Follow-up Care

Obstructive sleep apnea requires a 10-year follow up. Since patients who were diagnosed and treated
for obstructive sleep apnea usually have accompanying illnesses, these patients should be followed up
regularly to see if the treatment is effective in solving their snoring. Also, many of these patients are
prescribed with CPAP or dental devices where monitoring of its possible adverse effects is essential.
Follow-up for patients should be individualized. Some of the important pointers patient should
remember are:
a. Patients on CPAP
It would take a longer time to acclimatize to the CPAP. But you should notice an improvement in
fatigue and sleepiness once you get the hand of the CPAP. If you notice no improvement in your
sleepiness, you should seek consultation to your physician, however, you should remember that
sleepiness due to insomnia will not be treated by CPAP.
When using the CPAP, you should not be snoring. Sometimes, the air leaking out of the mask can be
mistaken as a snore. Observation and making sure that the mask fits you snugly should be done. The
CPAP should be check for malfunction if ever there are no problems with the mask.
b. Patients on Post-surgery
Follow up care for patients after surgery is individualized. For example, if a patient had tracheostomy
to relieve the airway obstruction, this patient should have more rigorous follow-up care. Tracheostomy
care should be taught to the patient and the relative, if not to an able caregiver.
Follow up visits should be taken to the surgeon who did the procedure. If you don’t notice any
improvement of symptoms after the procedure, you should feel free to contact your physician and
consider further tests or further treatment options.
c. Patients with Oral Appliance
Oral appliances are fitted according to the individuals’ size. If there are questions regarding the fit of
the appliance, you should consult the dentist who fitted the appliance. Re-evaluation should be done
at least every 6 months to determine effectiveness of the appliance in alleviating your symptoms and
check maladjustments. If needed, a new device could be prescribed to you to ensure the treatments’
efficiency.
d. Problems with breathing\nasal problems
Specific nasal problems or breathing problems need to be addressed according to its nature:
e. Nasal congestion
This may be due to allergic reaction, from a cold or a sinus infection. Unless you experience sinus pain
or cough, the symptoms mentioned are not contraindicated with the use of CPAP. However, you should
consult your physician for its treatment. If you find it difficult to breathe with a stuffy nose, sleeping
in reclining position may best suit you rather than in a side-lying one. In addition, humidifiers can also
alleviate nasal congestion.
f. Runny nose
A high setting on the CPAP humidifier can cause rhinorrhea or runny nose. In this case, changing the
humidification setting will solve this problem.
g. Nosebleeds
Nosebleeds during CPAP use may be due to the humidifying action of the CPAP. Nasal sprays should be
used as a first aid treatment, and then a trip to the physician should be done for re-evaluation of your
health or the device.Chapter 10. How to diagnose OSA

What Your Partner Can Do?

Recent studies reveal that snoring as become more and more a reason for relationship breakups,
separation and divorce. It also shows that snoring contributes to a variety of bad health conditions
for the snoring spouse and their partner. More importantly, I guess, is the impact of lack of sleep and
irritability on both individuals to the relationship. As the snoring becomes more unbearable, most
couples end up sleeping in different quarters resulting to lesser spontaneity in sexual aspect of their
relationship. In addition, heightened feelings of frustration, irritability, and fatigue makes even the
smallest problem seem a big deal, therefore putting a lot more strain in the relationship.
Although sleeping beside a person who snores loudly is a challenging task to do, the following are the
practical ways of still enjoying the company of your snoring loved one with a smile on your lips:
1. Communicating your grievances
Remember that your “snoring” partner may not be aware of his snoring problem. That is why; an
open and gentle communication should be opened. By telling him how concerned you are of his
health, suggest that he seek the help of a doctor, or else agree to do activities that can help them
lessen the symptoms of sleep apnea.
2. Anticipating the positioning of your partner
At a certain time at night, your partner may roll back over on his back, as we know snoring is at its
best at this position. So, by simply turning your patient into a side-lying position it can cause both
of you a temporary relief from the snoring.
3. Wear earplugs
This is a practical way not to hear those loud snores. There are different types of earplugs to
protect your ears from the deafening snore. Choose soft earplugs with a capacity to block sound as
high as 35dB.
4. Use white noise generators
White noise generators create a soothing sound, which competes with the highly irritating sound
of the snoring of your partner to help you sleep and relax for the night.
5. Seek support or help from other
Almost 40% of couple with one partner snoring end up in separate bedrooms. Added to this,
snoring affects the health of the non-snoring partner. Why suffer in silence and alone when there
is a number of support groups (either online or within the neighborhood) that can help you deal
with your problematic “snoring” partner.

