A Wake-Up Call on Snoring Treatments Millions of Americans have their nightly sleep interrupted by snoring -- their own or a partner's. Ira Flatow leads a discussion on the causes of snoring, and some potential remedies. Do over-the-counter treatments work? Who is a candidate for surgery?
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A Wake-Up Call on Snoring Treatments

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A Wake-Up Call on Snoring Treatments

A Wake-Up Call on Snoring Treatments

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This is TALK OF THE NATION/SCIENCE FRIDAY. I'm Ira Flatow. Time for a little experiment. Now, this is something that I want you to try the next time you're at a dinner party. Ask if anyone at the table is kept awake by someone else's snoring--yep, snoring--and here's what I predict will happen. There's going to be an awkward silence and then a furtive glance exchange between the couples at the table and then quietly one brave soul is going to confess to an occasional -- an occasional noisy night of snoring.

Right after that, the floodgates are going to open because it seems like almost everyone shares a bedroom with someone else who is losing sleep or snoring and they just can't get a good night's sleep; somebody is snoring next to you in bed or another room or right there. Oh! It's one of the dirty little family secrets, but believe me, it's a big secret.

By conservative estimates, as many as 60 to 70 million Americans snore. That's about one out of every three adults; one out of every three people snore. A large number! And, assuming that their partners haven't moved into a second bedroom yet, that means as many as 70 million Americans might be kept awake by that loud home wrecking sound of someone else's snoring. But, what can you do?

Well, you're bombarded with ads if you watch T.V.--ads--all kinds of remedies on T.V. What do you get, those little strips of tape to put over your nose? They sell that in the drugstore. Or, you got the acupressure ring. You can buy that on the Internet. Then there are other alternatives like surgery. And how is snoring related to sleep apnea--waking up during sleep?

We're going to talk about this and all the other things that have to do with snoring. We're going to sort it out for you. We're going to look at the treatments out there and ask you, if you snore, have you found something that works to stop it. Maybe you can tell us what you think is working for you or your experiences with snoring. Our number, 1-800-989-8255; 1-800-989-TALK. As always, you can surf over to our website at sciencefriday.com.

Dr. Mark W. Mahowald is a professor of neurology at the University of Minnesota and chair of neurology at the Hennepin County Medical Center in Minnepolis. He is also director of the Minnesota Regional Sleep Disorders Center there. He joins us by phone from his office. Thanks for being with us today doctor.

Dr. MARK W. MAHOWALD (Professor of Neurology, University of Minnesota; Chair of Neurology, Hennepin County Medical Center; Director, Minnesota Regional Sleep Disorders Center, Minneapolis, Minnesota): Yes, this is my pleasure.

FLATOW: You're welcome.

Captain Pete Michaelson is a head and neck surgeon at the Wilford Hall Medical Center on Lackland Air Force Base. That's in San Antonio, Texas and he joins us from the studios of KSTX in San Antonio. Thank you for talking with us today Dr. Michaelson.

Dr. PETE MICHAELSON (Head and Neck Surgeon, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas): It's a pleasure, Ira.

FLATOW: Let me ask you Dr. Mahowald, is there a profile, is there an average snorer? Who snores? What age? You know, who are they? I said there was like 60- 70 million Americans. That's a lot of people.

Dr. MAHOWALD: Well, the problems of snoring in people over the age of 50 or 60 is about 40% in women and 60% in men so it's extraordinarily high. It used to be thought it was primarily men and that women didn't snore very often because it's not considered to be very dainty, however, snoring is very, very prevalent in women. It's actually seen even in 10% of children so snoring doesn't respect age, sex, body habitus(ph) or age, so snoring can occur absolutely at any age, in either sex and any body weight.

FLATOW: Yeah, that was my next question because the mythology says usually it's overweight people who are doing the snoring.

