Somnoplasty

With the increasing knowledge obtained through the development of sleep centers studying patients' sleep patterns overnight, snoring has been found to be a definite medical problem. Heavy snoring interferes with normal sleep patterns which allow the brain and body to regenerate its energy and awaken fresh, well rested and ready to approach the day with vigor. Snoring not only robs patients of sleep, but other family members also lose sleep. Other stress-associated medical problems attributed to prominent snoring include high blood pressure, anxiety, and depression.

Snoring results primarily from vibrations of the soft palate, uvula and tonsillar pillars. Snoring occurs when the air in the nose and throat is blocked by these structures, interfering with the free flow of air and resulting in vibrations that create the snoring sound. Somnoploasty is a new, office-based procedure that uses radiofrequency energy to reduce the excessive tissues of the palate.

Somnoplasty is performed in the doctor's office under local anesthesia similar to a dental injection. The radiofrequency energy is then delivered to the palate using a small, inserted needle. The patient experiences no pain during the procedure and leaves the office after treatment, which takes less than 15 minutes. He or she can then return to his or her normal activities for the rest of the day, only taking Tylenol or Advil for mild discomfort if needed.

Over a period of three to six weeks, the lesion that is created in the soft palate with radioenergy is naturally reabsorbed by the body, leading to tissue volume reduction. This reduces the length and size of the palate and uvula, stiffening the tissue and reducing its ability to vibrate. With the reduction and tightening of the obstructive tissue, snoring is reduced in many patients. Most patients receive marked reduction in snoring after one treatment. However, an additional treatment may be needed for patients who are still snoring. There is a small group that may require a third procedure. These procedures are usually given eight weeks apart to give the palate time to heal fully and obtain maximum reduction in snoring.

Radiofrequency has been used in medicine and surgery over the last 20 years from treatment of lesions of the cervix, prostatic enlargement and special procedures on the heart to correct certain cardiac arrhythmias. This new technique of Somnoplasty has been developed as a less painful alternative to laser palatal surgery, which permanently removes a good portion of the palate, and often must be repeated several times. There is a painful recovery period that has made the laser-assisted uvulopalatopharyngoplasty (LAUP) lose popularity. Both the LAUP and Somnoplasty procedure are for patients with primary snoring problems who do not have sleep apnea. Sleep apnea is a condition where patients snore quite heavily, to the point that their airway is totally obstructed and they quit breathing for 15 to 30 and even 40 seconds. During this period of apnea, the patient's oxygen level drops significantly, interfering with the patient's sleep and general health. Profound apnea is often treated with a more aggressive removal of a large amount of the soft tissue of the palate, and all of the uvula and tonsillar tissue. One alternative to sleep apnea treatment has been the use of continuous positive airway pressure (CPAP).

Significant snoring may interfere with social relations at home. A family member may have to sleep in another room, wear earplugs or be constantly awakened by the snoring party. These snorers need to be evaluated by an otolaryngologist, a doctor who specializes in the ear, nose and throat. There are a number of other factors that cause people to snore excessively such as nasal obstruction from chronic nasal congestion, nasal allergy, nasal polyps, deviated nasal septum or chronic sinusitis. Some children, as well as adults, may have extremely enlarged or hypertrophic tonsils and adenoids which obstruct the airway, leading to excessive snoring. Often this nasal blockage and/or enlarged tonsillar tissue can be cured by removing the nasal obstruction or the tonsils and adenoids. Patients need to be carefully evaluated to delineate any and all causes of airway obstruction. Other factors that increase snoring include weight gain, hypothyroidism and being generally out of shape. Once the physician has taken a careful history and physical examination, he or she may want to order a sleep study to rule out sleep apnea, particularly if there is any history of the patient stopping breathing, experiencing severe fatigue or drowsiness during the waking hours. Once apnea has been ruled out by history, physical examination and possibly a sleep study, the patient can be considered for the in-office Somnoplasty procedure.

Snoring is usually considered a "cosmetic" problem by insurance carriers and is not a covered procedure. Some of the other problems that cause snoring - such as deviated nasal septum, nasal polyps and enlargement of the tonsils and adenoids - are considered significant medical problems and warrant coverage by insurance carriers. Surgical correction of sleep apnea, with either nasal correction or with uvulopalatopharyngoplasty (UPPP), is usually considered a definite medical problem requiring correction of the lowered oxygenation rate or abnormal breathing patterns. However, each case must be individually evaluated by an insurance consultant to see if it is considered a medical procedure your insurance will cover.

Somnoplasty received FDA approval to treat snoring in July of 1997. It is currently offered by about 200 doctor groups in the United States, according to the manufacturer, Somnus Medical Technologies, Inc., of Sunnyvale, California.