Somnoplasty to Treat My Snoring

A few weeks ago I wrote about undergoing a sleep test in March to determine if I suffered from sleep apnea. Sleep apnea is a potentially health-threatening condition where you stop breathing for extended periods while sleeping. As it turned out, I did not have sleep apnea – just good old-fashioned snoring. Since my snoring disturbs Tawn (and I also feel that it may keep me from getting a restful night’s sleep), this morning I underwent a procedure at Bangkok Hospital called somnoplasty.

Nasal Cavity and Mouth Annotated
Like the graphic? I made it myself using PowerPoint, then captured and annotated it with SnagIt.

Somnoplasty uses radiofrequency ablation to tighten up the tissues that cause snoring. “Ablation” is the removal of tissue through a variety of means. In this case, a metal probe that looks like a very narrow fondue fork pierces the tissue. Then the heat of very high frequency alternating current burns part of the tissue below the surface. As the injury heals, scar tissue forms, causing the surrounding area to tighten up and shrink. As a result, the area is firmer and less prone to vibration – which is what causes the noise of snoring.

Research on the procedure shows that 85% of patients experienced significant reduction in snoring, with their average “snoring score” (a 0-10 scale measuring the intensity of the snoring) dropping from 8.9 before therapy to 3.5 after. The procedure is significantly less invasive than other available procedures and my doctor was confident that a single treatment should be sufficient to essentially eliminate my snoring.

 

A walk-through of the procedure, in case you are interested:

(Warning – there is a small picture of the inside of my mouth further down the post – something you may not wish to see!)

Once seated in the exam room, Dr. Chidpong placed pieces of gauze soaked in a light anesthetic in my nostrils. He also applied a bitter-tasting medicine spray into my mouth, which started to numb the tissues immediately. Within a minute, my ability to swallow was gone and my teeth were numb. The doctor warned me that I would get the sensation that something was stuck in my throat – and indeed I did – and told me not to panic. A few deep breaths and I overcame that sensation.

After about two minutes, he gave me a series of shots – one in each nasal cavity and then three in the soft palate of the mouth. Along the way he asked if there was any pain. The nasal cavity shots were painless – in fact, I couldn’t feel any sensation at all. The shots into the soft palate were mildly uncomfortable, but brief.

The shots were a medicine that restricts the blood vessels, so that there would not be any bleeding during the procedure. While giving me the shots, he explained that I would notice my heart rate increasing and within a few seconds, that is what happened.

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About four minutes into the procedure he took the probe (the two needles are about a half-inch long) and inserted it into one nasal cavity, then the other. If I understand his explanation correctly, he ablated the middle nasal concha (also known as the turbinate), one of three bone shelves that protrude into the nasal passage. Each ablation took about ten seconds.

There was no pain nor any smell. Along the way, I did hear a few “pops” that reminded me of when a bug dies in a bug zapper. A couple of times, a feeling of mild panic rose and I had to remind myself to focus on breathing through my mouth. Each time the doctor inserted the probe, he first said “excuse me,” which I found very funny.

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(Click for a larger version.)

After the nasal passages, the doctor ablated three spots on my soft palate – left, right, and center. The picture above shows the injuries about twelve hours after the procedure. The resulting injuries look like canker sores.

The entire procedure took seven minutes. The doctor explained that earlier versions of this technology used less power and the procedure took about thirty minutes instead of seven. Thank goodness for advances in medicine!

Post-Procedure

After the procedure, I returned to the waiting room. A nurse checked my blood pressure a few minutes later. It had jumped from 120/65 at check-in to 150/85 after the procedure. As I waited, I noticed that the anesthetics were rapidly wearing off and the back of my throat and my nasal cavities were itchy. Within thirty minutes after the procedure started, I was downstairs picking up medicines and paying the cashier.

Twelve hours later, the sensation is similar to having a bad sore throat. Eating is a bit uncomfortable and I keep clearing my throat, reflexively trying to clear what feels like some phlegm. Of course, the sensation is caused by the wounds from the procedure and no amount of throat-clearing will help.

The pain should subside within about three days. I am taking paracetamol for the pain, an antihistamine for any nasal dripping, and an antibiotic as a precautionary measure. The pharmacist also gave me a medicinal gargle with mild anesthetic qualities. I was also advised to eat lots of ice cream, to help reduce the swelling.

