The 5 Levels of Obstruction

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Diagram of Sinuses

If you share a bed with a snorer, you know how annoying it can be. Though it makes it harder for you to sleep, it may make it harder for them to sleep as well. The causes of snoring and sleep apnea vary from person-to-person, but the effects of sleep disorders are always dangerous. Snoring is a common condition that occurs when the flow of air through the nose or mouth is physically obstructed. And while snoring can be a sign of sleep apnea, they are different sleep disorders. Sleep apnea is a serious sleep disorder characterized by breathing that repeatedly stops during sleep. This can happen hundreds of times in a night and causes the brain, and the rest of the body, to not get enough oxygen. Untreated sleep apnea can lead to serious health problems including chronic sleep deprivation, high blood pressure, stroke, heart failure, heart attack, diabetes, depression, and more.

Not everyone who snores has sleep apnea, and vice versa. How do you tell the difference between the two? The easiest way is to evaluate how you feel during the day. Normal snoring isn’t as intrusive to your sleep as sleep apnea, and you’re less likely to feel fatigued during the day. If you suffer from snoring or sleep apnea, obstruction is a common theme for both conditions. There are five levels of obstruction that can lead to both sleep disorders; those include the nose, back of the throat, back of the tongue, deeper part of the throat, or more serious complex anatomy. Let’s explore each level of obstruction:

  1. Nose: During sleep, the body naturally tries to breathe through the nose. When nasal obstructions force you to breathe through your mouth during sleep, pressure develops behind the uvula and soft palate, which causes vibrations and the sound associated with snoring. Physical obstructions for your nose can include a deviated septum, turbinate hypertrophy or nasal valve collapse. Normally your nasal septum lies in the center of the nose to divide the nasal cavity, but when it isn’t centered it is considered a deviated nasal septum. If the septum is too deviated it may block one side of the nose or obstruct the openings of the sinuses, which requires a septoplasty. The turbinates are three fleshy shelves on the sides of the interior of the nose that warm, moisten and filter air. Once enlarged, turbinates can cause nasal blockage, mouth breathing, snoring and sleep apnea, and sometimes require a partial turbinate reduction. The nasal valve is the entrance of the nose just past the nostrils and includes cartilage. For some, the cartilage of the nose becomes weak and collapses, and a nasal valve reconstruction should be considered.
  2. Back of Throat: The back of your throat can be another culprit for causing snoring or sleep apnea. The back of your throat consists of the soft palate, uvula, tonsils, and tonsil pocket; this is the area the sound of snoring originates from and when elongated, the area can flap backward and block your airway. If you suffer from this airway obstruction and require surgery,Dr. Pashais a certified Ear, Nose & Throat (ENT) physician and has his own technique for the procedures to modify the back of your throat to alleviate snoring, which include palatal reconstruction and transpalatal advancement procedure. Dr. Pasha developed a revolutionary method for palatal reconstruction, which minimizes side effects and improves outcomes. The procedure is essentially a face-lift for the back of the throat.
  3. Tongue: Your tongue is yet another cause for concern if you are sleep apneic or a habitual snorer. Your tongue can affect your sleep through enlarged lingual tonsils or airway obstruction. You have tonsil tissue on the base of your tongue, and if it becomes too enlarged it may cause a collapse of the airway. Often times a lingual tonsillectomy is used to repair this condition. Your tongue could also fall back during sleep, and if the obstruction is significant, a sleep specialist may recommend a reduction of the base of tongue. One technique is called a midline glossectomy in which the middle and back portion of the tongue is reduced. Dr. Pasha also offers a new, revolutionary procedure utilizing the da Vinci Robot to access the base of the tongue, which allows for better visualization and improved access to the deeper portion of the throat.
  4. Hypopharynx: If an even deeper part of your throat, the hypopharynx, causes snoring or sleep apnea your hyoid bone could be the cause of obstruction. The hyoid bone, located above your Adam’s apple, supports muscles that are connected to the back of the throat and tongue, and movement of the hyoid bone increases the risk of airway blockage during sleep. A Hyoid suspension procedure could be recommended to widen the airway in the deep throat, which prevents the collapse.
  5. Complex Anatomy: Finally, life-threatening sleep apnea or complex anatomy is the most severe cause of sleep apnea and difficult to approach surgically. Procedures such as a tracheotomy or maxillomandibular advancement surgery may be options. A tracheotomy includes inserting a tube into a small hole created in the windpipe. This tube stays closed during waking hours, and is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Maxillomandibular advancement surgery moves the upper jaw (maxilla) and lower jaw (mandible) forward to open the airway in the back of your nose and throat.

The first step in treating your snoring or sleep apnea is identifying the level of obstruction behind your inability to sleep properly. The best way to do this is to have a sleep study performed by a certified sleep specialist, which can be conducted at home or in a sleep center. Dr. Pasha is a board certified sleep specialist, and a leader in cutting-edge sleep disorder treatments in Houston. If you’re ready to treat your sleep issues, make an appointment today!