Dr. MAHOWALD: Well, I think weight certainly plays a role in snoring. You're more apt to snore if you are overweight. If you snore, your snoring may get worse if you gain weight, but what's important to keep in mind is that many people who are very, very heroic snorers are not the least bit overweight and conversely, many people who are severely overweight do not snore. So, weight is a risk factor for, but certainly not the sole cause of snoring.

FLATOW: Well, let's talk about the cause of snoring. Is there one cause inside your throat that causes you to snore?

Dr. MAHOWALD: Well, there's one cause and that is increased resistance of air moving through the upper airway. There's not one location in the upper airway and that's why there are so many generally ineffective treatments that are available for snoring. It's actually (unintelligible) the more treatments that are available for a given medical condition, the least apt that anyone of them is to be effective. I mean, if there were one good effective treatment for snoring, we wouldn't be bombarded by ads for 30 or 40 different purportedly effective treatments.

FLATOW: Mm hmm. Dr. Mahowald, when someone comes into your clinic with complaints of snoring, what do you do? Is there a set of tests that you conduct?

Dr. MAHOWALD: Well, the first order of business is to make sure that the snoring is not one of the manifestations of obstructive sleep apnea because that's a completely different issue in terms of treatment and in terms of medical consequences.

Now, virtually all people who have sleep apnea snore. The converse is not true. The majority of people who snore do not have sleep apnea. So, we ask about observed breath holding during sleep. We ask about symptoms of excessive daytime sleepiness. We ask about whether the individual has high blood pressure or heart trouble or diabetes. These can all be kind of indirect markers of obstructive sleep apnea.

Now, the treatment for obstructive sleep apnea is generally going to be quite different from the treatment that we might recommend for snoring. So, the first order of business is, does the snorer likely have obstructive sleep apnea. If the answer's yes, then that individual does need a form of sleep study to identify the presence and/or severity of any underlying sleep and breathing problems.

FLATOW: Mmm. Dr. Michaelson, let's talk about how you treat people with surgery. Tell us about the different surgeries that there are for snoring.

Dr. MICHAELSON: Well, just as my sleep medicine colleague stated, the first order of business is to determine whether or not the patient comes in with simple snoring or if the snoring is a symptom of a greater medical problem such as obstructive sleep apnea.

After the proper evaluation has been done, our treatment basically is dependent upon that answer. If there is actually just snoring occurring, we have extremely effective, either clinic or operating room procedures that a patient can undergo that have been time-proven in the literature to help snoring and to get rid of it.

There's been sort of an evolution with sleep surgery. Now, looking at old medical journals from London in the 1840's, even back then, obviously, snoring has been a problem for a long time, but surgeons back then were trying to decrease, you know, the floppy palate in the patients that had a lot of heroic snoring and sleep apnea.

After that, there was a long amount of time where there wasn't much that was not much in terms of evolution, but in the 80's or so, in the U.S., a palatal procedure, a uvulopalatopharyngoplasty, or UPPP, became very popular in which part of the palate is cauterized and part of it is removed and the tonsils are removed and that is a very destructive procedure and it was created with the thought of curing snoring.

What we've sort of moved on from there into is cure versus control and quality of life issues. Do you want to remove tissue or do you want to try to stiffen this palate? Now, this is mainly talking about patients that have snoring. What we see in patients that snore is that the palate, when they're sleeping, about 80 or so percent of folks where snoring arises, is floppy, as if you would see if it were in a wind tunnel.

And, what we're trying to move towards are clinic-based procedures that are less , and just as effective where we stiffen the palate and out of this idea was born procedures such as LAUP or laser assisted uvulopalatoplasty, CAPSO, cautery assisted palatal stiffening operation, the RFA treatments or radio frequency ablation where we actually put a probe into the soft tissues and deliver energy which creates scarring and most lately, injection snoreplasty where we actually inject a sclerosing agent of some sort into the palate for it to stiffen and mostly recently, the pillar implant system where small implants are actually placed into the palate, will stiffen it and thus decrease snoring.