It will take a few weeks to observe the full effects of the somnoplasty as the scar tissue develops and the surrounding area tightens. I will have to ask Tawn for his perception over the next few weeks, whether or not the snoring has appreciably lessened.

 

Undergoing a Sleep Test at Bangkok Hospital

I snore. I snore so loudly that it keeps Tawn awake. After trying various remedies such as weight loss and sleeping on my side, I decided to visit an Ear,Nose, and Throat specialist at Bangkok Hospital. After sticking a probe up my nostrils to inspect that things were roughly in order, he suggested I come in for an overnight sleep test.


(The volume on this video is just a little low… sorry.)

The purpose of the test is to get an accurate read on the quality of your sleep including your sleep patterns, physical movement, brain activity, and breathing. Sleep apnea is a condition often associated with snoring. You stop breathing for extended periods of time (more than ten seconds), which can lead to many health problems including irritability, fatigue, and high blood pressure.

P1200799 I arrived on a Thursday evening at the hospital. After having my vital signs taken, I went for a pair of chest x-rays. (I have to say, before coming to Thailand, I had never had an x-ray in my life. In the six years since, I’ve had close to a dozen. They really like their x-rays here.) Then I headed upstairs to the sleep clinic.

My room for the evening resembled a regular hotel room, but with linoleum floors and bedside equipment that reminded you that this was a hospital. The room was also outfitted with two cameras, one of which was infrared, that would allow the sleep technician to observe me throughout the night.

After changing into my hospital scrubs, the sleep technician started wiring me up. This took about thirty minutes and my recurring thought was that this must be roughly what a condemned man goes through leading up to his execution. Grim, no?

Electrodes were attached to various parts of my body. Having a shaved head made this process easier, I think. A tube was inserted into my nostrils. Straps around my belly and chest held wires and monitors in place. Finally, all the wires were pulled together like a ponytail and wrapped with medical tape.

When it was time to go to bed, I had to carefully position myself on the mattress. The technician stretched the wires across the bed to a trio of small devices, which then fed the data directly to the computers in his hidden control room. After saying goodnight to Tawn, I read for a little while until sleepy, finally turning out the light and shutting my eyes.

Once the thoughts of imminent execution left my mind, I kept repeating the question, “How can this really measure anything useful?” With this number of wires, electrodes, and monitors, my range of motion was limited. Add to that the unfamiliar bed and pillow and the fact that I usually fall asleep on my side before rolling over onto my back, and I was carrying more negative, skeptical thoughts than usual. I had been offered a mild sedative if I thought I would be unable to sleep, but declined it. After not too many minutes, however, I did manage to drift off to dream land.

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Sometime in the middle of the night, I awoke for about thirty minutes. I was thirsty and had to stretch awkwardly to reach a bottle of water on the bedstand. Instead of fully quenching my thirst, I merely sipped because if I subsequently needed to use the toilet, I would need to call the technician and be unplugged first.

I slept a restless few more hours before finally waking at 5:30. It didn’t take long before I decided that I had had enough of this experience and wanted to get up. I was surprised when the technician, perhaps reading my brain waves, entered the room about fifteen minutes after waking to unwire me without me having to ring for him.

Afterwards, I showered and changed into my street clothes, letting the nurse know I would skip the included breakfast and was ready to be discharged. By 6:30 I was home, taking care not to wake up Tawn who was enjoying a peaceful, snore-free night.

A few days later I returned to the hospital for my follow-up meeting. While I didn’t feel like my night had produced a representative sample of my sleeping habits, the doctor was confident of the test results. He explained that I suffer from a condition known as “regular snoring” and that I have no sleep apnea. All of the measures – blood oxygen, brain waves, sleep modes, etc. – we within a normal range. Whether I do anything further to treat the snoring is up to me, but it is posing no health risks at this point.

In retrospect, I have to give the Bangkok Hospital staff high marks for professionalism and attentive service. While I think the package might be a little steep at about US$500 (Why do they need to x-ray me, for example?) the experience was a positive one. My doubts about the effectiveness of the test may linger, just slightly, but at least I know that my health is in no immediate danger.