SNORE IMPLANT
LASER SURGERY
FAQ
SLEEP APNEA
WHY WE SNORE
STATISTICS
FAMOUS SNORERS
LASER CANDIDATES
SLEEP STUDIES
CPAP
ORAL APPLIANCE
PRICE INSURANCE
GETTING HELP
PREGNANCY
SNORING SEX
BROCHURE
UPPP ARTICLE
OBESITY ARTICLE
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How well did you sleep last
night?
There is a great possibility that you are visiting this page because someone
has told you that you snore! We hope that we can impress you with so much
information that just by going to various pages in our site all your
questions are answered. |
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The above
illustration demonstrates most common clinical signs, symptoms, findings and
contributing factors for obstructive sleep apnea. Note that there are many
factors causing the snoring sound as well and by performing surgery in one
or two area we cannot address all the problems that you may have. ( Mansoor
Madani, DMD) |
We all snore occasionally, but in most cases
it is a problem that self-corrects and does not bother anyone. In some, it
is compounded by a deadly condition of impeded breathing. Basically, you
stop breathing any where from a few seconds up to 20, 30, or even 100 times
or more per minute This stoppage of breathing plus snoring along with a few
other symptoms are known as obstructive sleep apnea.
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Dangers of Sleep Apnea |
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I snore and stop breathing,
could I die from it?
In fact, you can have very serious complications if you suffer from sleep
apnea. With sleep apnea, you are more prone to have:
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- Heart attack (myocardial infarction) or
MI
- Stroke
- Hypertension
- Emotional issues & mood problems
(getting agitated & upset easily, having shorter attention span,
depression, having anxiety)
- Sexual problems
- Car accidents
- Lose time from your work and unable to
perform well at work
- Increased chance of stopped breathing
altogether (higher morbidity & mortality), so a patient with sever
obstructive sleep apnea and other risk factors such as obesity, high
cholesterol level, hypertension, etc has much higher chance of dying young
and/or while they sleep! It has been estimated that over 3800 people die
every single year from complications of sleep apnea in the United States
only.
How about my life, my job?
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Quality of life issues range
from sleeping in separate bedrooms, body fatigue, irritability,
nervousness, arguments and even divorce has been brought up by many
couples.
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Personal financial impacts
range from an increased cost of medical care, prescription & over the
counter drug expenses.
Institutional impacts at
work could range from:
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Job related Illness and
injuries to self as well as coworkers
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Increased Healthcare
expenses to self as well as employee
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Causing injuries to others
(buss & truck drivers)
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Inability to focus &
concentrate at work
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Inability to perform complex
tasks
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Afternoon job performance
issues
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Reduced problem solving
ability
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Tired & sleepy at work
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Reduce productivity
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Why is it that more men
snore than women?
We have examined over 20,000 patients for snoring and sleep apnea and have
operated on several thousand patients. We estimate that ration of Men versus
women are 9:1. We believe that a major reason is the mens body size, and
their anatomy. We cant disregard genetics, hormones and other factors
either.
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Causes of Snoring and Sleep Apnea |
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The
above illustration demonstrates many areas that make us snore or stop
breathing from our mouth. Please see the following areas as described in
this site for further information. But note that one single procedure such
as laser surgery to trim the uvula or Radioablation of various tissues in
the mouth or nose cannot eliminate all sources of the obstruction. (
Mansoor Madani DMD and with permission from the Atlas of Oral and
Maxillofacial Surgery Clinics of North America)
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We have
been able to identify at least 10 different areas in the
head and neck that cause you to snore:
Starting
from the top of the airway:
1.
Nose also called the nasal
cavity - you could
have:
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A
deviated septum (the wall that divides your two
nostrils) interestingly enough
many people have a deviated septum,
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Enlarged nasal turbinates:
turbinates are the structures in your nose that get
enlarged when you have a cold
or for those that have a chronic congestion problem,
causing these structures to swell up and block your
nasal passages.
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Polyps
and other obstructive masses you may have in
your nose
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If you
had a previous injury to your nose you could have a
nasal adhesions, meaning that
the septum of your nose is in fact attached to the turbinate
2.
Roof of the mouth problems: soft
palate and uvula (elongation or excessive vibrating flap
on the roof of the mouth)
3. Adenoids (or pharyngeal
tonsils or nasopharyngeal tonsils) are a mass of
lymphoid tissue situated at the very back of the nose,
in the roof of the nasopharynx, where the
nose blends into the mouth.
Normally, in children, adenoids are much larger than
adults and in combination with larger than usual tonsils
can cause airway obstructions.
4.
Tonsils: on
both sides of your mouth, once again they get smaller
without any surgery in most cases as we get older.
Tonsils that are touching each others are called kissing
tonsils.
5. Large
Tongue: Base or far back and bellow end of
the tongue drops in the back of the throat and closes up
the wind-pipe. (This is probably one of the most crucial
area of obstruction especially when one sleeps on their
back.)
6.
Receded
chin
7.
Receded jaws
8.