FLATOW: And are these painful?

Dr. MICHAELSON: Well, it depends on what you're talking about. The earlier procedures such as a UPPP, if you--you were talking earlier about the dinner table discussion...

Dr. MAHOWALD: Right.

Dr. MICHAELSON: ...I can guarantee you that, not only would, you know, snoring bring up a good discussion, but if anybody had undergone a UPPP, they will discuss their post-operative course--because these are very painful. You know the typical way to perform this procedure is with cautery units, basically a hot stick that burns the tissue and removes it.

And an average adult will have one to two weeks of intense post-op pain from this procedure. Now the later procedures are different. These clinic procedures, such as injection snoreplasty are much less painful. We see patients come in from work and go back to work that day or the next day.

FLATOW: Dr. Mahowald, what do you think of the surgical technique?

Dr. MAHOWALD: Well, I would be in pretty much agreement. Certainly the best to describe the results of uvulopalatopharyngoplasty with regard to discomfort is memorable. Most of these patients will say that it was a very significantly uncomfortable procedure.

With regard to the palate procedures, you know, one problem with snoring is that it can arise from multiple different levels of the upper airway and very rarely from the nasal passages. And that's why the nasal dilating strips tend to be ineffective because snoring is almost never coming from the nose per se.

FLATOW: Mm hmmm.

Dr. MAHOWALD: In many people it is coming from the soft palate in which case, one of the palatal procedures may be effective. But many people, snoring it's coming from the base of the tongue or even the layer of pharyngeal walls. So what people need to know is that if they're snoring is coming purely from the soft palate, then one of the palatal procedures may be effective.

What we don't know is how, for how long these procedures are effective. And if we look at the uvulopalatopharyngoplasty procedure as an example, the short- term effectiveness for snoring, again this is not for sleep apnea, but for snoring it was very, very high: 75, 80 percent. However, after four years, 50 percent of the people are snoring again which tells us that for many people, snoring is a progressive condition. It gets worse over time and these procedures may buy some time in the progression of the underlying condition but many of the palatal procedures, we don't have any long term follow up data.

And I think that if the extreme procedure like uvulopalatopharyngoplasty shows the decrement in effectiveness over time, I think it's likely to suspect the palate procedures may also; but again, we just don't know.

FLATOW: You agree, Dr. Michaelson, that it's a temporary fix?

Capt. MICHAELSON: Well, actually that's true and we actually in the ear, nose and throat literature we have, as well as sleep literature, there are some studies that have followed the UPPP patients out. When we start moving past the three to five, we're actually past the two- to three-year mark, we start to see the patients that had in moderate to severe obstructive sleep apnea will often revert back to the same symptoms that they had before the surgery.

However, the difference is, is now they don't have much of a palate, they don't have tonsils and what do you do with that patient? And that's an addition to the additional problems that that procedure can sometimes move those folks into when they try to have additional therapies, such as continuous positive airway pressure.

But that is exactly why the majority of otolaryngologists are moving towards the newer therapies because the newer therapies are not designed to cure snoring. They are designed to control it.

FLATOW: All right, all...

Dr. MICHAELSON: So you come in for you know...

FLATOW: Hang on, doctor, I'm going to have to have you hold that thought because we have to take a break but it's an interesting thought and we want to flesh it out fully. So stay with us. We'll come right back and talk more about snoring.

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FLATOW: I'm Ira Flatow this TALK of the NATION: SCIENCE FRIDAY from NPR News.

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FLATOW: You're listening to TALK of the NATION: SCIENCE FRIDAY. I'm Ira Flatow. We're talking this hour about snoring and sleep apnea with my guests Dr. Mark Dr. Mahowald, professor of neurology at the University of Minnesota and Captain Pete Michaelson, head and neck surgeon at Lackland Air Force Base in San Antonio.

