Sleep Disorders: Minimally Invasive Procedures to Stop Snoring
Guest: Dr. M. Boyd Gillespie – Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing, today, Dr. M. Boyd Gillespie, who is an ear, nose, and throat doctor, and he’s Director of the MUSC Snoring Clinic. Dr. Gillespie, we’ve talked a lot about how snoring and sleep apnea often go hand in hand, but they don’t always go hand in hand.
Dr. M. Boyd Gillespie: That’s correct. Approximately 40 percent of the adult male population snores on a nightly basis, but only 10 to 15 percent will have apnea. So, the vast majority of snorers are just that; people that have turbulent flow of air through their upper airways, causing a loud noise, which is, perhaps, annoying to their bed partner, but don’t have the medical condition sleep apnea.
Dr. Linda Austin: So, what do you offer those folks?
Dr. M. Boyd Gillespie: The management of snoring really depends on the individual situation. However, most snoring sound is generated by a flutter, or motion, in the soft palate during sleep. The soft palate is the tissue at the back of the throat that’s attached to the uvula; the little piece of tissue that hangs down in the back of the throat. So, if we can reduce the flutter in the soft palate, that often reduces the snoring sound, and improves sleep for both the snorer, and their bed partner.
Dr. Linda Austin: So, how do you do that?
Dr. M. Boyd Gillespie: There are, fortunately, several methods currently available that can actually be done in the office under local anesthesia. We currently offer two of these treatments in our practice. The choice between the treatments, really, is based on patient preference. However, both treatments can be done in the office in a way that allows the patient to continue eating a normal diet with very minimal pain or discomfort after the procedure.
The newest treatment is one called the Pillar procedure. This is an innovative new treatment that involves placement of three small microfibers, or threads, in the soft palate tissue under local anesthesia. We start by anesthetizing the throat with a spray that numbs the throat. Then we inject a small amount of lidocaine or novacaine into the soft palate, followed by the placement of these threads. These threads cause a stiffening of the soft palate that reduces the flutter, and reduces the snoring by at least by half in most cases. In some cases, it completely eliminates the snoring.
The benefit of this procedure, and the thing that was somewhat new about it was that, prior to this time, most of the procedures required some destruction or removal of tissue. This, however, does not destroy tissue. It reinforces tissue. And that’s one reason why the pain is so minimal after the procedure. Most patients will take Tylenol for a day, but they’re able to eat a normal diet immediately afterwards.
Dr. Linda Austin: How long do the benefits last?
Dr. M. Boyd Gillespie: The procedure has been available in the United States now for three years, so our very long-term data is somewhat limited. But the results should be permanent. And that’s another advantage of this technique.
Dr. Linda Austin: That’s exciting.
Dr. M. Boyd Gillespie: It’s very exciting.
Dr. Linda Austin: And I would guess that this approach would also work for those who snore that have sleep apnea, assuming that it’s caused by a palate problem.
Dr. M. Boyd Gillespie: That’s correct. We’re also using this technique in patients who have mild levels of sleep apnea, or as an adjunct, or extra, procedure in some patients who are using other treatments, such as CPAP. For instance, one of my patients was a business man who had to take a lot of flights, but used CPAP at night. However, he wanted to take a nap on an airplane and would often snore and bother the other passengers.
Dr. Linda Austin: I think I’ve sat next to him.
Dr. M. Boyd Gillespie: So, we performed the Pillar procedure on him and helped resolve his snoring during the daytime, or at other times, when he didn’t have his CPAP mask available.
Dr. Linda Austin: Now, you mentioned that there was another procedure that you do. What is that one?
Dr. M. Boyd Gillespie: Another procedure we do is called the radio-frequency treatment. Radio-frequency involves, under local anesthesia, placing a small probe in either the tissues of the soft palate or tongue, and slowly heating that tissue, causing a scar formation, or a stiff area, that reduces flutter in those tissues. One of the benefits of radio-frequency is that it doesn’t just work for the palate. There’s a site in the nasal tissue that’s swollen, or a site on the tongue that is enlarged or swollen. It can also treat those levels as well. So, radio-frequency is a better treatment for snoring if it involves areas other than just the palate.
Dr. Linda Austin: As you describe these diagnostic procedures, and the treatment, I can’t help but think that it sounds uncomfortable. We all think of that part of our body as being very sensitive. Is it uncomfortable?
Dr. M. Boyd Gillespie: I describe it to my patients being similar to a visit to a dentist to have a minor procedure done. Often, patients find that it’s less uncomfortable for them than a routine teeth cleaning. We do use local anesthetics, and that increases the comfort level. The pain afterwards is typically minimal. Some patients describe a very mild level of sore throat that responds well to Tylenol or Advil.
Dr. Linda Austin: How about the examination itself, is that uncomfortable?
Dr. M. Boyd Gillespie: The examination of the nose and throat region typically involves evaluation of the entire airway, from the nasal tip down to the vocal cords. Often, as part of that, we use a flexible scope, that is very small, which we pass through the nasal passages to be able to assess the entire airway. We do use sprays to numb and decongest the nose. It’s slightly uncomfortable.
I have, and I often do, let medical students and residents practice this on myself, and I tell my patients that if it were so terrible, I wouldn’t let people practice on me, on a regular basis.
Dr. Linda Austin: Dr. Gillespie, thanks so much for talking with us today.
Dr. M. Boyd Gillespie: Thank you very much.
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