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WHO'S MINDING THE SNORE?VALLEY DOCTORS PUT A PILLOW OVER MANKIND'S LOUDEST SLEEP DISORDER

Tossing restlessly on her pillow, Jean B. took some solace in knowing that at least she'd tried to make it work.

But after 28 years of connubial bliss, she could no longer tolerate what her husband had introduced to their marital bed.

"I was being victimized," says Jean, whose unhappiness with what transpired in the couple's boudoir every night for the past four years ultimately forced her to take drastic measures. "I reached a point where I had to say, 'I can't take this anymore! I have to be comfortable, too!'" She did what she had to do. No longer able to cope with her snoring husband's explosive breathing patterns, Jean sought slumber in another bedroom in the couple's north Phoenix home. That was eight months ago. Still, Jean did not go gentle into that good night's sleep.

"We'd tried everything," she says, explaining that her husband first began performing his dreadful sandman sonatas right after a substantial weight gain he experienced some years back. "We bought the nonsnoring pillow--I didn't see any improvement there. We tried doubling the pillows so he's almost sleeping in an elevated position--that didn't work, either." Even staggering sleep schedules provided no relief from her husband's earsplitting pillow squawk. "If I would purposely go to bed earlier, I'd automatically wake up when he came in later," she says, sighing. Safely ensconced in her own bedroom, Jean should be able to sleep easy these days. She's not. Instead, she wonders how she'll cope with her husband's snoring while cooped up in a series of hotel rooms during an upcoming vacation to Europe the couple has been planning for several years.

"We're sure hoping it works out," says Jean, who sounds less than 100 percent convinced. "If I wear earplugs that are supposed to hold out 22 decibels, I can still hear him. His snoring is like listening to a jackhammer all night. It's awful." @rule:

@body:Jean B. is not alone in her nocturnal torment. How many of us haven't fought for sleep while being aurally assaulted by something that sounds like a drowning hog fighting to keep its head above water?

Very few. Because of the sheer volume of chronic snorers--between 20 and 40 million Americans, up to half of them women--not many folks have escaped the displeasure of trying to sleep in the same bed, the same bedroom or (in some particularly severe cases) even under the same roof with a power snorer, only to be jolted out of bed by log-sawing that can wake the dead. But for those who've got the time and the money, the snore wars may be finally coming to an end. In the wake of a breakthrough technique developed in France, several Valley doctors are successfully treating snoring patients' throats with a relatively simple laser process. According to some practitioners, the laser procedure is even effective in treating some forms of obstructive sleep apnea, a condition in which the snorer wakes himself repeatedly during the night.

For snorers who don't relish going under the beam, a number of local dentists now offer a nonsurgical alternative. One of them is Phoenix dentist Enrico DiVito, who, in collaboration with a local manufacturer of orthodontic appliances, has developed a plastic snore guard that fits over a patient's teeth. Priced at $850, and looking similar to a football player's mouthpiece, the custom-fitted appliance repositions the lower jaw slightly, allowing the patient's air passageway in the throat to remain open during sleep. "This is reversible," says DiVito, who claims a success rate approaching 100 percent. "Surgery isn't. The worst that can happen with the snore guard is that you haven't taken medication and you haven't had surgery." @rule:

@body:So what causes this audio difficulty that can clear a bedroom, wreck a marriage and even induce thoughts of murder? Although the end result isn't nearly as much fun, it's basically the same principle that makes a rubber Whoopie Cushion work. During sleep, the tongue and tissues of the throat relax; air passing through this slack tunnel of flesh sets up vibrations that create the noise we know and hate as snoring. Live long enough and you, too, will almost certainly join the ranks of the sandman's vocal majority. Although young adult men who snore chronically outnumber women who do so by a margin of ten to one, that sex differential disappears almost entirely by the age of 60. Even children are not immune; because tonsils (one potential source of snoring problems) are not removed as routinely as they once were, a new generation of boys and girls is snoring up a storm with the best of them.

As recently as the early Seventies, loud log-sawing was generally considered to be a nuisance at worst, the sort of quasi-comical problem that provided fodder for Three Stooges gags and "Dear Abby" columns. But with mushrooming research into sleep-related problems over the past 20 years (there are currently more than 200 sleep-disorder clinics in the United States, as opposed to the 20-some operating a decade ago), snoring has finally been taken seriously.

