UAE medical experts on snoring and how to combat it

Snoring is caused by vibration of the soft tissues in the throat as they relax while you sleep. If the upper airway is obstructed, a noise is created as air is forced through a narrow passageway.

Keeping partners awake during the night for long periods of time can lead to loss of patience and aggression on the partners’ side.
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Jet Benson often jokes about husband Bret’s loud snoring – but there is nothing funny about the impact it has had on her health.

For years, the 44-year-old Dubai resident has had to drown out the noise he makes while he sleeps by listening to nature sounds through earphones on high volume. When the problem is particularly bad and even this does not help, he or she is forced to sleep on a couch in the hall.

“It has definitely got worse over the years,” says Benson. “Now I can’t sleep without having that music plugged into my ears. It’s not a solution, it’s just a Band-Aid to the issue.”

Bret says he has tried several over-the-counter remedies – with little success.

“So when I am extremely tired, I sleep out on the couch so she is rested up for work and not waking up in the middle of the night to stop me from snoring,” he says.

Dr Sofia Aravopoulou, the general dentist and implantologist at Euromed Clinic Centre in Dubai, has seen many such distressed couples in her practice.

“Most of the patients I see are seeking treatment due to the impact snoring is having on their relationship with their spouses,” she says. “Keeping the partners awake during the night for long periods of time can lead to loss of patience and aggression on the partners’ side, as they are sleep deprived.”

But it is not only couples Aravopoulou sees. Businessmen also consult her, because they are worried about embarrassment on business trips with colleagues.

Snoring is caused by vibration of the soft tissues in the throat as they relax while you sleep. If the upper airway is obstructed, a noise is created as air is forced through a narrow passageway.

Inherited anatomical abnormalities, such as an enlarged, flaccid soft palate and uvula, are common causes of snoring.

According to Dr Nahel Sorour, an Ear, Nose and Throat consultant at Burjeel Hospital, other factors that contribute to excessive snoring include allergies, inflammation, obesity and smoking.

“It can also be caused by hormonal imbalances such as hypothyroidism or disturbed neurological functions,” he says. “Formation of masses such as polyps, adenoids, enlarged tonsils or soft tissue of the throat are also possible causes. Snoring affects one in 10 patients who visit my clinic.”

Bret says he comes from a family of snorers. Researchers have found that people who come from a generation of snorers have a three-times-higher chance of having a problem with snoring.

Bret admits that a weight gain has exacerbated the issue.

“I know there is a surgery for a deviated septum,” he says. “But I don’t necessarily want to have surgery. I need to lose weight. I’ve heard that helps. It is an ongoing process.”

Studies have shown that for every 10 per cent of body fat shed, the risk of snoring and sleep apnoea – a condition in which the airway is blocked briefly during sleep – drops by 32 per cent.

Dr Sorour also suggests simple lifestyle changes that can help to reduce snoring, such as avoiding heavy meals later in the evening and changing your sleeping position to ease breathing.

“People can also opt for anti-snoring mouth devices, clear their nose before going to sleep and trying to keep the bedroom air moist, since dry air can irritate the nose and throat,” says Dr Sorour.

Bret often uses a neti pot to irrigate his nose and clear nasal congestion.

But for people who have tried home remedies in vain, there is a new, advanced treatment called Snore3.

“It uses lasers to increase the muscle tone of the fibres of the soft palate and uvula to create new collagen and toned and better quality tissues. This leads to increased airways overall without any downtime,” says Dr Aravopoulou, the only specialist in the UAE certified to administer the procedure.

Dr Irshad Ebrahim, consultant neuro-psychiatrist and medical director at the London Sleep Centre in Dubai, says snoring can be a noisy indicator of an underlying chronic illness.

“Snoring is a key symptom of sleep apnoea,” he says. “Sleep apnoea indicates that either your airway is being blocked by something anatomical, such as large tonsils, or it is collapsing – that is, you have a weak airway.

“If it is a case of simple snoring, like a deviated septum of the nose, a minor nasal surgery can reverse the issue. If you have large tonsils, surgical treatment is recommended. “More commonly it is a symptom of sleep apnoea. If people leave snoring untreated, this can develop into sleep apnoea over time. If it is treated early on, you can prevent disturbed fragmented night sleep because the noise affects your brainwaves.”

Dr Fathahudeen Abdul Rasheed, a specialist pulmonologist at Zulekha Hospital in Dubai, says 24 per cent of adult men and nine per cent of adult women worldwide are affected by obstructive sleep apnoea. In the UAE, it is estimated 23 per cent of adult men are affected.