Our number: 1-800-989-8255; and when I rudely interrupted Dr. Michaelson, he was telling us about something that was I was so sorry to hear about it: that the surgical techniques you were saying, some of them don't work. And then you have to go on to the next stage that might be controlling if not curing the snoring.

Dr. MICHAELSON: Well, exactly when these, some of these procedures came out, when the UP3 came out there was so much excitement because it was so effective for snoring. And initially, it helped a lot of the patients with apnea. But like I said, as we follow those patients out, a lot of them kind of wound up in the same boat that they were in when they came in for treatment initially.

And the newer treatments that we have, now these are the treatments that I can offer as an ENT doc, such as the clinic based-procedures: the RFA, the palate and or tongue base, injection snoreplasty, the pillar system. These are designed to control snoring. They are designed to help stiffen the palate now and that's a whole other discussion: where exactly is the snoring coming from? This is based on the fact that we know about 80 percent of the folks that come in with simple snoring and that is snoring without apnea, the source, by and far, is the palate so that's why a lot of our procedures are aimed at treating the palate.

FLATOW: Mm hmmm.

Dr. MICHAELSON: We can treat the palate in the clinic. It is associated with some discomfort but not a lot.

FLATOW: Describe what you're doing, what that pillar technique is.

Dr. MICHAELSON: Well, the pillar implant system is basically, it's a commercially made product. They're small implants that are basically with a special implant device are placed into the palate, into the soft tissue of the palate in front of the uvula. And they're submucosal so they're basically under the skin. And these implants, probably by a combination of the implant itself and the reaction to the implant in the soft tissues over time, will decrease the palatal flutter during sleep and decrease snoring.

FLATOW: So it doesn't eliminate the snoring it controls the snoring, as you're saying.

Dr. MICHAELSON: Well, it depends, first of all, on the patient and second of all it is probably one of the newest devices out on the market. We're still awaiting, we have some data on the pillar implant system, which is multi-year. We're actually anxious to see the data that brings it out further because there are obviously are all so some potential complications of all of these procedures. Such as if you place a foreign body into the palate, your body's natural reaction is to get rid of that foreign body. And well, it could be spit out--will you get an infection? Following these patients out long term is something that is data that I'm anxious to see. What we do know is that the efficacy, I'm sorry?

Dr. MAHOWALD: I'm particularly looking for long-term data from studies that are not sponsored by the pillar's manufacturer.

Dr. MICHAELSON: Exactly and that's why, I mean, me speaking selfishly, some of the studies that I have done, now I have not studied Pillar, I did help some of the earlier work with the Pillar System and did note that personally, my colleague and I, Eric Mear(ph), when we did some work back in Washington D.C. had a problem with extrusion rates. We noticed that a lot of the implants we were placing were extruding. Now this was before the implant and the device for implantation was redesigned with our, with you know, what we gave as input to the company. But it's nice to be able to do studies when we're in the military because we are not sponsored by anybody. And we're just looking out for the best interest of the patient.

I did study some other commercial snoring agent in the past and in working and using all of these methods in the clinic, they seem to be somewhat equally comparable in efficacy. And if the patient such as the injection snoreplasty or RFA gets treated, the thought is if they reoccur in two to three years they can come back in, get another treatment, go back to work that day and sort of like come in to get a booster shot for snoring. That's kind of where I foresee it going.

FLATOW: Does it affect your swallowing or your voice or things like that?

Dr. MICHAELSON: Well, probably the most common complaint that we'll see, and once again it's very procedure specific, but we will see complaints of dysphasia or, you know, difficulty or my swallowing is a little bit different. Somewhat of a transient symptom, we do see in the majority of the patients that gets some of these procedures is due to the swelling that happens in the palate. Very small amount of swelling in the mouth will be perceived as anybody that has difficulty swallowing but it tends to go away with time and...

Dr. MAHOWALD: You might not want to do this on an opera singer.

FLATOW: Mm hmmm.

