Table of Contents
Sleep Disorder Snoring & fatigue?
Sleep Disorders: Sleep problems and nightmares
Obstructive sleep apnea & tonsils
Wellbutrin, insomnia & depression
Sleep Disorder
During normal breathing, air passes through the throat on its way to the lungs. The air travels past the soft palate, uvula, tonsils, and tongue. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place preventing them from collapsing and/or vibrating in the airway. During sleep, the uvula and soft palate frequently vibrate causing the distinctive sounds of snoring.
The LAUP procedure is a laser surgical procedure designed to sequentially trim and shorten these structures, thus preventing or reducing snoring.
Risks and Complications You have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications. The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. They are listed here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning this surgical procedure.
1. Failure to resolve the snoring. Most surgeons feel that about 85% of patients who undergo a LAUP will have a significant or complete resolution in their snoring; and an additional percentage of patients will notice reduced levels of snoring such that their sleep partners will report that it's level is no longer offensive.
2. Failure to cure sleep apnea or other pathological sleep disorders. Pathological sleep disorders, like sleep apnea, are medical problems which may have associated serious complications. At this time, the LAUP procedure has not been proven to cure these disorders.
3. Bleeding. In very rare situations, a need for blood products or a blood transfusion. You have the right, should you choose, to have autologous or designated donor directed blood pre-arranged. You are encouraged to consult with your doctor if you are interested.
4. Nasal regurgitation, a change in voice, or velopharyngeal insufficiency when liquids may flow into the nasal cavity during swallowing (rare).
5. Failure to resolve coexisting sinus, tonsil, or nasal problems.
6. Need for revision, or further and more aggressive surgery.
7. Prolonged pain, impaired healing, and the need for hospitalization
Sleep Disorder Snoring & fatigue?
During normal breathing, air passes through the throat on its way to the lungs. The air travels past the soft palate, uvula, tonsils, and tongue. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place preventing them from collapsing and/or vibrating in the airway. During sleep, the uvula and soft palate frequently vibrate causing the distinctive sounds of snoring.
Sleep apnea is a condition associated with breath holding. Most patients with sleep apnea will be very loud snorers. Sleep apnea is a chronic medical condition associated with chronic fatigue, morning headache, sudden death, and car accidents.
Any person who is a loud snorer and is observed to have breath holding during sleep should be suspected as having sleep apnea. Sleep apnea is diagnosed with a sleep study. I would suggest that you see your doctor regarding this problem. Fatigue can be related to snoring.
Sleep Disorders: Sleep problems and nightmares
During a nightmare your body muscles which are under your control (except for eyeball muscles) such as legs, speech, arms, etc are paralyzed--ie you can't run downstairs!! What she had was called a "night terror"--similar to what others do when sleep walking. The person is asleep, may occasionally wake up spontaneously, but until that time has no idea what is going on--night terrors are really most frightening for the observer vs the patient. To learn more about sleep issues pick up a copy of "Solve Your Child's Sleep Problems".
Large tonsils and snoring?
Large tonsils, or hypertrophic tonsils, can frequently cause severe snoring, breathing holding, difficulty eating, choaking, and sleep apnea. This can occur as an isolated event or in conjunction with recurrent tonsillitis. If the problem becomes severe, tonsillectomy with adenoidectomy is often recommended.
Obstructive sleep apnea & tonsils
Obstructive sleep apnea in normal children is almost always caused by enlarged (hypertrophic) tonsils and adenoids). These children will display the typical sleeping patterns of sleep apnea. They have loud snoring, frequent pauses with breathing at night, frequent awakening from sleep, restless sleep, nightmares, and bedwetting (enuresis). During the daytime, these children are mouth breathers, may have excessive daytime sleepiness, and poor school performance.
Other more rare causes of sleep apnea include any congenital (present from birth) or acquired cause of upper airway obstruction.
The treatment of obstructive sleep apnea is directed to the cause of the obstruction.
As noted above, most cases of obstructive sleep apnea in children is caused by enlarged tonsils and adenoids. Surgical interventions are therefore directed to what is causing the obstruction. In the case of enlarged tonsils and adenoids, tonsillectomy and adenoidectomy is usually successful in relieving the problem. If the problem is not the tonsils and adenoids, the cause of the obstruction must be determined. For example, surgery of the jaw may be required. In some cases, even a tracheostomy is necessary. Non-surgical therapies include oral prostheses (difficult in children), medications (steroids, stimulants), and weight reduction.
In almost every case of obstructive sleep apnea in children who do not have unusual anatomic problems, tonsillectomy and adenoidectomy is a safe and effective treatment, and is highly recommended.
Sleep Apnea sleep disorder
In general, surgery for sleep apnea is only about 50% successful. However, you would need to talk with your surgeon regarding your specific situation. Surgery is usually recommended only after medical therapy has failed. If your main concern is the snoring, then either the laser procedure or the new Somnoplasty carries about an 85% success rate for resolution of the snoring.
Snoring & sleep apnea help?