“The majority of patients are overweight or obese,” says Dr Rasheed. “There are several mechanisms whereby obesity can predispose sleep apnoea. These include upper airway fat deposition, leading to decrease in the upper airway size. This compromises the flow of air during sleep and reduction in the upper airway muscle tone and reduction in the lung volume.”

Left untreated, he adds, it increases the risk of heart and respiratory problems, and can affect memory and the immune system. There is a 30 per cent increased risk of heart failure and silent heart attacks during sleep, and patients are susceptible to high blood pressure and early onset diabetes.

He is currently treating a patient whose condition became worse because she ignored the cause of her snoring for years. In 2015, the 71-year-old Emirati woman, had to spend two weeks in hospital as a result of a severe heart condition and water in her lungs. Her son, Waleed B, says the problem might have been avoided had the family paid more attention to her health and sleeping patterns.

“She has always struggled with sleep and breathing issues, but never took it seriously – but when her health deteriorated in 2015, we had a wake up call,” he says.

An assessment suggested sleep apnoea and she was advised to use a nasal Continuous Positive Airway Pressure machine to keep the airway open. Many insurance companies in the UAE recognise this as a serious disorder and cover the costs of sleep tests.

Comprehensive plans might also cover treatments for sleep apnoea. A CPAP machine costs about Dh6,000 and can last up to 10 years. Oral appliance therapy, which uses mouthpieces to prevent snoring, can cost up to Dh9,000.

Waleed’s mother also uses an oxygen-concentrate machine for 14 hours a day, which filters nitrogen from the air and pumps more oxygen into the lungs.

“It’s not just her quality of sleep, but her quality of life has improved immensely,” says Waleed. “Her mood has improved because she is not exhausted all the time.”

Snore3 uses laser to treat snorers

Dr Sofia Aravopoulou, the general dentist and implantologist at Euromed Clinic Centre in Dubai, demonstrates the Snore3 laser. Delores Johnson / The National

One of the biggest drawbacks to snoring treatments is how invasive they can be.

There are surgical procedures that can widen the nasal passage and remove crooked cartilage from your nasal septum (the barrier in the middle of the nose separating the right and left nasal package).

There is even the pleasant- sounding uvulatomy – where your uvula (the piece of flesh that dangles at the back of the throat) – is removed because it is so limp it obstructs the airway.

The latest development in snoring treatment is designed to do away with surgery. Instead, the aim is to make it as convenient as a simple cosmetic procedure or going to the dentist.

Instead of scalpels, the Snore3 uses lasers to treat heavy snorers.

The first stage involves a consultation session at Euromed Clinic Centre with cosmetic dentist and dental-laser specialist Dr Sofia Aravopoulou.

Once relaxed on the dental chair, a camera is used for a reconnaissance mission around my gaping mouth.

“It’s your uvula,” says Dr Aravopoulou.

It was too flaccid and floppy: while it has been doing a good job of safeguarding my nasal passage away from any errant piece of food for the past 35 years, it had become too comfortable and complacent.

Instead of standing tall and rigid, befitting its status as an oral sentinel, much of my uvula slouched on the back end of my tongue – the friction caused by the flesh and the air rushing through when breathing through my mouth was causing the decibels to rise.

The process begins by receiving a 20-minute session, split into 10 two-minute zap sessions.

Dr Aravopoulou points her laser wand at the uvula – the warm sensation at the back of my throat is similar to swallowing some tea.

After the treatment comes the homework: five minutes of what might be described as mouth aerobics, where I kept my uvula bouncing up and down to keep it toned.

I then tracked my progress using Snore Lab, a free sleep-monitoring mobile-phone app.

My progress was slow, but things got increasingly better.

My snore score dropped from a high of 136 (a typical figure for a snorer) to as low as 33 – however, it fluctuated depending on the hours of sleep and exterior factors such as smoking.

There are no limits to the number of Snore3 sessions you can have, but a series of three weekly sessions will undoubtedly get you on the road to improvement – providing you do the homework.

As Dr Aravopoulou cautions repeatedly, it is not designed to cure you completely of snoring, but to keep the noise level down for your own health and that of your loved ones.

Snore3 at Euromedic Clinic Centre, Dubai, costs Dh6,000 for three sessions. For more details, go to www.euromedclinicdubai.com

aahmed@thenational.ae