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Murray

Why You Should Get a Snoring Cure

The other day Jason L. age 40 came for a revisit. All his life he had suffered because of his snoring. A month ago I told him to sew a tennis ball on his T Shirt back in order to keep him sleeping on his side, as therapy for snoring. Now he no longer snored. His snoring cure was successful! He wept at all the years that he had wasted in not seeing a cure for his snoring. If only he had known of this snoring cure before! He kept postponing seeing a doctor because the only cures he found on the internet were surgical or dental.

I am part of a five person ear nose and throat group that specializes in snoring procedures. We have pioneered some of the procedures used for sleep apnea and our members are invited to lecture on this subject at medical meetings. The scene of Jason weeping in our office is not unusual.

Many snorers avoid getting treated because of fear of surgery. Many of our patients have scoured the internet and all they found were articles on surgery for snoring; that is why they avoided coming to the doctor. Imagine their relief when they learn that the cure is as simple as clearing their nasal stuffiness!

For most snorers, we first try clearing them with pulsed irrigation. The Hydro Pulse™ is particularly suited for snoring because you need to treat both the nose and the throat.

If someone is keeping a chronic nasal congestion, it is often due to poor nasal cilia function. Normally, nasal cilia beat in synchrony to move bacteria and pollen out of the nose. When the cilia stop moving the bacteria out, they lay in place and multiply. Then this infected material causes the nose to swell, leading to nasal airway blockage and to snoring. When the nose/sinuses are irrigated with the pulsed wave form of irrigation, that frequency of pulsation is timed to restore the nasal cilia. Once the nasal cilia are restored to normal, there is no need to continue Hydro Pulse™ irrigation, now the cilia do the therapy.

When there is nasal infection, the bacteria and toxins drain to the throat by passageways called lymphatic channels. This results in swelling of throat tissues, especially the back of the throat and the sides of the throat where the tonsils are located. Actually, the tonsils are designed to filter out that nasal drainage. But if they swell, the airway is affected and people snore. One of the best ways to reduce that swelling is by massage and irrigation. The Hydro Pulse™ comes with two throat attachments. Using regular warm water, the pulsing stream is directed to just behind the last tooth on the right. This washes and massages the right tonsil, then swirls around to exit on the left side. By this massage action, the swollen tissue is reduced in size and becomes firm again.

For some patients there are holes in the tonsils called crypts. These may be filled with bacteria products that the systemic antibiotics can’t get to. For this condition called tonsoliths, the Hydro Pulse irrigation pulses the stale material out easily.

By clearing the nasal cause of snoring and also the throat problem caused by that drainage, many persons stop snoring.

There are other factors that help snoring. One is good sleep and this calls for good sleep habits.

For most persons, a sleep problem can be solved:
a. Regular Sleep Time. The more consistent the better. This sets the sleep clock.
b. A sleep routine. The more complex the better. A warm bath, brush your teeth, cream your face and hands, constant room temperature. Doing this consistently sets your sleep clock and gives better sleep.
c. Bed should be only for sleep, not doing office work or reading exciting novels or watching the 10 o’clock news. Especially bad is eating in bed. If you must read, a good book on algebra is best.
d. Do not linger in bed in the morning.

The more “dull” the sleep time the better. For some men, having the Shopping Channel on works; for some women the Sports Channel may be useful.

Whether snoring is social or leads to sleep apnea, before any surgical procedure is contemplated, the non-surgical approach to a snoring cure should be tried first.

More therapies for snoring will be coming here in the weeks ahead.
This material from Free Yourself from Sinus and Allergy Problems – Permanently.

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Why You Should Get a Snoring Cure Part Two

I previously told about the fact that many patients avoid seeking a snoring cure because they look in the internet and they see hundreds of surgical snoring cures. Then they read comments by patients in whom the snoring surgery failed – or worse.

Fact is that there are many non-surgery snoring approaches. In part one I discussed using pulse wave irrigation with the Hydro Pulse™ to clear the nasal inflammation that drains to the throat and causes swelling there. Then use the Hydro Pulse™ throat irrigation to reduce that swelling.