Dr. MICHAELSON: Exactly and obviously all the patients I come in, after they're properly evaluated and that includes not only an objective test such as a polysomnogram, but our own physical examination. We speak to them about the risks and benefits. And to be honest you know, even if we affect the voice of an opera singer, which these procedures would not, how much of their life being affected by them not sleeping at night or their spouse moving to a separate room for the past 10 years.

FLATOW: Mm hmmm; 1-800-989-8255 is our number; let's go to Mike in Minneapolis. Hi Mike.

MIKE (Caller): Hello there.


MIKE: I've had a problem with snoring for many years and I've hit upon something that works for me, and that is a set of exercises that I do after brushing my teeth and before going to bed at night. I do an exaggerated yawn. I work the muscles at the back of my throat and the base of my tongue. And I, you know, my wife tells me that when I do those exercises regularly I don't snore. When I, you know, forget to do them, go without doing them for several days, then things go lax and I start snoring again. Is there any studies done on the effect of exercises such as that?

FLATOW: Dr. Mahowald?

Dr. MAHOWALD: I'm not personally aware of any and although the idea is attractive, one of the problems with waking muscle exercises, you may strengthen muscles during wakefulness but sleep is associated with the dramatic change in muscle control. And many muscles actually lose all of their strength during our sleep, particularly dream sleep. And so if snoring were to occur during dream sleep then muscle-strengthening exercises would be completely sabotaged by the REM...

MIKE: What led me to this was I was wondering: what is the purpose of a yawn?

Dr. MAHOWALD: Why do we yawn in general?

MIKE: Yeah it, I mean it's to get oxygen or what have you; but also there's this exaggerated stretching motion that we go through.

Dr. MAHOWALD: Again, I'm not aware of any studies that have really specifically addressed the effect of any upper airway muscle exercises or muscle strengthening exercise on snoring. It may be that it's effective, but I'm not aware of any studies.

FLATOW: Mike, if it works for you do it.

Dr. MAHOWALD: I think one thing we haven't talked about, another very noninvasive treatment and one that is often very effective, is the mandibular advancement device. These are completely noninvasive. These look like hockey tooth guards and they basically are fitted to each person's mouth specifically, individually and they serve to jut the lower jaw forward. And they have adjustment screws so you can progressively protrude the lower jaw...

FLATOW: Mm hmmm.

Dr. MAHOWALD: ...and what that does is the base of the tongue is attached to the lower jaw.


Dr. MAHOWALD: And so as you move the lower jaw forward the base of the tongue is moved forward and for the people who snoring is not coming from the palate region, but rather is coming from the tongue region, this may be very effective. And in the hands of the dentists that we've worked with for the last 25 years with this their success rate ends snoring again, not apnea. I think everybody should know what we're talking about today is snoring and not apnea is about 75 or 80 percent. This is just completely non-invasive if it works fine, if it doesn't work, there's no harm done.

FLATOW: What about these CPAP masks that I hear so many people wearing? Describe what they're used for.

Dr. MAHOWALD: Well CPAP is an achievement for obstructive sleep apnea. It's spelled C-P-A-P and that stands for Continuous Positive Airway Pressure. It's simply a mask that typically goes over the nose and out the mouth and is attached to a blower that blows in room air and not oxygen just room air. And it serves as a simple mechanical splint to keep the upper airway open. And it is used for people that have obstructive sleep apnea and it's effective in virtually everybody.

Now some people have trouble tolerating it, but it is very, very effective. It will eliminate snoring and obstructive sleep apnea because it eliminates or reduces resistance to the airflow going through the upper airway. I don't know what my colleague's experience is with this, but for snoring, I don't think, we have 15,000 people using CPAP from our sleep center who are using for apnea.

I don't believe we have anyone who is using it solely for snoring. I think that the CPAP is cumbersome enough and uncomfortable enough that there has to be a bigger payoff to the patient. And usually the patients who have obstructive sleep apnea have severe excessive daytime sleepiness--which is almost immediately treated by using nasal CPAP. So they have a payoff and they feel much better the next day.