Narrow breathing
tube, windpipe or small oral and pharyngeal
airway.
9.
Floppy and large
muscles that cover the sides of your windpipe
(medically defined as lateral pharyngeal walls
constriction due to pharyngeal muscle hypertrophy or
enlargement and , constricted airway passage)
10.
Receded hyoid bone (this is the bone which
helps to support the tongue and serves as an attachment
point for several muscles that help to elevate the
larynx, during swallowing and speech. By being
positioned further back in the neck the tongue has more
tendencies to drop in the airway and blocking
it.
11. Elongated
epiglottis: this is also a flap of tissue
that sits at the back and bellows the tongue that keeps
food from going into the trachea, or windpipe, during
swallowing. When it is excessively swollen or
inflamed, it can obstruct, or close off, the windpipe,
causing blockage of the airway.
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The above illustration demonstrates many areas
that make us to snore or stop breathing. The sound of
snoring could arise from many locations or passages in
the upper airway. That is the reason that one single
procedure can not eliminate all sources of
obstruction. ( Mansoor
Madani, DMD and with permission
from the Atlas of Clinics of North America)
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Is there a single operation
that can fix my snoring problems? |
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Very
frankly and simply said the answer is NO! We tried
with illustrating in this site to show our visitors that
there is no single, magic cure
to all your snoring and sleep apnea problems. But having
performed procedures on thousands of patients, over 95% are happy to have had this
procedure done in our center. As one expects, the experience of a surgical team
and the clinical knowledge of the surgeon are of the
utmost importance in getting the
best possible response to the treatment. Here is a
combination that works best:
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The
right patient with understanding and knowing the
surgical limitations
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Normal
patient and bed partners expectations
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Presence
of abnormal anatomy
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An
experienced surgeon with many years of practice and
knowledge
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The
right setting as far as the diagnostic tools, devices
and up-to-date equipment
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A
patient who will follow the post operative
instructions
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An individual who tries the best to lose weight
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| Laser Surgery |
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There are
several terms that you must
understand before having snoring treatment done. An
older multiple staged laser
surgery called LAUP: this is a procedure that is
primarily directed to reduce the length of the uvula.
The reason that it does not work effectively is because
there are the tissues around the uvula that continue to
vibrate and cause the snoring
sound. One other drawback is that this procedure is done
under local anesthesia and multiple visits. Our
extensive research showed that this procedure is
ineffective and there is great chance of relapse with
it.
Then there is the traditional
UPPP (Uvulo-palato-pharyngo-plasty) - generally done in an
operating room and under general anesthesia with
intubation. It has been reported in the literature that
although traditional UPPP is one of the most effective
methods of treatment, several patients had
developed fluid reflux from their nose and also some had
voice changes. The incident of this unfortunate side
effect has also been reported to be between 3-10% of all
cases.
What we have done is use the
laser to perform UPPP (UPPP with laser).
Additionally, we have modified the surgery so that
excessive amounts of tissue are
not removed hence reducing the chance of voice change or
fluid reflux from the nose. In fact of thousands of
cases treated many have reported that the quality of
their voice and the clarity has been improved and no
patient had fluid running out of their nose after
surgery. The primary goal and effect of this procedure
is to reduce the intensity of snoring and not to cure
body fatigue or severe obstructive sleep apnea. On
average, based on our published data, the intensity of
snoring is reduced up to 60-75%, significant enough to
help patients sleep with their bed partners and be
successful in 95% of cases.
This
technique has helped certain individuals with very mild
obstructive sleep apnea. Every patient is
going to respond differently to these treatments and
although hundreds of patients were able to discontinue
the use of their
CPAP
(a sleep device that pumps air into your body through a
nasal mask if you suffer from sleep apnea) we do
recommend continuation of the device even after
surgery. The LA-UPPP is not a cure for sleep
apnea.
How
is laser surgery for treatment of snoring done?
After a
careful analysis of your problem(s) and detailed discussion of the technique we use
in our center, you are guided to a state-of-the-art
examination room. Your mouth, nose and throat are
carefully examined using a
high-tech digital camera. You can actually see
the problem(s) and clearly understand the cause as well
as limitations of any kind of surgery. Your
questions are carefully answered. During this
period of evaluation, you must discuss with us any
medical problems you may have. That should include
any past hospitalizations, surgeries, important medical
conditions, any drugs you may presently take and so on.
You can, in fact, access our forms online, print them out and bring it with
you. Please tell us if you had a recent cold or if you
take aspirin (or any other blood thinners). Of
course, history of allergies or other important medical
information should be brought to our attention.
Once we
reviewed all the procedures, alternatives (which
includes weight loss & CPAP,
dental
appliances as well as no procedures at
all) risks and complications then we are ready to
proceed with your care. If you are extremely
overweight or have major signs of sleep apnea we may
recommend a sleep study prior to your treatment.
All our patients are given that option to rule out sleep
apnea but once again we want you to know that
LA-UPPP
is not a cure for sleep apnea.