The reason you get snoring in the first place is that when air passage is narrowed, instead of a steady flow of air, the air is narrowed and is caused to vibrate. Think of 8 lines of cars that are narrowed to two lanes, yet don’t slow down. Those 8 lanes suddenly into 2 lanes would make a terrible noise! Similarly when air passage is narrowed.
Now visualize the air being narrowed and that narrowing moves back and forth or more likely up and down. Air passes liquid surfaces that may narrow the passage, as is allergy mucus or postnasal drainage and this can make a fluttering sound.
When you lie on your back, the soft palate, which is the back part of the roof of your mouth, is soft and could fall back and block the breathing. But when you are awake, your muscles of the soft palate prevent that from falling back and causing the air to vibrate.
But in deep sleep, with weak soft palate muscles, gravity can pull the palate back and this can block the air flow. Since you want to get air, you force against this closure and this causes the soft palate to more up and down, thereby vibrating the air, and you set snoring sound.

Fact is that many snorers have weak or flaccid throat muscles. These weak muscles allow airway blockage in sleep. How to make strong throat muscles? The same way you make any muscle strong, by exercise.

Speech therapists use throat exercises to strengthen the throat muscles and make throat tissue stiffer with less fat. Forceful mouth blowing can be therapeutic. Any forceful blowing – trumpet, blowing a balloon, the didgeradoo – all these strengthen the throat muscles and reduce snoring. Try these throat exercises that have been reported in the medical literature for snoring relief:

Throat exercises:
These throat exercises reduce snoring:
Hold the tongue on the hard palate. Say the vowel sounds. Move the tongue around as you do these. Do three minutes on each vowel.
Place the tongue in front of the roof of the mouth. Then slide it all the way to the back of the roof of the mouth.
Pronounce vowels rapidly for 3 minutes.
Press the tongue hard against the hard palate. Press frequently.
Press the tip of the tongue into just behind the incisor teeth while pushing the back of the tongue into the floor of the mouth.
Blow up a balloon by sniffing air in hard through the nose and forcing it out hard against the balloon.
Swallow keeping the tongue on the roof of the mouth.

These exercises need to be done for 3 minutes each. It takes time to build and strengthen muscles by exercise and the throat is no exception.

Vibrating the throat muscles is also helpful. Hum “oooommm.” Feel the throat vibrate.
When you use the Hydro Pulse™ throat irrigation that too is a means of vibration and massage to the muscles. The flabby fatty areas are massaged and muscles can become more functional .

Once more, reading about these throat exercises won’t help. They need to be repeated daily until the snoring goes away.

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Why You Should Get a Snoring Cure Part Three

In the book by New York ENT specialist, Steven Y Park, he shows how early snoring creates a vicious cycle that eventually leads to the worst kind of snoring where oxygen is denied to the brain and heart for long periods of time, called Obstructive Sleep Apnea. Thus, you should get a snoring cure as early as possible.