FLATOW: Mm hmmm.

Dr. MAHOWALD: For snoring without any other symptoms, I think it's unlikely the people will where CPAP on a regular basis.

FLATOW: Dr. Michaelson what about some of these over the counter devices we've been seeing. The nose strips, I actually saw a popular one on the Web these days which is an acupressure ring. Are you familiar with these and do we know if they work or not?


FLATOW: It's a ring you put on your pinky I think and then there's an acupressure point it says that will stop you from snoring complete with testimonials.

Dr. MICHAELSON: Exactly and that's mainly all you're going to get with many of these products. I was asked I was called as far as from USA Today recently to ask my opinion on the ring. That was the first I had heard of it. 'Cause there's no way even as a physician, I mean you can't become familiar with all of the remedies that are out there. There's 500 plus commercially made snoring remedies that are basically in reference with the U.S. Trade and Patent office right now. That's 500 plus, this is a multibillion-dollar industry. This is an industry that promises that it's going to cure--and this is without a filter or a physician looking at a patient.

So, a patient won't know exactly where their problem is, but they'll be told that this thing will cure it. So often they'll go out and buy it. And I'm bombarded all day long in my clinic with patients asking me if these things work. On an average clinic day, seeing approximately 50 to 60 patients, probably 10 or 20 are going to come in with questions about snoring or sleep apnea. In half will walk in and the other half will be dragged in by their spouse and won't admit that they do when their spouse asks me about it. But many of them, the vast majority have already tried many of these aides and so a few years ago, I kind of set out to determine if some of these worked.

Now I couldn't in no way examine all of the possible remedies. And scientifically to figure out which ones to study didn't seem like the way to go either. So what I did was I started asking patients what they had tried. I went on the web and looked at what popped up when I typed in a Google search engine for snoring, and I basically. And I went to the local drug store. And I looked what was on the shelves, and what was expensive, and what was inexpensive. And what was there the most of, and I finally decided, myself and Eric Mear(ph), this colleague of mine at Wilford Hall Medical Center decided to study three main categories. One was the lubricating mouth spray, second was the nasal dilator strips. And third were the head positioning pillows.

And what I did was I took these three products. I had 40 plus patients at my medical center that enrolled in the study and then I took a week for each patient. Now each patient had seven independent sleep tests. That is every night for a full week where I had them wear one of the devices one night and no device the next night. So that basically each patient with their own control. I also had the patients as well as their bed partner fill out subjected questionnaires as far as whether these devices worked.

Now of note, the sleep test that I used, was a home sleep test. It's called the snap test, and one of the, one of the benefits of using this particular type of polysonogram is it also utilizes, it studies the acoustics of the sounds of your snore when you sleep. So not only can it give us some, give us an idea of the presence of apnea, but it can also give us an idea based on the frequency and duration of your snore. Tell us possibly where the snore is coming from. Is it coming from palate? Is it coming from your tongue base? And we looked at all this data, and went through Stasta Medical Center(ph) and found that none of these devices worked period, none of them.

And that was not only objective sleep data, but the subjective questionnaires with the patients asking the patients would you use this again? Spouses, would you have your spouse use this again? And then I asked them problems they had with these devices. Now unfortunately, most of these devices already been utilized when you discover that they're not working. Now for some people they might but objectively we looked at it, and they did not.

And what I envisioned doing and I hope will be done is further studies on the more available commercial products. But it's very disheartening. It's very disheartening for me to see that many folks that come in don't know that there are excellent, excellent options that can be given to them by the pulmonologist, neurologist or ENT doc that can cure the snoring problem. Sometimes they go straight to the drugstore.