Sleep apnea is when someone involuntarily does not breath during sleep. It can be either central or obstructive. Central apnea, which is less common, is when the brain forgets to tell the body to breath. Obstructive apnea occurs when the muscles or soft tissue in the throat prevents the normal movement of air. The signs of obstructive sleep apnea include severe snoring, breath holding, fatigue, and morning headache.
Sleep apnea must be diagnosed by a sleep study. A sleep study measures the heart rate, breathing patterns, and brain waves of the patient while they sleep. It is absolutely essential that this study be done on anyone suspected of having sleep apnea.
The treatments for sleep apnea include weight loss, avoidence of sleep depressants (alcohol, sleeping pills, etc), CPAP ( a mask used at night to keep the airway open), dental repositioning devices, and surgery.
During normal breathing, air passes through the throat on its way to the lungs. The air travels past the soft palate, uvula, tonsils, and tongue. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place preventing them from collapsing into the airway. During sleep, these structures can fall into the airway causing snoring and obstructive sleep apnea. Uvulopalatopharyngoplasty with or without tonsillectomy are surgical procedures designed to circumvent this sleep releated collapse of these structures. The new Laser assisted uvulopalatoplasty (LAUP) is a laser surgical procedure designed to sequentially trim and shorten the palate preventing or reducing snoring. Its effect on sleep apnea is unproven.
Oxygen for sleep deprivation?
Your problems can be evaluated by an Ears, Nose, Throad (ENTor otolaryngologist) doctor--if you are having sleep problems associated with significantly enlarged adenoids and a very relaxed palate then various surgical operations may be necessary to review. The problem is not one of too little oxygen, but rather may be related to anatomical issues (how his air passages are designed). Speak with your doctor about this. Many times it is helpful to make a video tape for either his doctor or the ENT doctor to see--a picture and sound is worth a thousand words.
Twilight sleep in obstetrics
The term "twilight sleep" applied to the combination of analgesia (pain relief) and amnesia (loss of memory) that was produced by a mixture of morphine and scopolamine ("scope") given by a hypodermic injection (an injection under the skin). The mixture of the two drugs created a state in which the woman, while responding somewhat to pain, did not remember it after delivering her baby. Twilight sleep was once in vogue in obstetrics.
Morphine and scopolamine are both venerable drugs that have been around a long time. Both are also naturally occurring members of the very large chemical class of compounds called alkaloids:
Morphine: The name "morphine" was coined in 1805 by the German pharmacist Adolf Serturner -- "morphine" refers to Morpheus, the mythologic god of dreams -- to designate the main alkaloid contained in opium. Opium, of course, comes from a plant: the poppy. Morphine is a powerful narcotic agent with strong analgesic action and other significant effects on the central nervous system. It is dangerously addicting. Scopolamine: Scopolamine was introduced in 1902 and used up until the 1960s. The name comes from that of the 18th-century Italian naturalist Giovanni Scopoli. Together with atropine, scopolamine is a component of belladonna which comes from a plant called "deadly nightshade," once used as a means of poisoning ones enemy. When scopolamine is given in lower (non-poisonous) doses, it causes drowsiness, amnesia, and euphoria (a "high") and was thus used as a preanesthetic agent. Combined with morphine, scopolamine provided childbirth without pain (or without the memory of pain), once a much sought-after objective. However, there were serious problems with twilight sleep. It completely removed the mother from the birth experience and it gravely depressed the baby's central nervous system. This sometimes made for a drowsy depressed baby who was difficult to resusitate, to get breathing normally.
Twilight sleep has, therefore, fallen entirely out of favor and is now merely a chapter in the past history of obstetrics.
Chronic snoring cures
During normal breathing, air passes through the throat on its way to the lungs. The air travels past the soft palate, uvula, tonsils, and tongue. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place preventing them from collapsing into the airway. During sleep, these structures can fall into the airway causing snoring and obstructive sleep apnea.
Sleep apnea is characterized by loud snroing and distrubed or interruped sleep patterns. Sleep apnea can have serious consequences including cardiac problems. Frequently patients will awaken in the morning with a headache. If they become sleep deprived they may feel sleeppy all day, and may fall asleep while driving in the car.
Sleep apnea is diagnosed by a sleep study. During a sleep study, the patient's breathing patterns, heart rhythim and brain waves are monitored.
If it is found that sleep apnea is present, most doctors recommend the use of CPAP. CPAP is a breathing device worn during sleep to help keep the airway open. In some situations surgery is recommended. The uvulopalatopharyngoplasty with or without tonsillectomy are surgical procedurs designed to open the airway. In rare situations, a tracheostomy is necessary. These are procedures designed to circumvent this sleep related collapse of these structures.
Wellbutrin, insomnia & depression
Insomnia occurs in 18.6% of patients who take bupropion (Wellbutrin). Two percent of patients discontinue bupropion because of insomnia and agitation. Interestingly, 19.8% of patients experience sedation instead of insomnia. Decreasing the dose, adding a sedative drug or switching to a different antidepressant may alleviate the problem.
