How To Stop Snoring Singapore!

Do you or your partner snore loudly or sleep poorly? As a busy ENT specialist in Singapore, I see many patients who suffer from disturbed sleep, snoring and difficulty breathing at night.

The one main concern is that symptoms and signs of sleep apnea may go amiss. Yes, we screen for sleep apnea with a sleep study but what do you do after this? Or what if you decide you don’t wish to have a sleep study? If all you want is to sleep better and breathe clearly when asleep, then read on to explore surgery to help your snoring go away.

Not all patients are good surgical candidates though so CPAP (Continuous Positive Airway Pressure) may be another option to consider. But not everybody tolerates wearing a CPAP mask throughout the night. In addition, if there are clear nasal and throat sources of your airway obstruction causing your snoring, then surgery may be worth exploring.

What Causes Snoring?

Snoring happens when airflow entering the mouth and nose becomes partially obstructed when you’re asleep. This obstruction may be due to:

1. Nasal congestion: Blocked airways from allergies or a deviated (crooked) septum may cause snoring
2. Throat muscle “floppiness”: With age and weight gain, the musc
3. les of your throat tend to collapse inward, leading to narrowing of your airway. When this occurs, the blood oxygen levels fall, stimulating the gasping, choking and nocturnal waking episodes that underpin sleep apnea.
4. Alcohol: If you had a few drinks before bedtime, don’t be surprised if you snore louder than usual. Alcohol relaxes your throat muscles even more and may also cause nasal congestion due to increased bloodflow in your tissues.
5. Weight gain: Putting on weight makes snoring even worse. The excess fatty tissue building up around your neck and face press on your airway to cause obstruction and snoring. Sometimes, medications such as Ozempic, used for diabetic control, may be useful for weight loss.
6. Sleep position: Guess what? Sleeping supine or flat on your back is the worst position a snorer could adopt. Sleeping on your side may help to alleviate your snoring if it’s mild to begin with.

So what happens when conservative measures such as weight management, changing your pillow and treating your nasal allergies fail?

This is where surgery plays an important role to clear your obstructed airway for snoring patients. I usually quote 70% success rate in improving my patients’ snoring. The main thing to understand is that some patients may continue snoring, no matter what kind of surgery they have. So CPAP and surgery may sometimes have a dual combi approach to snoring management.

What types of Snoring Surgery in Singapore are there?

There are many types of snoring surgery procedures in Singapore. Ultimately, we use a customised approach to assess which type of surgery might benefit you to help your snoring.

1. Septoplasty with Turbinoplasties (Nose surgery): I usually perform both types of nasal surgery together to open up the blocked nasal airway to help patients breathe better. The septum is a plate of cartilage and bone which may be crooked or deviated, narrowing your nasal passage. The inferior turbinates are the “sausages” of the nose which swell up due to allergies and infection, to cause nasal congestion.So by straightening the nasal septum and trimming the “sausages”, we help to widen the nasal passages to breathe more clearly.

2. UPPP (Uvulo-pharyngo-palatoplasty):

This procedure is quite important to help snoring patients snore less. The uvula is the long “worm” structure dangling at the back of your throat in the midline. It tends to vibrate and stick to the back of your throat to close your airway off. This leads to snoring, mouth-breathing and basically just lots of noise and disrupted sleep.

So the goal of UPPP surgery is to trim the long uvula and stitch up the soft palate to stiffen it. This prevents the soft palate from collapsing backward to obstruct your airway.

There are many ways to perform a UPPP surgery to stop snoring: The method chosen is based on surgeon experience and preference. Both tonsils are usually also removed at the same time to widen the throat airway further.

No pain, no gain, certainly holds true here for UPPP surgery. You may suffer from a sore throat for the first few days but this is easily controlled with oral and topical painkillers. There is also a small 2% risk of bleeding after snoring surgery within 14 days postop due to secondary infection, even with antibiotics. But most patients recover quite well and are pleased when their partner no longer complains about their snoring!

3. Tongue base coblation: In some snoring patients, their tongues are rather bulky at the back, falling backward to cause airway obstruction. So such patients may benefit from procedures to reduce their tongue base. Coblation is a safe tool which uses low energy to cauterise the bulky tongue base tissue to make it shrink.

There are many techniques to tackle tongue base level obstruction, including robotic surgery. But you must be aware that there is a risk of heavy bleeding after surgery due to tissue breakdown, which can sometimes be difficult to manage in a tight narrow site.

4. Hypoglossal nerve stimulator: If all else fails and you still don’t want to go on CPAP, then this option may suit you. This involves the insertion of a pacemaker device in your neck to stimulate the tongue muscles to push forward. This then opens up the airway by preventing your tongue from falling backward.

Conclusion:

So surgery for snoring can be extremely effective and life-changing for those patients who suffer from persistent snoring. Snoring affects their sleep quality and overall wellbeing. You should be aware of the many different surgical options out there, such as UPPP, septoplasty, turbinoplasties, before you embark on surgical treatment for snoring.

Seeking an opinion from your experienced ENT surgeon with an interest in snoring and sleep is always helpful to find out which surgical option is best for you. From the surgeon’s perspective, we want to make sure that we select the best surgical candidate for surgery to optimise our surgical results. This means ideally, such snoring patients should have a Body Mass Index (BMI) of 30 or less. They should probbaly not be suffering extremely severe sleep apnea e.g. Apnea-Hypopnea Index (AHI) should be 30 and below.

You should ideally already have tried CPAP and failed to tolerate it, before you consider surgery as an option. In Singapore, many snoring patients decline to explore CPAP and are more keen to give surgery a go first before they have to rely on a machine for longterm. We have many snoring patients whose life has improved for the better with surgery but this can only be possible with the right patient, right surgery and management of lifestyle factors.

I hope the above discussion has been helpful in allowing you to make an informed decision.With the right snoring surgery, you can breathe better and sleep better. Not to mention the social and emotional positive effects on your sleep partner!

Share this blog via: