By Jana Soeldner Danger
City & Shore Magazine
Snoring can be annoying for a person’s sleep partner. But loud snoring can also be a sign of obstructive sleep apnea, a potentially serious health problem. Now a new, minimally invasive procedure developed by Dr. Lee Mandel, MD, an otolaryngologist with offices in Plantation and Fort Lauderdale, uses laser technology to correct the condition. The procedure has significant advantages over older treatments, he says.
Obstructive sleep apnea is a disorder in which an individual experiences either frequent cessations or limitations of breathing for a minimum of 10 seconds, or a drop in oxygen saturation, or both. The condition is usually caused by narrowing of the nasal airway and excessive size or flaccidity of the soft palate. In many cases, lack of nasal airflow while sleeping causes the mouth to open, creating negative pressure that pulls the palate and tongue backward, causing obstruction, Dr. Mandel says. The obstruction results in the individual waking briefly, something he or she may not even be aware of, to re-establish airflow. In patients with severe OSA, the process can occur more than 30 times in an hour, Dr. Mandel says.
The frequent waking, which can cause an individual to lose up to an hour of sleep each night, often results in tiredness the next day. The consequences of this lost sleep can be poor concentration and irritability and may contribute to high blood pressure, heart attack or stroke, and increased risk of car accidents, Dr. Mandel says.
The most common method of treating the disorder is with a CPAP (continuous positive airway pressure) mask that covers the nose and mouth. The mask is attached to a hose connected to a machine that blows air into the nose and mouth, creating a cushion of air to keep the airway open. But about 50 percent of users can’t or won’t tolerate the mask, or may use it for only part of the night, Dr. Mandel says.
Another treatment is surgery in which a portion of the soft palate is cut away. But the procedure is often painful, requires significant recovery time and has a 50 percent failure rate, he says.
A new technique
So Dr. Mandel set out to design a procedure to treat the disorder that would be minimally invasive, yet have a high rate of successful outcomes. The technique he developed uses a contact diode laser to create a controlled abrasion in the patient’s soft palate. The scarring that occurs contracts as the abrasion heals, shortening and stiffening the soft tissue of the palate and pulling it upward. Some patients also require treatment in the narrowing of the nasal airway.
The procedure is done in the office, takes 15 to 20 minutes and has an 85 percent success rate, Dr. Mandel says. The remaining 15 percent of patients can often be maintained with a dental appliance that adjusts the jaw and pulls the base of the tongue forward. Most people see an improvement within a week, with maximum improvement after eight weeks, Dr. Mandel says. The main side effect is a sore throat that lasts a week or two.
No more CPAP
Michael Hirsch, a tax service manager in Fort Lauderdale, is glad he had the procedure. He first went for treatment about four years ago when his wife complained about his loud snoring. “I was also feeling tired during the day,” he says. He began using a CPAP but didn’t like it. “It was just kind of a hassle,” Hirsch says.
When Dr. Mandel described the new procedure, Hirsch decided to try it. “They were good about giving me all the information,” he says. “I had an excellent outcome. I haven’t used the CPAP since the night before the procedure. I go to sleep with no snoring, and wake up refreshed.”