Losing weight and singing to cure snoring

Among the many reasons to cure snoring, is that you must stop snoring if you need to lose excess weight.
When you snore you gain weight:
Diet doctors today tell their patients they must clear their snoring in order to lose weight! The reverse of this is also true: snoring that accompanies obesity, may be cured by losing weight! We see this success in our clinic, and patients have avoided surgery this way. Of course losing weight is not easy. Knowing the relation between snoring and weight gain may assist persons who want to become thin.
Bill S., age 50, had hypertension and was obese. He complained of fatigue. One look at his nose and throat and I immediately knew he was snoring. I asked his wife, “How bad is his snoring?” She threw up her hands in disgust, “It’s terrible. It’s making me sick.”
Bill protested, “But I have been trying to lose weight for years.” I explained that the reason he couldn’t lose weight was because of his snoring, causing him to be fatigued and pushing him to eat for the energy to work all day. Fortunately, when we cleared his postnasal drip with pulsatile nasal irrigation and reduced his swollen throat tissue with pulse wave massage, his snoring improved and he could improve his weight by understanding the process.
One of the worst things about snoring is that next day you feel fatigued. So, you need to take that cookie in order to get through the day. The more cookies, the more fat deposits in the throat and the soft palate gets heavier and falls back and blocks the breathing. The more blockage, the more cookies are needed to wake up during the day.
Singing to cure snoring!
At the Department of Complementary Medicine, School of Postgraduate Medicine and Health Studies, University of Exeter, Exeter, UK. they studies the effects of singing exercises on snoring. This was published in Complement Ther Med. 2000 Sep;8(3):151-6. Titled: Can singing exercises reduce snoring?
The study showed that performing singing exercises for 20 minutes a day did reduce snoring significantly. Singing exercises can vary from therapist to therapist.
Judy S told me that her husband used to complain about the cost of her singing lessons. But when he noticed that her snoring decreased, he said the cost of the lessons was well worth it, because her snoring had stopped. I explained to her how repeating the singing lessons made her throat muscles stonger, and I encouraged her to continue the exercises.
These are throat exercises I use for my patients that reduce snoring:
Hold the tongue on the hard palate. Say the vowel sounds. Move the tongue around as you do these. Do three minutes on each vowel.
Place the tongue in front of the roof of the mouth. Then slide it all the way to the back of the roof of the mouth.
Pronounce vowels rapidly for 3 minutes.
Press the tongue hard against the hard palate. Press frequently.
Press the tip of the tongue into just behind the incisor teeth while pushing the back of the tongue into the floor of the mouth.
Blow up a balloon by sniffing air in hard through the nose and forcing it out hard against the balloon.
Swallow keeping the tongue on the roof of the mouth.
In summary, any repeated exercise to strengthen the palate and throat muscles has been shown to improve snoring. However the throat exercises alone won’t work unless the nasal congestion, postnasal drainage or sinusitis is cleared. Using the Hydro Pulse™ sinus irrigation to restore nasal function clears the drainage that enlarges throat tissues, particularly the tonsils.
Greg S. came to our office about having more snoring surgery. He had had a uvulopalatopharyngoplasty performed and was disappointed with the results. This is a procedure where the tonsils are removed as well as a part of the uvula and soft palate. When I checked his nose, he showed left maxillary sinus disease, Previously his doctor had recommended nasal sprays that hadn’t worked for him. The CAT scan showed left maxiallary sinusitis, (see illustration) and he was placed on Hydro Pulse Sinus irrigation. His sinus drainage was cultured and the appropriate antibiotic was delivered via the Hydro Pulse irrigation. Once his sinus problem cleared, he no longer had the sinus drainage, his throat tissue and other problems cleared and his snoring condition improved.

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Why You Should Get a Snoring cure part four
The ten cent cure for snoring

In the early days of rhinoplasty, doctors often commented on how much the patients benefitted when they had cosmetic nasal surgery. Why was the patient so much happier, had more energy, and the family commented on how much better she was since her surgery? Today we understand that the cosmetic surgery improved the patient’s nasal breathing and improved her sleep.

Lifting the nasal tip:
Your nose has a valve. It is located where the tip of the nose joins the “hard” part of the nose. In childhood, the nasal tip is high up, and wide open. As you age, the angle between the bottom of your nose and the lip may be exactly 90 degrees. With aging, the tip droops down. The lower the tip, the more blockage to breathing in sleep. Try lifting the nasal tip; see if that opens the breathing. If it does, get a roll of ½ inch medical grade tape:
Cut a 4 inch strip
Attach it to the underside of the nasal tip
Bring it up over the front of the nose, up to the area between the eyes.
When you do this, gently lift the nasal tip to open the airway and then attach the tape.

This can be the snoring cure for many persons. And it only costs a dime!
In some persons, there is a deviation of the front part of the nasal septum. When you look at the bottom of the nose it is off to one side. This blocks breathing; try moving the nasal tip around to find a place that overcomes this blockage.

