As an international expert in the evaluation and surgical treatment of snoring and obstructive sleep apnea, Dr. Kezirian is committed to providing outstanding, comprehensive, and state of the art patient care while advancing the field through innovation and research. Dr. Kezirian works closely with patients from the Los Angeles area and from around the world to ensure that they receive the highest-quality care from a team of providers that tailors a snoring or sleep apnea treatment plan to them. His primary expertise is in sleep apnea surgery and snoring surgery, but he understands clearly the array of treatment options that can often be used in combination with surgery.

What are snoring and obstructive sleep apnea?

Snoring is sound produced during sleep, typically from vibration of structures inside the throat. Snoring can have important effects by itself. However, it can be a sign of a more-serious problem called obstructive sleep apnea that can lead to sleepiness and fatigue during the day and create serious health problems.

What about upper airway resistance syndrome (UARS)?

Upper airway resistance syndrome (UARS) was described many years ago, and it is really just another type of obstructive sleep apnea. UARS occurs when someone is able to get enough air but is basically working too hard to do so. This results in their waking up repeatedly throughout the night (without knowing it) and still feeling unrefreshed in the morning. If a sleep study is performed in a way that can measure these arousals from sleep, it is possible to make the diagnosis of obstructive sleep apnea if these arousals are related to difficulty in breathing. Dr. Kezirian uses the same approach to treating UARS that he does for obstructive sleep apnea because UARS can be every bit as important to patients.

Who is at risk for snoring and sleep apnea?

Risk factors include being male, weight gain, race and ethnicity, and the natural aging process that affects everyone (not just the elderly). The size and position of many structures of the head and neck often have important effects on the risk of developing snoring and sleep apnea.

What are the causes?

Typically, snoring sound comes from the back of the roof of the mouth (soft palate and uvula), but successful treatment of snoring and obstructive sleep apnea is much more complex than just focusing on that one area. Different patients have different causes. The critical importance of identifying these causes and developing personalized treatment plans is the reason why he has focused his career exclusively in this area.

How do I find out if I have snoring or obstructive sleep apnea?

Individuals who snore are often told by others that it is bothersome, but that is not always the case. Individuals with loud snoring or other signs/symptoms like sleepiness or fatigue should have a sleep study. A sleep study can be performed in a sleep laboratory or at home, and it serves multiple roles: establishing a diagnosis (snoring vs. sleep apnea) and directing appropriate treatment (different for the two conditions).

Why do we treat snoring?

Snoring without obstructive sleep apnea has important effects on personal relationships and often disturbs the sleep of others, leading to fatigue, sleepiness, and decreased quality of life. Research suggests that snoring may also directly affect the snorer themselves, with health risks and sleepiness, but these are not as clearly documented as for obstructive sleep apnea.

Dr. Kezirian has written about the potential health risks of snoring without sleep apnea on his blog.

Why should I get treated for obstructive sleep apnea?

There are three potential reasons to pursue obstructive sleep apnea treatment:

• Snoring. Some patients (and bed partners) are more concerned with snoring than with the other two consequences of obstructive sleep apnea. Although the primary purpose of treating obstructive sleep apnea is not to improve snoring, it is often very important to patients and bed partners.
• Health impacts. When blockage in breathing occurs, patients often have drops in oxygen levels and wake themselves up with a response like an adrenaline rush. This places stress on the cardiovascular (heart), pulmonary (lung), and endocrine (metabolism) systems. Obstructive sleep apnea is strongly associated with the risks of developing hypertension, stroke, heart attack, and early death. These risks are greatest in those with more severe sleep apnea.
• Sleep disruption, fatigue, memory problems, and decreased quality of life. Sleep apnea can prevent patients from getting refreshing sleep because the blockage in breathing is often worse during deep sleep. Interestingly, the degree of sleepiness or other symptoms is not related to sleep study results, so that some patients with what is called mild obstructive sleep apnea can experience significant symptoms, and vice versa. The bottom line is that if patients are not getting good sleep, they need treatment to function well during the day.

What are my options to stop snoring and treat sleep apnea?

Conservative snoring and sleep apnea treatments include weight loss, avoiding sleeping while lying on one’s back, and avoiding alcohol or other sedating medications. Weight loss can improve snoring and sleep apnea, especially in men, and the benefits often depends on the amount of weight loss. Although results vary, one large study estimated that a 10% weight loss was associated with a 25% reduction in the severity of sleep apnea. Dr. Kezirian wrote a blog post explaining the link between weight gain and snoring or sleep apnea.  A bed partner often knows whether body position during sleep affects snoring, and a sleep study may determine how body position affects breathing patterns in sleep apnea. Finally, individuals with snoring or sleep apnea should avoid alcohol and other sedating medications within 3 hours of bed time because they produce muscle relaxation and other effects to worsen snoring, sleep apnea, and sleep quality.

Positive airway pressure (CPAP, BiPAP, or AutoPAP) is a non-surgical therapy that works by delivering air pressure to prevent blockage of breathing in the throat. It is recognized as the first-line treatment for obstructive sleep apnea because it works well in the ideal situation where patients can wear it and sleep comfortably through the night, every night. Unfortunately, many patients do not tolerate it well, and it is important that these patients undergo evaluation to improve compliance or seek alternative treatment.

 

Surgical snoring or sleep apnea treatment must be directed at the areas that are responsible for snoring and airway narrowing or complete obstruction. There is a wide range of procedures available to stop snoring and to enlarge and/or stabilize the airway to prevent blockage of breathing in the three major areas where it can occur: the nose, palate, and tongue regions. Dr. Kezirian's research and that of other experts in the field has shown that often more than one of these areas is responsible and that accurate identification and treatment of the involved areas is critical.

Oral appliances represent an alternative non-surgical therapy for certain patients with snoring or obstructive sleep apnea. Dr. Kezirian works closely with dentists who have expertise and experience in sleep dentistry to identify patients who might benefit most from these devices.

The following videos present a summary of snoring and obstructive sleep apnea and the first two categories of treatment options:

For more information, please continue to Snoring and Sleep Apnea Surgery Overview.