 

"Snoring can be a socially destructive problem," says Dr. Bernard Levine, director of the sleep-disorder center at Good Samaritan Regional Medical Center. "In many patients, it's terribly severe--enough to destroy relationships and people's ability to stay together."
In some cases, snoring not only jeopardizes domestic happiness, but life itself. The medical community now recognizes snoring as a possible symptom of sleep apnea, a potentially fatal condition in which a relaxed tongue and throat tissues close off the windpipe, stopping a person's breathing. Though few people actually die on the spot (the body monitors oxygen levels during sleep, momentarily waking most apnea sufferers), the condition takes it toll.

"These people are constantly sleepy because, in effect, they're waking up hundreds of times in an evening without realizing it," says Dr. Robert Kearl, a pulmonary specialist affiliated with the sleep laboratory at St. Luke's Medical Center. "It's like answering a phone call in the middle of the night; by morning, you don't even recall you woke up."
@rule:
@body:Since the dawn of man (or, far more likely, the first sleepless night that preceded it), cranky bed partners and roommates have sought relief from the sounds of slumber. Because the best solution--distance--is rarely a viable one, the sleep-deprived Gyro Gearlooses of the world have lain awake nights figuring out how to silence snorers. Today, the U.S. Patent Office lists more than 300 antisnoring devices, most of them amusing looking and many dating back 100 years. Because a lot of snoring problems are positional in nature (people who sleep on their sides tend to snore less), many of the gismos are designed to keep the sleeper off his back. One leather harness patented in 1900 attempted to do this by strapping a cannonball to the snorer's back. Proving that there was very little new under the snoring sun, 80 years later, advice columnist Ann Landers urged readers to insert Ping-Pong balls into pockets sewn on the back of the snorer's pajamas.

Another recurring theme in early-day antisnore science was a glut of bondagelike chin and mouth muzzles; these low-tech devices may not have stopped snoring, but they'd come in mighty handy when dressing up for the next Hannibal Lecter look-alike contest. And just last spring, U.S. Patent 5,284,161 was awarded to a San Francisco doctor who'd invented something named the Snopper Snoring Stopper. A battery-operated device worn in the mouth, the invention tightens relaxed muscles responsible for snoring with an electric shock. And until the bugs are worked out of that one (the device reportedly also zaps any fillings in the immediate vicinity), you can pick up a $60 antisnore wristband at The Sharper Image that gently vibrates the hand whenever a small microphone embedded in the strap picks up the sound of snoring; in theory, the vibrations will cause the snorer to turn over. Cannonballs, muzzles, vibrators? Give it a rest.

"I wouldn't call these things 'quackery,'" says snore specialist Dr. Joel Cohen, a Scottsdale ear, nose and throat doctor. "All of these things work. Nobody snores with these devices. And the reason they don't snore is that they don't sleep. I don't see that as much of a solution. "Then there's the problem of compliance--a lot of people simply don't want to wear an apparatus on their face at night."
Last summer, Cohen grabbed the snoring problem by the throat when he introduced the Valley to a laser surgery technique named laser-assisted uvulo-palatoplasty (LAUP--or "lay-up," as Cohen calls it, in deference to the Valley's basketball mania). Now a fairly common procedure around the country, the laser technique has been adopted by a handful of other Valley specialists. Originally developed in France six years ago for the treatment of snoring and imported to the States just last year, the laser treatment involves reshaping the uvula (the fleshy appendage dangling at the back of the throat), as well as removing excess fatty tissues that block breathing passages during sleep.

"You're basically tightening up the inside of the throat," says Cohen, who has treated more than 100 patients for snoring in less than a year.

"In a way, it's kind of like a facelift. And like a facelift, over time, it's going to start sagging a little bit." Unlike those of plastic surgeons, however, Cohen's fee includes periodic laser touchups.

Enthusiasts of the laser technique favorably compare it to uvulopalatopharyngology (UPPP), a similar--but far more complicated--surgical procedure previously performed on patients with severe nighttime breathing difficulties. Unlike UPPP, the new laser technique is bloodless, can be performed during an office visit using a local anesthetic, and the patient can usually return to work the same day. Depending on the severity of the snoring problem, multiple treatments (usually no more than four, spaced out at four-week intervals) may be necessary. Patients typically suffer from a sore throat for several days, a condition minimized by prescription pain medication. Because snoring is considered a "cosmetic" problem, cost of the procedure--typically in the $2,000 range--will probably not be covered by insurance unless treatment for obstructive sleep apnea has been recommended by a sleep-disorder clinic.