Chronic sinusitis and snoring:
Any kind of nasal congestion such as allergy or a common cold will result in snoring. It is reported that thirty seven million people have chronic sinusitis; no wonder there is so much snoring! Fortunately, many sinus problems can be resolved when the nasal cilia are restored
When the nasal cilia slow down, bacteria remain in place. Normally, these cilia beat to remove bacteria and allergens from the nose. When bacteria remain in place, they multiply, and the toxins drain into the throat. Here they cause inflammation and swelling, for example chronic tonsillitis. If postnasal drip is causing your snoring:
a. Drink tea, green or black, with our without caffeine. Best to add lemon/lime with honey
b. Hum. When you hum at a low tone, like “oooommmm” that vibration also vibrates the nasal cilia. Put your fingers on the nose; the more you feel vibration the better.
c. Use Hydro Pulse™ nasal irrigation. This pulses at a rate to pulse the nasal cilia back to good speed.

Some persons clear their nasal blockage at night using one of the prescription nasal sprays. (find a doctor with lots of samples to try out)

Sleeping on your left side:
Alice had no choice in seeking a snoring cure. Her husband was sleeping in the living room and was most unhappy. Her cure turned out to be simply to sleep on her left side. First she used a tennis ball that she sewed on her T Shirt and slept with it. When she was on her back, the tennis ball nudged her. This stimulated her to turn to her side, which stopped her snoring Later she didn’t need the tennis ball any more.
Why is position so important? It is a matter of gravity. On your back the tongue, soft palate, and loose tissue falls back and narrows the airway. On your left side, these factors are reduced.
An additional factor is that sleeping on your side reduces acid reflux. When you eat a full meal and go to bed, on your back, you have an easy channel for stomach acid to go up the swallowing tube, the esophagus, and irritate and swell the throat tissue. Some persons have stopped snoring just by not going to sleep right after eating. Best to wait four hours. Elevating the head of the bed is also useful: when you lie flat the liquid stomach acid has easy access to the throat, nose and even the ears! You can purchase a wedge that raises you head level and prevents reflux. The fancy name for this condition is Gastro Esophageal Reflux Disorder. It is commonly called GERD.
Months ago I had a patient whose snoring was due to clenching her jaws when she sleeps! The cure was to use the TMJ Therapy from my book, Stressed? Anxiety? Your Cure is in the Mirror. Essentially you draw a vertical line on the mirror and practice relaxing the jaw so that it drops by gravity. She did this 15 minutes a day and now no longer is a jaw clencher; she sleeps much better without the snoring.

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Why You Should Stop Snoring Part Five –CRRS.

Clear nasal condition, Reduce throat swelling, Reduce reflux, Strengthen throat muscles.

OSA stands for obstructive sleep apnea. Doctors define sleep apnea based on a test performed in the special sleep laboratory. Here the oxygen level, breathing activity and brain activity is recorded during actual sleep. Depending on how often a person stops breathing, and how long that non-breathing (apnea) lasts, we give them a score that says yes, they have OSA or no, they don’t have it. If they are diagnosed OSA, then usually insurance will pay for recommended treatments that may include surgery and/or CPAP. If they fall below a certain score, these therapies may not be covered. CPAP stands for continuous positive airway pressure

However, many persons don’t have full OSA scores, but are still fatigued, tired next day, fall asleep or nod off and may have a traffic or industrial accident. They gain weight because they eat to fend off the fatigue.
Dr Christian Guilleminault of Stanford University studied tired young men and women who didn’t fit the OSA diagnosis after having overnight sleep studies. He found that in deep sleep they had frequent arousals where they came out of deep sleep. They didn’t have periods of apnea (no-breathing), but they had significantly less deep sleep. This turned out to be the cause of their fatigue. When treated, their fatigue cleared.
Should you have an overnight sleep study done? If hypertension, obesity, fatigue, is present, with overnight chocking and restlessness, such a study will help with the accurate diagnosis.
if you have the signs of frequent periods of non-breathing, with drops in oxygen levels, and a diagnosis of Obstructive Sleep Apnea, OSA, a therapy that works is Continuous Positive Airway Pressure, or CPAP. With CPAP you sleep with a mask that is attached to an air source that applies air at a certain pressure that forces air into the lungs and overcomes airway blockage. The results may be dramatic: end of morning fatigue, increase in energy and cognitive ability, even increased sexual energy.
As was pointed out in the Stanford study above, the snoring may not be the severe kind, but if the snoring is there, or the fatigue next day persists, therapeutic measures are indicated.
My philosophy is, instead of sending any snoring patient first to the sleep lab, let’s use the simple steps outlined previously:
o Clear the nose
o Reduce the swollen throat tissue
o Reduce Gastroesophageal reflux disease GERD
o Strengthen the throat muscles
o

