Treatment Options for Sleep Apnea and Snoring
The pillar procedure is a wonderful office-based procedure for the treatment of snoring and sleep apnea. In just 15 minutes, individuals who have suffered with snoring for years can have relief of their symptoms with this minimally-invasive procedure. The Pillar Procedure is FDA-cleared for treatment of snoring and mild to moderate obstructive sleep apnea.
Clinical data for this procedure has shown the following:
- Bed partner satisfaction at 80% or better
- Improvement in snoring intensity
- Improvement in daytime sleepiness.
How It Works
Snoring is caused by vibration of the soft palate against the back of tongue or throat. The pillar procedure involves the insertion of 3 or more small woven implants into the muscular layer of the soft palate. The physical characteristics of the implant will cause the soft palate to stiffen. There will also be favorable stiffening of the tissues because of the body's natural scar tissue reaction around the implants that takes several months to occur.
The procedure is performed in the office and takes less than 30 minutes. Topical and local anesthesia are applied to the soft palate. The pillar implants are placed with a specially-designed insertion device into the muscular layer of the soft palate. The procedure is not painful. There may be a very mild sore throat for 1-2 days.
What are the benefits
Improvement in snoring and/or sleep apnea with a simple office-based treatment.
What are the risks
There is a small chance of implant infection or extrusion which would require removal of one of the implants. This can be replaced at a later date if necessary. It is possible that the procedure will not adequately correct snoring or apnea. In this case, another treatment such as RF tongue base treatment or an oral appliance may be appropriate.
Our cost for the procedure is $1500.
Obstructed nasal breathing is a factor in many patients with snoring and sleep apnea. Our Board-Certified ENT physicians will accurately diagnose and treat any causes of nasal breathing difficulties. We provide a full range of care for issues related to nasal congestion.
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Home sleep studies make the diagnosis of sleep apnea much more convenient and affordable than spending the night in a sleep laboratory, away from the comfort of your own bed. It provides a more realistic picture of how you are actually sleeping in your own environment. Patients check out the device from our office in the afternoon and take it home. It is worn on the wrist and has two probes on the fingers to measure oxygen and blood pressure. It is activated when you lie down to sleep and records information all night. You bring it in to the office the next day and the data is collected and interpreted at the time of your follow-up consultation that day.
Insurance covers home sleep studies in most situations. Deductibles or co-payments may apply as a specific plan dictates. Home sleep studies are considerably cheaper than laboratory based studies. They are also more representative of your actual sleep patterns. Our cash price for patients without insurance coverage is $250.
An oral appliance is a device that is worn in the mouth, similar to a dental retainer, that causes slight protrusion of the lower jaw. There is an adjustable screw that allows us to optimally set the position of the lower jaw. The device is worn at night during sleep to prevent the soft tissues of the tongue base from falling back and causing snoring and sleep apnea. Thus, this is a non-surgical treatment alternative for snoring and sleep apnea. It is much less cumbersome and much more portable than a CPAP machine.
We perform the fitting of the device in our office in about 15 minutes. Patients who have active dental disease may not be good candidates for this treatment. The device is molded to the upper and lower teeth. The protrusion screw is set at a length that causes slight protrusion of the lower jaw but is still comfortable to wear. Patients take the device home and are ready to start using it immediately.
Most insurance plans have benefits that cover oral appliance therapy. We will verify your insurance benefits so that you will know how much (if any) you will have to pay out of pocket for the oral appliance. A sleep study is required that documents the presence of obstructive sleep apnea.
RF tongue base treatment is a minimally-invasive treatment option for snoring and sleep apnea. For many patients, obstructed breathing happens during sleep because of the the bulky soft tissues at the back of the tongue falling back and hitting the soft palate or throat. RF Tongue base treatment is performed to shrink this bulky soft tissue.
The procedure is performed in the office and takes less than 30 minutes. For most patients, a series of 3 treatment sessions will be planned about one month apart.
Topical and local anesthesia are applied to the back of the tongue via the mouth. Next, a curved radiofrequency probe is inserted underneath the mucus membrane at the back of the tongue. The radiofrequency energy emanates from the tip of the probe to cause a low level of heating to the surrounding soft tissues. This will cause contraction of the proteins and volumetric reduction of the bulky soft tissue at the back of the tongue.
Afterwards, there will be a sore spot at the back of the tongue for several days. Generally, this can be controlled adequately with over-the-counter pain medication, but prescription pain medication will be made available if needed. Patients can resume a normal diet and activities the next day. There are no incisions in the throat, so this procedure is much less pain than surgery of the tonsils and soft palate that has traditionally been done for treatment of obstructive sleep apnea.