Diagnostic digital
radiographs are taken from your
head and neck to evaluate, jaws, teeth, sinuses, nose,
airway and other visible structures in the x-ray.
After
many years of research, working with CO2 & Nd YAG
laser, radiofrequency, ultrasound, Bovie,
EllmanTM, CoblationTM and
SomnoplastyTM/SM as well as the surgical
blade and more recently with palatal implants, we will determine what technique
works best for you. In general, we use the CO2
laser in our present practice to trim the elongated
uvula and the part of the roof of the mouth adjacent to
the uvula. If tonsillar tissues are present, they
will be treated with radiofrequency to make the tonsils
smaller or even remove a portion of the tonsils.
This technique reduces pain and allows you to return to
your work or school the day after surgery or a few days later.
All
of patients are sedated (an IV line with a small amount
of medication given to relax you). It requires
patients not to eat or drink for six hours prior to
their treatment. If you are considering having a
procedure done on the day of your first visit, this is
an important consideration. A responsible driver
must also accompany you. Procedures are performed
on site at our facility, so you dont have to go to a
hospital and be admitted. Recovery is very fast
from this type of anesthesia.
The
procedure is fairly simple and
done right in our
state-of-the-art
Bala Cynwyd center
(just outside Philadelphia). In
general, most patients prefer to be asleep for this
procedure. The experience of the surgeon has a lot to do
not only with how fast the procedure could be done but
how well and how precise. We have performed thousands of
laser surgery cases. We are extremely proud to be
invited as the guest editor of the prestigious Atlas of Oral & Maxillofacial Surgery
Clinic of North America on the subject of snoring
and sleep apnea.
For
surgeons contemplating doing these procedures we highly
recommend getting a copy of this wonderfully written
guide before embarking to perform such services for
their patients.
A link to the
publication can be found
here.
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A few things you may want to know about laser
surgery for treatment of
snoring...
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Actual
procedure time is short:
Procedures are performed in our center and in the shortest period of time
on average in less than 1 hours.
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Length
of stay in our center is very short:
We encourage our patients to anticipate up to 3-4
hours of stay in our center on the day of their
surgery.
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The
degree of pain while you are having surgery
done:
You are sedated and anesthetized during the procedure
so you will wake up without much pain, your throat
will be numb and it will feel
like you are a having
difficult time swallowing at
first. This will last between 4 to 8 hours and the
sensation will come back. Just like any other surgical
procedures, expect pain
afterward.
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Shorter
period of pain:
Unlike surgical procedures done in the operating room
the duration of pain is exactly 14 days with various
severity depending on ones pain tolerance. If you
follow the comprehensive instructions we give you,
your recovery will be smoother and with least amount
of complications.
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In-office procedure:
Procedures are performed under monitored anesthesia in
the center, so you dont have to waste a whole day in
the hospital and possibly another day for preparation
to go to the hospital.
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Bleeding:
Laser coagulates the tissues as it ablates or removes
tissues, generally bleeding is rare. Of course if we
encountered bleeding dissolvable sutures will be used
to control the bleeding. These sutures do not need to
be removed.
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Fast
recovery: You can return to work the following day
after surgery. Once again note that you must take
pain medication and they may contain narcotics and you
must avoid driving, operating
heavy machinery or driving
trucks, or flying a
plane (if you are a pilot) and
so on if you take such medication.
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No
hospitalization: Procedures are performed in our
center so no hospitalization is needed.
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General
anesthesia versus IV sedation: No operating room
and nasal or oral intubation needed. All patients will
be offered IV sedation, so you will be asleep but breathe by yourself and
will be monitored extensively.
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Breathing
while you are having the surgery:
You breathe by yourself during the procedure under
anesthesia which means lower risk of respiratory or
breathing complications
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Return
to work:
We encourage all patients to return to work the next
day after surgery. Once again with the above precautions. Every patient is going
to respond differently to the procedures and some may
need a day or two to stay at home.
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Our
State of the art technology plus a one of a kind and
very impressive power point presentation will surpass
your expectation of a 21st century surgery
center. |
What are the potential
benefits of surgery?
Once
again, every individual
reacts and responds differently
to any surgical treatment. Although the following
statements are all positive,
less than 5% of patients with more severe type of
problems reported that surgery did not correct all their
problems. Here is what over 95% of our patients have
told us after they had laser surgery:
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My
snoring sound is reduced by about 60-75%
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I
wake up in the morning much more alert
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I
sleep much better
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Quality
of my sleep is different
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I
breathe much better from my mouth
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My
wife (husband or bed partner loves me again!)
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I
wish I had it done earlier
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It was certainly cheaper than divorce!
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Dr. Madani is one of the
pioneers of a new laser surgery technique to treat snoring and mild sleep
apnea. The material contained herein is provided for informational purposes
only and should not be considered as medical advice or instruction.
Individuals with suspected or diagnosed sleep apnea syndrome, any sleep
disorder or other conditions discussed in this site should consider a
personal evaluation in our facility or contact a qualified professional for
further treatment. |
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