These are simple, easy to do, and don’t involve surgery or expensive therapies. Then, if the snoring, morning fatigue, sleepiness persists, then I order the sleep study. Refer to this standard therapy as the CRRS method. With the CRRS method, you clear the nasal condition with Hydro Pulse Sinus irrigation, you reduce the swollen throat membranes with Hydro Pulse Throat pulsation irrigation, stop the Gerd with diet and bed position, and strengthen the throat muscles with the above throat muscle exercises.
Yes, I left out weight loss in the above list, because it is very difficult to lose weight when you snore and have morning fatigue and need that cookie for energy to get your work done.
It is important to realize that all patients are different. Some have huge tonsils that Hydro Pulse therapy hasn’t been able to shrink and would benefit by having surgery; it may be necessary to remove the tonsils to open the airway. Some patients are so sick from the effects of poor sleep( especially hypertension,) and snoring that there is a rush to get them into therapy of CPAP.
What is most important is to stop the snoring as soon as possible to prevent the condition from developing into OSA, where the brain doesn’t get adequate oxygen.

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Why You Should Stop Snoring Part Six.
What is a sleep study?
When a patient has a history of snoring, periods of not breathing, chocking or gasping for air during sleep, restlessness in sleep – excessive tossing and turning, and excessive daytime sleepiness, the sleep study is recommended for accurate diagnosis, and as an aid to therapy. This is a test for Obstructive Sleep Apnea, OSA, when the brain and heart don’t get proper oxygen due to obstruction of the airway.
In OSA, you see excessive daytime fatigue. Daytime fatigue is a cause of traffic and industrial accidents. Obesity, hypertension, certain kinds of heart and lung conditions may be a sign of OSA. In Australia, someone who has had two traffic accidents is required to take the sleep study to see if they have OSA – obstructive sleep apnea.
The sleep study, called polysomnography (poly –many, somno –sleep, grapy –writing) is ordered in order to evaluate the extent to which oxygen fails to get to the brain and heart.
There are stages of sleep:
Stages of sleep are defined as Non-Rapid Eye Movement stage, or NREM, and Rapid Eye Movement or REM. You start to fall asleep in NREM. The brain wave rhythm slows, there is reduced muscle activity and breathing slows. Heart rate slows. Here you might get an answer to your question with a slightly loud voice. As the sleep deepens, heart rate is reduced, and it takes a louder voice to get an answer. There is a third stage of NREM sleep where heart rate slows and brain waves slow too. Next, sleep goes to REM sleep.
In REM sleep, you have rapid eye movements. This is where you have active dreaming. The brain waves are actually similar to those in the awake state. Skeletal muscle tone is significantly diminished; here is where the soft palate and the tongue can fall back and block breathing. You may get cardiac arrhythmia here, because air is blocked, as when persons die in their sleep.
It is fortunate that skeletal muscle tone is lowered because some of the dreams may be quite active and otherwise the partner might get hurt.
In the sleep study, recordings are made of
• brain waves
• eye movements
• chin movements
• leg movements
• heart EKG
• nasal air passage
• blood oxygen
• chest movements
• abdominal movements
These measurements help determine if the snoring is significant, or social snoring. The episodes of apnea, or non-breathing of more than ten seconds, are counted and compared to the oxygen levels, as well as their effect on the brain and heart.
A significant result of years of sleep studies is that we recognize a condition called Upper Airway Resistance Syndrome (UARS) where there is daytime fatigue and snoring but not enough apnea episodes to be defined as OSA. Here the tongue or soft palate may fall back to obstruct and cause the deep sleep person to “wake up” in order to get the tongue back up. If these episodes, called arousals continue to interfere with good sleep, you get the symptoms of OSA, even though the sleep study is negative. Some of the symptoms associated with Upper Airway Resistance Syndrome include insomnia, headaches, TMJD, GERD and others.
These are the patients to actively treat with pulsing sinus and throat irrigation and strengthening the throat muscles in order to prevent progression to OSA.