Dr. Mahowald: There's a sort of study we need. I'm familiar with that study. It was a very, very nicely done study, and what we need are objects of studies and not Oral Roberts testimonials. And despite the fact that this information is now in the medical literature, those devices are still widely purchased by people which underscores the fact that the story really is a big problem. People will do just about anything even if it doesn't make any sense, or even if we know it doesn't work because they hope it will work, they'll do anything to treat their snoring.

FLATOW: We're talking about snoring and sleep apnea this hour on TALK OF THE NATION SCIENCE FRIDAY. From NPR News. And if you have a snoring problem and you don't know it, you might be having a sleep apnea problem and that can be dangerous right?

Dr. MAHOWALD: Right.

FLATOW: Why is that dangerous?

Dr. MAHOWALD: Well sleep apnea is a kind of extreme form of snoring where the resistance becomes so great, that the airway actually closes. And the individual is trying to move air and is unable to. And then what terminates the breath holding spasm very brief arousal just enough to open the airway, not enough to actually, actually awaken the individual. That allows the patient, the individual to take a few deeper breaths, but as soon as they, he or she falls asleep again, this just happens repeatedly. And many people with sleep apnea stop breathing anywhere between 50 and 100 times an hour, completely unbeknownst to them.

So this has two major consequences. One, it makes them too sleepy during the day, and that's because of the fragmentation of their sleep. So they will present with the complaint of falling asleep inappropriately during the day without apparent reason. Because again, they are completely unaware-- astonishingly unaware--of the fact that they've stopped breathing 50 or 100 times an hour.

FLATOW: Some people have told me that they've been in a traffic light and just fall asleep.

Dr. MAHOWALD: Well if you look at motor vehicle crashes, I mean falling asleep crashes, kill more young Americans under the age of 26 than alcohol related crashes. When you fall asleep in the midst of driving, it's a very serious problem. With people with apnea, and there have been studies on this, there's seven to eight times apt to have fall asleep crashes than people without apnea. So it's serious from a public safety standpoint.

The other consequences related to fall in the blood oxygen level, which happens during the breath holding spell. And over many years, this very clearly could resolve in problems with high blood pressure, heart trouble and diabetes so. The socio economic consequences of sleepiness and the medical consequences of hypertension, diabetes and heart disease underscore the fact that obstruction sleep apnea is indeed a very serious condition. And it's so easy to treat. All you do is put nasal c-pap on you. You put, blow air in their nose that splits the airway open and completely eliminates the snoring and the apnea.

FLATOW: But you have to get use to this device right?

Dr. MAHOWALD: You do. And there is some getting use to it. But again, as I mentioned earlier, the majority of the people with sleep apnea have very unpleasant symptoms during the day namely severe daytime sleepiness. And just after a couple nights of wearing this, their sleepiness is virtually gone. I mean this completely eliminates sleep apnea. And they usually find that they feel so much better during the day that they are you know happy to wear the C- Pap at night. Plus it stops the snoring so that bed partners are happy.

FLATOW: Is there a cutting edge so to speak in snoring research. I mean is there a magic device you'd like to have that you know if you could have it, or if you knew how to do this, or you knew how to the air was going this way, you could pick something good? Dr. Michaelson?

Dr. MAHOWALD: He knows more about this than I do.

FLATOW: We've got about a minute till the break but go ahead.

Dr. MICHAELSON: I guess the magic device I would want is the ability to tell everybody to get a real evaluation, 'cause there are treatments. And there are treatments I feel folks don't even know are out there. So we have the opportunity to speak to everybody and examine everybody. I think we could really make a dent in this, especially--obviously I'm talking more about the snoring.

Dr. MAHOWALD: I'd like to see a device that would allow us to identify where the snoring is coming from in a given individual because we could then more accurately tailor a specific treatment recommendations.

FLATOW: Alright stay with us and we're going to have to take a short break. When we come back lots of folks on the phones. You know they're all snoring out there and hopefully not during SCIENCE FRIDAY, but stay with us we'll be right back and take some of your phone calls.