Should I have RF Treatment of the Tongue Base?
Should I have RF treatment of the tongue base?
This procedure is indicated for mild to severe obstructive sleep apnea. A sleep study is needed to determine if you have sleep apnea if you have not already had one. We perform convenient home sleep studies if you have not yet had a sleep study.
One of our board-certified ENT doctors will examine your airway to assess which procedure(s) would be necessary for the best chance of cure. If your doctor determines that the tongue base is contributing to the obstruction, then RF treatment of the tongue base would be an excellent option.
Keep in mind that untreated obstructive sleep apnea is very harmful to your health. If you have been diagnosed with obstructive sleep apnea, and you are not currently being treated, then you need to address this important health problem. If you have been told that you needed to wear a CPAP mask, but you are unable or unwilling to do so, then you should consider a minimally-invasive treatment that we provide.
What Are the Risks of the Procedure?
There will be some soreness at the back of the tongue for several days after each procedure. There may be rare instances of swelling or infection that would require hospitalization or surgery. There may be rare instances of tongue numbness, tongue weakness, difficulty with speech, or difficulty swallowing. There is always a chance that the snoring or sleep apnea will persist, which may result in needing another form of treatment.
What Are the Benefits of the Procedure?
Studies show that radiofrequency tongue base treatment is safe and effective. Specifically, the procedure has been shown to decrease apnea index scores as measured on sleep studies, decrease daytime sleepiness, and improve sleep-related quality of life. For a summary of the data on this procedure, please view the American Academy of Otolaryngology--Head & Neck Surgery position statement on the procedure.
This procedure is covered by most insurance plans for patients with a diagnosis of obstructive sleep apnea. Deductibles or co-payment rules may apply as each individual plan dictates. We will verify insurance benefits so patients are aware of out-of-pockets costs that may be incurred.
Tonsillectomy and Adenoidectomy in Children
Children with large tonsils and/or adenoids are at risk for snoring and sleep apnea. In children, symptoms may include restless sleep, mouth breathing, bed-wetting, difficulty with concentration, memory/learning problems, and behavioral problems. In fact, sleep-disordered breathing is the most common reason for removing tonsils and adenoids.
In children with large tonsils and adenoids, surgical removal will result in cure of sleep-related breathing disorders in approximately 90% of patients.
Tonsillectomy in Adults
Adults with large tonsils also benefit from tonsillectomy as part of the treatment for snoring and sleep apnea. In some adults tonsillectomy alone may be curative.
Surgery of the Palate
UPPP (uvulopalatopharyngoplasty) is a surgical procedure of the tonsils and soft palate for treatment of obstructive sleep apnea. The procedure takes about 1 hour in the operating room under general anesthesia. The tonsils are removed and a small triangle of tissue is removed adjacent to the base of the uvula on both sides. The uvula is shortened as well. Sutures are placed to facilitate proper healing.
In properly selected patients, UPPP is curative in approximately 80% of cases.
Surgery of the Mandible
Patients with a recessed chin are at increased risk of developing obstructive sleep apnea because the structure of the jaw lends itself to crowding of tissues in the throat. Genioglossus Advancement (GA) is performed to create a more favorable mandibular anatomic alignment. This procedure is often performed in conjunction with other procedures such as UPPP or tongue base radiofrequency ablation.
CPAP stands for continuous positive airway pressure. It refers to a medical device that is worn over the nose or mouth and connected with tubing to a small machine. The machine delivers a certain amount of positive air pressure to assist breathing during sleep.
CPAP has been the mainstay of treatment for obstructive sleep apnea for many years. Its benefits are well-documented in the medical literature. There is little to no risk involved in using CPAP. It reverses the ill-effects of obstructive sleep apnea immediately when worn appropriately.
The problem with CPAP is that it is cumbersome and not always comfortable. In fact, studies show that upwards of 50% of patients who are prescribed CPAP are not able to use it. We encourage most patients to try using CPAP before undergoing a procedure but we are well aware of the fact that CPAP is just not going to work for everyone.
We typically prescribe CPAP using an auto-PAP device. With this technology, the machine finds the optimal pressure setting for each patient. Therefore, once sleep apnea is diagnosed, patients can move directly to treatment.
Most insurance plans have benefits that cover CPAP therapy. Indication for coverage include anyone with moderate or severe obstructive sleep apnea. Mild apnea is also covered if associated with symptoms such as daytime sleepiness or medical conditions such as cardiovascular disease, high blood pressure, or mood disorders. We fill out an order form for CPAP and patients then take this to any medical supply store. The medical supply store will verify insurance benefits for the CPAP machine.