New ‘cures’ for those who suffer from sleep apnea or are heavy snorers.
The third and final part of this feature examines more recent developments in the treatment of heavy snoring and sleep apnea.
You can have your tongue stitched to the base of your mouth.
This new approach, on trial at Westside Ear Nose and Throat Clinic in New York, involves ‘tying’ the tongue to the base of the mouth so that it cannot fall back and is primarily for sleep apnea sufferers and heavy snorers.
Sleep apnea occurs when the muscles that would normally hold the airways open relax during sleep — as a result, the base of the tongue and other soft tissue collapse. It’s the vibration of this tissue as air passes over it that causes the characteristic sound of snoring.
In some cases the airways can close completely — the patient then stops breathing for several seconds before the brain steps in to get things working again. However, this can lead to a patient briefly waking up to 100 times a night. If left untreated, sleep apnea is linked to daytime sleepiness, hypertension, depression, coronary artery disease and stroke. Current treatments range from lifestyle changes, such as avoiding alcohol and losing excess weight, to surgery.
The most common treatment for moderate to severe cases is a continuous positive airway pressure (CPAP) device. This is a mask worn over the mouth and nose that gently blows air into the throat to keep the airways open while the patient sleeps and a number of patients find the mask hard to use.
Another option is surgery. Surgeons move a section of the lower jaw forward, which pulls the muscle attached to the tongue and prevents it from flopping back. Potential complications include jaw bone fracture or broken teeth.
In this experimental surgery, a tiny hole is drilled into the lower jaw bone at the base of the chin — a very thin needle is then threaded through into the back of the tongue. The needle contains a special type of surgical tape that has a number of tiny plastic cones threaded along it, like beads on a string. Not only do these cones anchor the thread in the tissue, but they trigger tissue to grow in and around them. The cones slowly dissolve over a period of three months, but this new tissue helps provide permanent anchor points for the tongue, preventing it moving out of place. Once it’s been stitched in place, the thread is gently pulled to anchor the back of thetongue to the base of the mouth.
Because this is deep in the tissue, it won’t interfere with talking or chewing. However,the anchoring is still strong enough to prevent the tongue from flopping back at night and blocking the airway.
‘The purpose of surgery is to eliminate the need for a continuous positive airway pressure device,’ say the researchers. ‘People who undergo this procedure will have a significant drop in the rate of breathing pauses at night. By lowering the apnoea rate, most patients wake up much more refreshed and have more energy during the day. It will also lower your risk factors for heart disease in the future.’ Commenting on the new procedure, Andrew McCombe, an ear, nose and throat surgeon at Frimley Park Hospital, Surrey, said: ‘It should work, but as ever it is very important that patients are thoroughly and carefully assessed to make sure it is the right people who get the treatment because it won’t work for everyone’.
Verdict: ‘This is going to work best for those where a big tongue, or specifically tongue base, is the cause of the problem. A full and thorough upper airway assessment is required to identify the exact nature of the problem so as to make sure the right treatment is provided. People whose snoring or apnoea is caused, for example, by nasal obstruction, large tonsils or laryngeal tumours may not benefit from the surgery.’
Have they got your number on this cure?
In another development, the vibration technology found in mobile phones is being used to combat sleep apnoea and chronic snoring.
Scientists have devised a small ring-shaped device, about the size of a 10p piece, which is attached to the back of the neck and vibrates whenever the wearer turns onto their back.
The device contains a pressure sensor that triggers the alarm ten seconds after a person lies on their back. It vibrates with gradually increasing strength until the wearer changes position.
In a clinical trial at St Lucas Andreas University Hospital, Amsterdam, 30 patients wore the device for a year. As yet there has been little further development or news of this method.
Verdict: Don’t ring us, we’ll ring you…..
By John Redfern