heals as scar tissue, and the palate becomes stiffer and vibrates less.
Generally, scar tissue in the palate continues to form for up to three months.
Up to 77% of people report reduced snoring after this procedure, however, as the
tissue continues to heal over time, the palate may soften and re-obstruct. One
study demonstrated a 29% relapse in snoring after one year.
Palate implants
Palate implants are now being used to treat snoring. They are made from
Dacron, which is a non-reactive material that has been used for many years for
heart valve surgery and hernia repair. Dacron also encourages the normal tissue
to grow into it. Small Dacron implants are placed into the palate under local
anesthesia. The implants stiffen the palate like scar tissue after
radiofrequency treatments. The implants stay in the tissue, so recurrence of
snoring should be reduced.
There is a small increased risk of infection after
insertion of foreign material in the palate tissue. If this occurs, the implant
should be removed and replaced with another implant. Although this sounds like a
negative consequence, infection actually leads to scarring, which helps decrease
the vibrations of the palate. The implant procedure results in less tissue
inflammation and therefore the procedure does not hurt as much or for as long as
following radio-frequency treatments.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
The common cold (viral upper respiratory tract infection) is a contagious illness that may be caused by various viruses. Symptoms include a stuffy nose, headache, cough, sore throat, and maybe a fever. Antibiotics have no effect upon the common cold, and there is no evidence that zinc and vitamin C are effective treatments.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
It is thought that the tonsils and adenoids assist the body in fighting incoming bacteria and viruses by helping the body form antibodies. This is thought to be important only during the first year of life. Acute tonsillitis, strep throat, mononucleosis (mono), chronic tonsillitis, peritonsillar abscess, and hypertrophic tonsils and adenoids are all common problems involving the tonsils and adenoids. Treatment of tonsillitis and adenoids include antibiotics and other medications depending on the cause. In some cases, a tonsillectomy or adenoidectomy (the removal of the tonsils or adenoids) may be necessary.
Marfan syndrome is hereditary condition affecting connective tissue. A person with Marfan syndrome may exhibit the following symptoms and characteristics: dislocation of one or both lenses of the eye; a protruding or indented breastbone; scoliosis; flat feet; aortic dilatation; dural ectasia; stretch marks; hernia; and lung collapse. Though there is no cure for Marfan syndrome, there are treatments that can minimize and sometimes prevent some complications.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
A deviate septum is a condition in which the bone and cartilage that divide the nasal cavity of the nose in half (nasal septum) is significantly off center or crooked. The causes of a deviated septum can be congenital, or develop after a trauma or injury to the nose. Symptoms of a deviated septum include nasal congestion, recurrent sinus infections, nosebleeds, headache, facial pain, postnasal drip, snoring, and loud breathing. A deviated septum can be relieved with medications, and if necessary surgery, called a septoplasty.
Periodic limb movement disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. They tend to cluster in episodes that last anywhere from a few minutes to several hours. These movements are very different from the normal spasms, called hypnic myoclonia, that we often experience initially while trying to fall asleep.
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