Faq’s

Snoring is nothing but the noise caused by the air attempting to flow past some blockage in the upper airway.  By basic principle of physics if we narrow the diameter of a pipe, resistance increases. And this resistance results in sound when air is flowing through it. This sound is manifested as snoring in our upper airway.

When you sleep, air passages at the back of the nose and mouth become partially blocked. This might be due to floppy or thick soft palate ( the area located on the roof of your mouth between the hard palate & uvula) blocking nose from behind or may be due to bulky tongue falling behind.

Snoring is a common problem, and you are not alone.Nearly 16% of adult Indian population snore and about 3.6% of people have Sleep Apnoea. Snoring complaints have increased by 40% in the last three to five years.

When you are aware and conscious, there is an active effort of your muscles. So resistance cannot take upper hand. But when you are falling asleep, muscle tones drop and resistance increases to a significant extent. Particularly if you sleep on your back, palate and tongue falls back due to gravity, aggravating the block. This block is called dynamic block.

No, snoring cannot be cured by changing your sleep position. But if you lie on one side (laterally) its intensity can be reduced.

When you are snoring, actually inspired air is facing resistance to pass through. This results in fall of oxygen concentration in your blood (as suboptimal oxygen is passing). So whole night your vital organs are depriving of oxygen supply.

All Sleep Apnoea patients snore but all snores are not Sleep apnoeic.To make it simple, apnoea means no respiration. When oxygen concentration is falling gradually, a crucial point comes when you are undergoing a breath holding spell (so momentarily there is no sound) followed by a choking spell and arousal.If you don’t have this kind of breath holding spell, choking and arousal, then even if you snore, you are not a sleep-apnoea patient.

Obesity is the most important risk factor. Apart from this, smoking, excess alcohol intake, stress and different metabolic disorders particularly diabetics.

Actually OSA and obesity is a vicious cycle. Means, obesity aggravates OSA which leads to chronic hypoxia (i.e. Oxygen deficiency), and this hypoxia aggravates your obesity further. So you have to manage obesity and OSA simultaneously.

That means you might have blockage at the level of nose e.g. crooked septum, Polyp, turbinate hypertrophy. This is called upper airway resistance syndromes (UARS). You have less chance of developing frank OSA. Though we get non obese OSA patients also due to tongue and jaw-bone abnormality.

If your spouse reports that you get apnoeic spells and choking with multiple arousals you need urgent treatment. Even if there is no apnoea, you need treatment if you are a heroic snorer. It not only imparts your health but also disturbs your partner’s sleep.You should also note for the common symptoms of snoring and OSA, e.g. excessive daytime sleepiness, early morning headaches, and lack of concentration, lethargy, personality change, and impotence.

Certainly. You have to understand the basic reasons why it happens. Then you’ll realize that it is not a disease to be cured by some tablets or pills. Snoring and OSA management is basically a comprehensive programme. You have to obey your doctor’s advice for the maximum output.

You have to reduce your BMI (which is nothing but weight proportionate to your height). There is a formula. If it falls less than or equal to 25 then you are normal, otherwise you are overweight. If it is more than 30, then you are obese.You have to do pranayams, Smoking and alcohol cessation, physical exercise, dietary modifications, stress management.

You have to go to the next step. That is assessment of the disease severity by Polysomnography (night time sleep study) and assessment of the levels of blockades by Sleep Endoscopy (DISE). Then we have to overcome the blockades to give you cure.

No, it is not essential. Now-a-days home level sleep study is also available. Technicians will go to your home and spend whole night at your bedside to perform the test.

Not really. Particularly home level portable devices are now-a-days available which gives reliable results at a very affordable price. And technicians need not to spend the night at your residence.

The recent protocol doesn’t suggest so. Because blockades vary from person to person. Unless and until we are sure about the exact structures causing obstruction in your airway, Surgical planning (i.e. which surgery is recommended in your case) is not possible.

By a procedure called DISE (Drug Induced Sleep Endoscopy).

It is nothing but flexible fibre optic nasopharyngo-laryngoscopy in a snoring patient whose sleep is artificially been induced by anesthesiologist in O.T. setting (with all back-ups) for a period of 8-10 minutes only. We actually assess the levels of obstructions (i.e. vellum/oropharynx/tongue base/epiglottis) during snoring events.

15 mins you’re out of O.T. & certainly within 1hr your drowsiness will be over and by 2 hrs you will go home.

We will sit together and visualizing the sleep endoscopy video, we will discuss the scenario and exchange our opinions. If you need multiple level obstruction correction then you will have to decide whether you’ll opt for single stage or multi-stage operation.

If you require nose job (including septoplasty and turbinoplasty ) and palatal channeling then approx 1 ½ hr. O.T. time and 1-2 day stay. Recovery period 1 week. If you require palatoplasty (in any form) with tonsillectomy then approx 2 ½ hrs and 3 days stay. Recovery period 10 days. If we do tongue-base channeling then it is a 15 mins. Procedure only with no extra recovery period. But, if you require glossectomy (tongue-base ablation) then the total multilevel procedure would take approx 4 hrs. Recovery period would be 2-3 weeks.

It is a novel minimally invasive technique by which we debulk and stiffen a tissue (e.g. – palate, tongue) to reduce the incidence of snoring using COBLATION^® Plasma Wand. Procedures take less than 15 mins; can be done under Local Anesthesia, without the discomfort and inconvenience associated with traditional surgeries.

COBLATION^® channelings (unlike lasers) are nearly painless procedures. Because working principle is by plasma (excited ion field) at 60°c -70°c only. It can be done even as OPD procedure under LA. You will be able to take soft-semisolid diet from next day. But if you need major palatoplasty procedures then pain will be a bit more. Even then soft semisolid diet is permissible from 7th day onwards.

You can take CPAP (Continuous Positive Airway Pressure). This is a portable machine with a pipe and a mask to be worn on the face while sleeping. The machine will send oxygen to your body overcoming the airway resistance.

If your BMI is > 40 and you are unwilling for surgery, then CPAP would be your best option.
But if you are a simple snorer or OSA with high AHI score but low BMI or you don’t want to carry that CPAP machine whole life then you are a good surgical candidate.

 In pediatric age group, Sleep apnoea surgeries are nearly 100% successful, because just tonsil-adenoidectomy is enough to give optimal result.
In adults, multi-level sleep surgeries can never give 100% result as you would get from CPAP machine. Surgery might give suboptimal (e.g.90%) success rate, but once done it is permanent. Whereas long term acceptance of CPAP machine (especially in young adults) is not good.