 

"The big problem with UPPP was that you had to make a decision at the time of surgery: 'How much do I take off?'" explains Dr. Mark Baldree, a Phoenix ear, nose and throat specialist who has been performing the laser technique for nearly a year. Take away too much tissue, says Baldree, and the patient might experience a voice change or difficulties in swallowing. Don't take away enough and the patient might continue to snore even after enduring the ordeal of surgery. "With the laser technique, you can go back and take some more off if you need to," continues Baldree. "It's kind of like doing a haircut."
Says Cohen, "UPPP is probably an operation that will never be done again for snoring."

Still, not everyone is ready to hop into bed with the miracle snore laser just yet.

"In skilled hands, [the laser technique] should be as safe as the [UPPP] surgical procedure--which is pretty safe," says Good Samaritan's Bernard Levine. "But there's one major danger in all of this. If you suffer from snoring and sleep apnea [and] you have the [laser] procedures, it's possible to get rid of the snoring without getting rid of the sleep apnea. When the snoring is gone, the patient may have sleep apnea and the problem will be more difficult to detect."
St. Luke's Robert Kearl agrees. "Like any new procedure, it often takes a year or two to shake out what [the procedure] is really about. If you just treat snoring and the person has sleep apnea, then you may just be covering up the problem."

Even Jean B., who's willing to try almost anything to restore peace to her boudoir, remains skeptical.

"My husband looked into it, but I discouraged it," she says. "It's still really innovative and new. I'm really afraid that they don't know what the true side effects will be down the road. Plus, understand there's no guarantee that it will even work. I'd hate for us to spend all that money for nothing."
@rule:
@body:In spite of those reservations, some former apnea sufferers claim that laser therapy was the light at the end of a very long, dark tunnel. "I was falling asleep all the time," says Valley pharmaceutical representative Glenn Nelson, whose sleep apnea was eventually diagnosed during an overnight stay at a local sleep-disorder clinic. "I was tired so much of the time that it was very difficult for me to drive."

A salesman, Nelson's job requires frequent car trips to service accounts in northeastern Arizona; miraculously, his sleep disorder never resulted in an automobile accident. Still, Nelson reports that he often grew so weary behind the wheel that he'd fend off fatigue with gallons of anything that contained caffeine. "I used to compensate by drinking lots and lots of coffee," remembers Nelson, whose apnea was later cured with a single laser treatment. "I was chugging down at least a six-pack of Coke a day just to stay awake."

Like many people, Nelson erroneously equated loud snoring with a good night's sleep. That's why Nelson couldn't figure out why he woke up dead-tired every morning in spite of the eruptive snoring spells that finally drove his wife from their bedroom.

Although sleep apnea, like snoring, most often occurs in overweight, middle-aged men, the condition is not limited to those who fall into that high-risk category. Donna Holman is neither overweight nor male. A retired Arkansas school teacher who winters in Mesa, Holman spent several years in a waking fog before doctors traced her debilitating daytime exhaustion to the tortured, apnea-induced snoring that ruined her sleep (as well as her husband's) each night. "I just couldn't seem to stay awake," reports Holman, remembering how she'd routinely fall asleep in the middle of meals and conversations, and of how she'd have to pull her car over to the side of the road for en-route catnaps before giving up driving for good.

For several years after her apnea was diagnosed, Holman found relief with a nasal continuous positive airway pressure unit (nasal CPAP, for short). Resembling a fighter-pilot mask attached to an air pump, the device keeps breathing passages open by pumping a steady stream of air into the apnea sufferer's nose during sleep. "It sounds fairly uncomfortable, but it's considered the treatment of choice for sleep apnea if it works," says St. Luke's Kearl. "When you look at large numbers of patients [who use the nasal CPAP device], once they start wearing it, they feel so much better that they swear by it."

 

"It took some getting used to," admits Holman, who nevertheless wore the mask for several years before learning of the laser treatment. Finally able to shuck the mask after undergoing laser therapy several months ago, she says, "If you've never had to sleep with that thing over your face, you can't imagine what it's like. I feel like I've gotten out of prison." @rule:

@body:Will laser-assisted snore therapy ever replace a well-aimed elbow or the couch in the den?

Dr. Joel Cohen sincerely doubts it. "I may be able to stop the snoring, but if that marriage is not a good marriage, nothing's going to help it," says Cohen. "This operation can't make a bad marriage a better marriage."

The point was dramatically driven home last year, around the time he began performing the procedure. Running into the wife of a friend whose legendary snoring was so bad the couple hadn't slept in the same room for years, Cohen couldn't wait to share the news of the laser treatment that would change the pair's life.

The woman cut him off instantly. "Do me a big favor," she told Cohen. "Whatever you do, don't tell my husband about this. I like sleeping alone."

Cohen shrugs. "Like I said, this isn't for everybody.


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