The Latest News from Dr. Linda Dahl
November 17. 2022
Hello beloved patients, friends, and colleagues,
We have some great news! To better serve our community, we now have office hours at our Manhattan location on Tuesdays, Wednesdays, and Fridays from 9 am to 5 pm for ALL of our patients. (We will be closed next Friday for Thanksgiving).
We also have a new email: info@drlindadahl.com. Complete contact information is below.
As we look forward to the holidays, we are also dealing with shorter days and colder weather. With that comes more illnesses. Included in this issue are some tips to stay healthy and an article on the history of snoring treatments.
Love,
Dr. Dahl
In ENT News:
This fall has brought more than our share of illnesses. Now that most industries are back to work in person, we are getting sicker more often. Along with Covid (believe it or not, there are over 300 circulating subvariants around the world) we have above-average levels of the flu and respiratory syncytial virus (RSV).
But exposure alone doesn’t cause illness. There are a lot of ways to protect yourself and help yourself heal more quickly when you’ve been exposed.
Taking at least 5000 ius a day of Vitamin D helps prevent illness and also helps your immune system fight off infections.
Immucore is a supplement made from vitamins and Chinese mushrooms that can guard against viral infections.
If you get congested, try to dry out your sinuses to prevent a bacterial infection. Medicines like Dayquil, Mucinex D, Claritin or Zyrtec, and Afrin (for ONLY 3 days) can be helpful if you are able to take them.
SinuOrega, a nasal spray made with oregano and clove oil, can clear up your nose and make it harder for viruses, bacteria, and yeast to take hold.
If you’ve ever wondered about all the treatments available for snoring, read the full-length article below:
Snoring and a Brief History of the Quest for a Cure
When I was eight, my dad moved our family to North Dakota. If the culture shock of living in a tiny town in the middle of nowhere wasn’t bad enough, he made the five of us move into a two-bedroom apartment while our house was being built. Sure, my sisters and I complained about having to share a bedroom and all, but that wasn’t the worst part. Every night around 2 am, when my dad finally passed out in front of the news, the walls of that apartment shook with the thunderous sounds of his slumber.
His snoring started off gently; a low rumble with each breath. As his body relaxed, it gathered resonance. The rumble escalated into the sound of a motor. The motor into a roar. Once he was fully in REM sleep, he added a percussion section of sputtering and choking sounds. He would continue like that through the night, the ebb and flow of a cyclical power saw punctuated by pauses of deafening silence. On nights when the pauses lasted more than a few seconds, my older sister would stand over his bed, worried he would stop breathing altogether. For six months, he was the only one who got any sleep, even if that sleep wasn’t particularly restful.
Snoring is common, but it’s not normal.
We’ve probably all experienced living with a snorer. Whether or not we admit it, we’ve probably even been that snorer. About half of us snore at some point in our lives, with men (57%) being the culprits more often than women (40%). It even happens in 27% of kids. It can be transient, from a cold or allergies, or limited to certain positions, like sleeping on our backs. Sometimes we snore under certain circumstances, like after drinking too many beers or taking a sedative. Weight gain can make snoring more persistent, as can a whole host of upper respiratory blockages, like big tonsils, big adenoids, or a deviated septum.
Snoring is loudest in the deepest stages of sleep when your muscles are the most flaccid. Although the average snorer reaches a loudness of between 60 decibels (normal conversation) and 80 decibels (New York City traffic), the loudest snorer on record is a British grandmother. She maxed out at 111.6 decibels–the equivalent of a jet plane.
Snoring is annoying because it’s trying to warn you that something is wrong.
Air is supposed to be able to move in and out of your nose silently. But if the pathway from your face hole to your lungs is blocked, the floppy tissue surrounding the pathway vibrates. The blockage can be in your nose, all the way in the back of your nose (your nasopharynx), in your mouth (your tongue), or in your throat/neck. The bigger the blockage, the harder your body has to work to pull in the air, and the louder the snore. The tissues that vibrate usually include your nasopharynx, soft palate, uvula (the dangly thing in the back of your throat), throat, or all of the above. It’s often hard to pinpoint where the sound is coming from, which is why finding an effective treatment is so challenging.
Although snoring itself doesn’t mean you have sleep apnea, it is an early indicator that you may be headed down that road. A sleep study is the only way to know for sure. There are different kinds of sleep studies–some you can do at home and more involved ones where you get hooked up to a bunch of wires in a sleep lab while someone watches you sleep. Neither of these studies is perfect but at least they let you know how often you stop breathing and if you are getting enough oxygen. Sleep apnea can lead to heart problems, high blood pressure, and diabetes, among other problems.
From an evolutionary standpoint, snoring seems like a mistake. Imagine you’re sleeping in the wild. The last thing you’d want is to announce your noisy siesta to a nearby lion. But humans usually live in groups so we can theoretically watch out for one another. One researcher hypothesized that the snorer offers the advantage of keeping everyone else in the group in a semi-awake state so they can be ready for invaders. Interesting in theory. My sleep-deprived sisters and I would beg to differ.
Snoring treatments: from desperate to bizarre
The funny thing about snoring is that, unlike other medical conditions, the snorer is rarely the one who notices the problem. They are asleep, so what do they care? They are usually made aware of the problem by someone very dear to them who complains about the noise. Even so, they often avoid diagnosis unless threatened (As recently as the 1970s, divorce was considered a valid solution.) because the treatments can be so, well, unsavory. Although snoring has plagued humanity for millennia, we still haven’t come up with a simple cure. But that hasn’t stopped us from trying.