Snoring and acid reflux.

If you have excessive snoring, you get a sort of vacuum effect that pulls the stomach acid into the airway. Of course this irritates the throat and causes swelling and makes the snoring worse. The worse the snoring, the worse the reflux.
GERD stands for Gastroesophageal Reflux Disease. Usually we think of GERD as an upset stomach, sour stomach, major indigestion. But, in snoring there may be none of these symptoms. Because of snoring, the stomach contents get into the esophagus and results in severe irritation of the swallowing tube and the throat. In some cases the acid may get into the area behind the nose. Generally GERD is attributed to a weak esophageal sphincter. This is the muscle that opens when you swallow and closes to prevent stomach acid getting into the swallowing passage. But, in snoring, reflux can occur independent of that sphincter.

GERD can be a major factor in voice problems. The acid affects the voice mechanism – the larynx and structures. When the vocal cords are swollen, there is hoarseness. The acid may affect the arytenoids, the cartilages that the vocal cords are attached to. This impairs the full movement to the cords. If the cords are swollen or the areas of this level are affected, this can increase the snoring. When the stomach acid or bile leaks into the windpipe you can get coughing and chocking. Just a simple cold, with mouth breathing, can create a sort of vacuum effect to bring up the stomach acid bile, and pepsin. However, in some persons, even when the cold or sinusitis clears up, the acid irritation remains and results in snoring due to swollen throat tissue; the more the snoring the more the reflux.

Laryngopharyngeal reflux disease (LPRD) is a term that refers primarily to reflux that affects the voice box or larynx. Usually the symptoms are limited; for example there may not be any heartburn or stomach distress. It is also called silent reflux. Commonly patients complain of excessive throat clearing, hoarseness, a lump in the throat sensation, or a persistent cough. Sometimes patients complain of a sensation of postnasal drip, and chronic sore throat without any fever, or gland swelling or elevated white count. Cultures looking for infection are negative. Voice teachers suspect laryngopharyngeal reflux disease (LPRD) when a singer complains of voice changes.
In suspected cases of GERD, doctors can look at the larynx with instruments and actually see the areas that are affected by the acid.

Whether it is GERD or LPRD, both may be caused by nasal blockage, and cause increased snoring. Treatment is to clear nasal and throat obstruction, elevate head of bed, avoid eating three hours before sleep and possibly take one of the acid inhibitors, such as Nexium.

Treatment for GERD or LPRD:
• Lose weight, if needed.
• Quit smoking,
• Avoid alcohol.
• Restrict chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine, and caffeine.
• Stop eating at least three hours before going to bed.
• Elevate the head of the bed about 4 to 6 inches.
• Avoid wearing tight-fitting clothes around the waist.
• Try chewing gum to increase saliva in order to neutralize acid.
To confirm the diagnosis, in addition to looking directly at the throat with a flexible scope, the pH of the throat and esophagus is monitored over a 24 hour period. This clearly tells how much acid is causing reflux symptoms.
With the symptoms of either GERD or LPRD, the goal is to use as minimal medication as possible. Medications used include:
Proton Pump inhibitors to reduce gastric acid. Some examples are Aciphex, Dexilant, Nexium, Prilosec and others.
H2 blockers which also reduce gastric acid outpu. Some examples are Axid, Pepcid, Tagamet, Zantac and others.
Antacids to neutralize the acid.

In many patients, clearing the nasal blockage can significantly reduce the reflux.