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FLATOW: You're listening to TALK OF THE NATION SCIENCE FRIDAY. I'm Ira Flatow. We're talking about snoring and sleep apnea this hour with Dr. Mark Mahowald and Capt. Pete Michaelson. Our number is 1800-989-8255. Let's see if we could get a phone call or two in here.

Jaime, in Medford, Oregon. Hi Jaime.

JAIME (Caller): Yes hi Ira.

FLATOW: alright go ahead.

JAIME: Well this I know will not apply to everyone but it has worked for me. when I was younger, I did not snore. Now I'm 50 years old, and I've been told I do snore, and basically how I found out was my partner, she rolled me over onto my side because I'd been sleeping on my back. I, evidently when I was younger, I was sleeping on my side. I'd Like to ask your guests whether the position of the body could work. I basically used a home remedy. I used a pillow between my knees so I wouldn't roll over onto my back when I was sleeping. (Unintelligible) save my back.

FLATOW: Interesting. Dr. Mahowald does one position work you know?

Dr. MAHOWALD: For almost all people, snoring, if it's going to progress over time, initially it's present only when you're lying your on your back. Then it might spread to when you're lying on your sort of back or your side, and then it assumes it's present in all positions. And probably the most extreme form is where people if they fall asleep sitting up, they snore sitting up. and those people probably have sleep apnea. So currently position is very, very important early on what many people try to do is they would try to keep people sleeping off their backs, and so one of the earliest treatments was just show, sew tennis balls on the back of the jammy top. And so if you rolled over on your back, you'd be uncomfortable. And then roll off your back onto your side and your stomach.

That works occasionally but what usually happens is people are going to sleep in whatever position they want to sleep in. and if they wanted to sleep on their back, they're going to sleep on their back even with the tennis balls there. Or the tennis balls are going to keep them awake and they're not going to be able to sleep at all. So position is important but it's been very, very difficult to find a device that will, or a technique that will keep people from sleeping on their backs, if they snore predominantly in that position.

FLATOW: We're running out of time, but I have one final question. We've been hearing recently about the proliferation of sleeping pills. More and more people taking sleeping aids before they go to sleep. Does it affect the quality of your sleep? And does it lead to more snoring or less snoring, or do we not know?

Dr. MAHOWALD: First of all, there are now a lot of very, very affective sleeping medications than I'm personally am all for it because I think the complaint of insomnia has been overlooked and ignored for a long period of time. We have medications that are very, very effective for inducing sleep. The newer ones should have absolutely no effect upon snoring. Some of the older ones and alcohol actually will make snoring worse. Alcohol, even very, you know, small amounts of alcohol in certain individuals make snoring much worse-- but the newer sleeping medications should have no affects on snoring.

FLATOW: Dr. Michaelson do you agree?

Dr. MICHAELSON: I wholeheartedly agree. Actually listening to Jaime's comments. The caller there. He actually hit on a point that I'd read about in the past where you know the treatment of having folks go from the backs to their side dates back to the Revolutionary War when snoring was a problem with sleeping in close quarters. Where you know they would actually command soldiers to tie cannonballs in the back of their sleep shirt so they were actually forced to kind of roll onto their side. So these are, these are problems that have been around for a very, very long time.

And I wholeheartedly agree. Alcohol from what I've seen and sedatives can greatly increase the incidents of snoring and sleep apnea, but the newer ones seem to be doing real well.

FLATOW: Well gentleman I want to thank you for taking time for being with us. Mark W. Mahowald, M.D., professor and Chair of Hennepin County Medical Center in Minneapolis; also director of Minnesota Regional Sleep Disorder Center. Capt. Pete Michaelson, head and neck surgeon at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio, Texas.

Thank you.

Drs. MICHAELSON/MAHOWALD: Thank you very much.

FLATOW: And hopefully you'll have a good night sleep tonight.

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