You may think, with the plethora of gadgets on the market today, that snoring is a modern-day problem. But, according to the Schnarchen Museum, a German museum solely dedicated to the history of snoring treatments, the first recorded snorer in history was Dionysus in 460 BC, which makes sense with all his drinking. His snoring was reportedly managed by being poked throughout the night with his own thyrsus rod (probably by a nymph). Even before Dionysis, ancient Egyptians used thyme to treat snoring, which is still found today in snoring oils.
Although surgical treatment is a more recent phenomenon in the U.S., it has been practiced in Morocco for hundreds of years. Traditionally, babies had their uvulas cut off to improve speech and breastfeeding, with the added benefit of preventing their tonsils and adenoids from getting big and blocking their airways. This practice was also widely practiced by healers in African tribes to prevent throat and lung infections and had similar benefits.
Crude but less invasive methods were utilized during the U.S. Revolutionary War in the form of cannon balls which were sewn inside the uniforms of noisy sleepers to prevent them from turning onto their backs. In 1900, the cannonball was replaced by a star-shaped metal object attached to the snorer’s back with a strap. Less aggressively, marbles have been sewn into the back of nightshirts as reminders to avoid the supine position. One doctor even suggested a soft collar to keep the neck extended during sleep. If only it were that easy.
By the late 1800s, inventors went straight to the source. The first oral device was invented by Otto Frank. Other models followed, fashioned out of metal or very stiff leather that pulled the tongue forward. These devices looked more like props in a Ryan Murphy show than medical interventions and were about as effective. Next came the chin bands, which looked equally menacing and wrapped around the head to hold the mouth closed.
By the 1950s doctors were ready to start cutting. Early snoring surgeries focussed on removing tissue from the soft palate to make it tighter and therefore less apt to flop around. In the 1960s surgeons started copying the Moroccans and chopped off the snorer’s uvula, which only changed the pitch of the snore but didn’t stop it.
In 1970, doctors noticed that some snorers had more concerning symptoms like severe daytime sleepiness and high blood pressure. They realized the only way to really stop this kind of snoring was to bypass the head altogether and cut a hole directly into the neck (tracheotomy). Understandably, this wasn’t popular with patients. Sometimes just taking out the tonsils and/or adenoids or shrinking structures in the nose, called turbinate reduction, did the trick.
Around the same time, Japanese surgeons were rearranging the whole back of the throat with a procedure called uvulopalatopharyngoplasty (UPPP). UPPP involved cutting out the tonsils and uvula and sewing the soft palate together. This surgery is still performed today, even though it has a terribly painful recovery and doesn’t always stop snoring.
Once doctors were able to diagnose sleep apnea in the 1980s, treatment had to move beyond merely silencing the annoying noise. The UPPP and other, even more aggressive, surgeries aimed at preventing tissue from collapsing in the back of the throat gained popularity in the U.S. One example involves sawing a piece of the chin bone, moving it forward, and screwing it in place to prevent the tongue from falling back during sleep (mandibular osteotomy with genioglossal advancement). Some surgeons burn the base of the tongue to scar it down (radiofrequency ablation). The list of surgeries gets pretty gory, but you get the picture.
Less invasive but equally abusive procedures have also been tried, like implanting “pillars” in the soft palate, burning the palate with radiofrequency, or injecting it with a scarring agent to make it tighter.
In 1975 Continuous positive airway pressure (CPAP) was adapted to treat snorers with sleep apnea. These machines work by pushing air into the nose and/or mouth of the snorer with enough force to get past any obstructions. Early CPAP machines were huge and loud, but they are now quieter and more portable. The earliest masks were also not user-friendly. A plaster mold of the snorer’s face was used to make a fiberglass mask that had tubes attached through tiny holes all over it. Before going to bed, the snorer had to attach the mask to their whole face with silicone adhesive. Face masks have evolved to be more streamlined and less Jason Voorhees, and now come in three varieties: nose, mouth, or nose and mouth. They are still hard to wear.
For snorers who refuse to be stuck with that “horrible machine,” there are countless other options.
Oral appliances were developed by dentists to hold the jaw forward ever so slightly to prevent the tongue from falling back into the throat. There are over 500 varieties of customizable appliances. For those who can’t afford the hefty price tag, there are over-the-counter versions that may or may not work, and cause jaw pain and move your teeth if they don’t fit right.
Disposable options include Breathe Rite strips to spread your nose open from the outside and silicone inserts that prop your nose open from the inside. Nasal vents prevent exhaling through your nose, so the backed-up pressure keeps your airway open. You can imagine how comfortable those are.
There’s always the wedge pillow, used to prop your head up and a new gadget called the Hypoglossal nerve stimulator, a small device that is inserted under the clavicle with wires that stimulate the tongue and chest muscles.
Among the more colorful options are Snore Stop Spray and antisnoring chin straps. A popular recent offering is Sleep Strips, which are basically tape that holds your mouth closed. If you believe the Amazon reviews, consumers apparently love them. But as an ENT doctor, I find the notion of sealing your mouth closed alarming. By nature, we prefer to breathe through our noses. We only mouth-breathe when our nose is blocked. Mouth taping is the equivalent of unplugging the smoke alarm instead of putting out the fire. It may stop the noise, but your breathing may get even more labored.
I’m sure there are many more devices I missed, but I can assure you of one thing. The quest for snoring’s cure will continue on.
If you’d like to read more of my articles, you can access my Medium page here. You can become a Medium member here.
To Make an Appointment:
EMAIL: info@drlindadahl.com
CALL 212-920-3047
Office hours:
Tuesdays, Wednesdays, and Fridays, 9 am to 5 pm
535 5th Avenue, 32nd Floor, New York, NY 10017 (entrance on 44th Street, between 5th and Madison)