Prevention of Snoring

1. Maintain a healthy lifestyle
Eating well balanced meals, maintaining a regular exercise regimen, and having the right attitude
enhance your well being. Stop smoking and do not consume alcohol or sedative drugs.
2. Sleep on your side
Much of the reason why people snore is positional. Sleeping on your back pulls your tongue back
onto your posterior pharynx. To avoid this, you can place two tennis balls inside your sock. Pin the
sock at back of your pajama top. This way, it will make you so uncomfortable to sleep on your back
that you’ll prefer to sleep on your side.
3. Avoid alcohol and tranquilizers
Alcohol and tranquilizers or sedatives, as it is commonly known, can depress your central nervous
system and relax the muscles of your throat and jaw. So, to avoid disturbing your partner’s sweet
slumber, avoid taking these substances before you sleep.
4. Lose weight
Excess body fat especially around the neck puts pressure on the airway. This causes turbulence to
the outgoing air. The turbulent air causes the soft tissue to flap, which causes the noise during
snoring. Losing weight will surely take off the pressure; however, only when you shed about ten
percent of your total body weight that snoring can be resolved.
5. Get your allergies treated
Chronic respiratory allergies cause snoring because of nasal congestion brought about it. It forces
the person who suffers from it to breathe through their mouth. A nasal decongestant or an
antihistamine before bedtime will surely help.
6. Stop smoking
Smoking irritates the lining of the upper airway, including the nose. This causes nasal congestion,
causing you to snore. Quitting may definitely improve the way you breath thus, helping you to
stop snoring
7. Keep a regular sleeping schedule
Sleep deprivation increases the volume of your snoring. Keeping a regular sleep-wake-cycle will
have your body have an internal clock that will surely help you avoid excessive daytime sleepiness.
8. Elevate your head
Propping yourself with pillows will ease some pressure off your airways, helping you to achieve a
snore-free slumber. Elevating your head would also reduce the pressure off your airways, helping
you breathe easier.
9. Avoid eating a heavy meal before bedtime
A heavy meal may exert pressure on your diaphragm as you lay supine in your bed. This would
make you snore because your diaphragm has to work double time. Having your midnight snack
3-4 hours before sleeping would surely help stop the snoring. At this time, your gut has almost
completed the digestion of food.
10. Do tongue exercises
Tongue training strengthens the muscles of the throat. Tongue exercises, such as sticking out your
tongue repeatedly can help cure snoring. Touch the floor of your mouth with your tongue and
hold it in that position for about 5 second. Repeating the exercise around 15 times for 3 sets is
surely effective.

Causes of Snoring

There are many reasons why people snore. There are reasons that we can control, while some are out
of our hands.
The following are the reasons where we cannot blame ourselves:
1. Genetic predisposition
Some people are born with an anatomy that predisposes them to snore. Narrow throats,
hypertrophied or enlarged tonsils, short necks and enlarged mandibles or jaws are often the
reasons why an individual snores.
2. Congenital deformities
People who were born with cleft palate, poliomyelitis, and muscular dystrophy are at increased
risk for snoring and obstructive sleep apnea. Abnormalities in the airway anatomy can obstruct the
flow of air as it passes through airway passages.
3. Advancing age
Many people who snore are usually diagnosed with obstructive sleep apnea in their 40s and above.
This is due to increased weight and decreased muscle tone.
4. Male sex
There is a male preponderance to the incidence of snoring, which is maybe due to their narrower
air passages as compared to those of women’s.
5. Atopy
Inflammation of the airways, which occur during a colds, asthma, sinus infections or allergies, can
cause nasal congestion. The accumulated respiratory secretions block the airways, causing difficulty
in breathing. This may create a vacuum that leads to snoring.
The following are the modifiable causes of snoring:
1. Obesity
Obesity increases the adipose or fat tissues in your throat, blocking the airways. Also, obese people
have fat pads, or increased fat tissues around the neck area, making the airways narrower. This
contributes to breathing difficulties and snoring.
2. Smoking
The substances present in cigarette smoke relax the throat muscles during inhalation, predisposing
a person to snore. Also, smoking or second-hand smoke causes nasal congestion, blocking your
airways.
3. Use of alcohol
Some people choose to drink alcohol before going to bed because, as they say, it relaxes them.
However, though it can contribute to your blissful sleep, alcohol relaxes your throat muscles, more
than what is expected when you sleep. This causes airflow obstruction and snoring.
4. Use of medications
Sleeping pills and drugs that make you drowsy can decrease air ventilation and reduce muscle
tone, making you prone to snoring. These medications cause relaxation of the throat muscles as
well, causing the pharynx to partially collapse and cause airway obstruction.
5. Sleeping position
Lying in supine position causes your tongue fall back, causing further obstruction of your airways.
The obstruction narrows your airways, making you snore.