Ryan Soose, MD, Associate Professor in the Department of Otolaryngology at the University of Pittsburgh, and Director of Division of Sleep Medicine and Upper Airway Surgery at UPMC talks about the many aspects of life that snoring affects, and how Theravent may be the answer for some patients.
Interview conducted by Ivanhoe Broadcast News in May 2018.
Is your expertise in Sleep or Sleep Apnea?
Dr. Soose: I am double boarded and trained in both sleep apnea and otolaryngology so my area of expertise encompasses the medical and surgical management of snoring and sleep apnea.
I want to ask you specifically about snoring. How common of a problem is it?
Dr. Soose: Snoring is really common, It affects tens of millions of people in the US. It’s estimated anywhere between twenty five percent up to fifty percent of the US population snores on a regular basis. It affects men, women, young, old, all ethnic backgrounds – it really doesn’t discriminate.
What are some of the causes?
Dr. Soose: Snoring is essentially the vibration or flutter of the soft tissues of the throat during sleep. It can be caused by many different things including weight gain, nasal congestion, small jaw structure, sleeping position, or large tonsils and adenoids.
How much of a problem is it for a person and for some is it barely noticeable, what is the range?
Dr. Soose: I think snoring is really a big problem for two reasons. One, is it affects the bed partner or spouse, and the second is it affects the patient or the snorer themselves. We know that it negatively affects bed partner’s sleep, in fact that’s often the reason that people seek treatment. It’s often the spouse bringing the patient in for evaluation at the doctor. Secondly, it can affect the patient’s sleep. Patients often report walking up through the night, un-refreshing sleep, waking up with a dry mouth and sore throat.
What are some of the common treatments, do you have a first line treatment, something that you start with that you move on from there?
Dr. Soose: For such a common and disruptive problem, there really aren’t that many effective and go-to treatments. It’s often a neglected and under-evaluated aspect in the medical world. There are currently hundreds of over-the-counter snoring products that are made and marketed specifically for people with snoring but without the more full-blown sleep apnea condition. But what’s interesting is that even though there are hundreds of treatments available, the vast majority are either unproven or ineffective. I think that the best way to initiate effective treatment is to start by seeing a snoring specialist. A snoring specialist can evaluate each person’s individual anatomy and causes of snoring and then tailor a personalized treatment plan to each individual.
When you’re looking and examining a patient and coming up with therapies or treatments do you start less invasive or lifestyle change, even changing your sleep position. Where do you start in terms of suggesting relief for patients?
Dr. Soose: Absolutely. Again the treatment for snoring is often started conservatively and again it’s tailored to each individual’s reasons for snoring. So, weight loss is common, changes in sleep position, treating nasal congestion, a simple dental appliance that stabilizes the jaw, reducing evening alcohol. Those are very common things that we start with. But even with those conservative tools in the tool box there is still millions of people that snore and require a little bit more effective medical or surgical treatments.
If people aren’t getting that deep sleep over a period of time what happens? Are we talking about quality of life or are you talking about the potential for other health conditions down the road?
Dr. Soose: The distinction has to be made between snoring alone or snoring as just one symptom of a more serious sleep apnea condition. Sleep apnea is a more advanced breathing problem that carries other health risks. So making that distinction first is very important. But even with just snoring alone, it negatively affects the patient’s sleep, it negatively affects the bed partner’s sleep so it can pose unnecessary strain on marriages, family trips or vacations, etc, and there is new and emerging evidence that snoring alone carries health risks too.
You had talked about over the counter treatments, can you talk a little bit about some of the ones that patients have found some success with?
Dr. Soose: Some of the over the counter treatments that have success in at least some of the patients who snore have to do with improving nasal breathing. We know that if you can’t breathe well through your nose you’re more likely to snore. So breath right strips or nasal dilator strips, nasal sprays that reduce allergy inflammation, and even nasal surgical treatments for instance that fix a deviated septum can improve snoring in some individuals.
I wanted to talk about Theravent, I have heard of CPAP before I have never heart of EPAP. Can you tell me what we’re talking about?
Dr. Soose: CPAP is the most commonly used and effective treatment for the more serious sleep apnea condition. It adds extra air pressure to the patients breathing passage to stabilize the breathing and eliminate the snoring. For patients with just snoring but without sleep apnea a CPAP is a bit too involved and expensive and cumbersome. Theravent is a new device that allows the generation of that same positive air pressure with a much smaller more convenient more cost effective device. Theravent is a disposable adhesive strip that covers the nostril and it contains a unique one-way valve system. It allows the patient to breathe in freely but when they breathe out the valves close, generating extra air pressure back in the breathing passage. This extra air pressure then stabilizes the throat and reduces the vibration and flutter which is snoring.
So which patient would Theravent work best for? You’re not talking about someone who has the nasal congestion. It’s a different complication?
Dr. Soose: Right. I think that Theravent can work for a whole variety of different anatomies and different patients. People with chronic nasal congestion due to allergies or a deviated septum may have difficulty using Theravent but remember Theravent is just one tool in the tool box and can be combined with treatment of the nose, with weight loss, and with other snoring treatments to get even better results.
The bottom line if you or someone that you love is snoring a lot of people tend to just ignore it, it will go away or let it go on. What do you recommend?
Dr. Soose: I agree, I think that snoring, for too long, has been brushed under the rug as just something that everyone in the family does or just a social nuisance. But the reality is it affects patients’ sleep, it may even affect their health, and it certainly affects marriages and relationships. So for anyone dealing with loud disruptive snoring, I would recommend seeing a sleep specialist again to first distinguish between snoring alone and sleep apnea. And then evaluate each person’s individual anatomy and why they’re snoring. Once you find out the causes of the snoring you can then tailor a treatment plan with Theravent, with weight loss, with other snoring treatments, etc.
You had mentioned earlier that Theravent at one time had been prescription only. Can you tell me why it’s available now over the counter, why it’s changed?
Dr. Soose: There is a version of Theravent that is also made for more significant sleep apnea. But to provide treatment to the broader population of patients who just snore but don’t have more full-blown sleep apnea, Theravent is designed as a more accessible, more cost-effective alternative. It’s available online and over-the-counter at most drug stores. And there’s essentially no risk and that’s the biggest upside to Theravent is there’s really minimal-to-no risk to putting a little adhesive strip over your nose.
If it’s not working well for a patient they’ll know. Because you’re telling me it’s a one way vent to your nose and right away I’m thinking I would want it to go both ways, bring air in bring air out. But each patient would be able to tell, it’s not like they’re going to choke in their sleep because they have this thing on their nose, right?
Dr. Soose: Correct. I think that using Theravent just like any other device for snoring or sleep apnea requires some acclimatization. Theravent just like any other device requires some time period to accommodate to it and get used to it but after a few days most people find it comfortable. And prior studies have shown approximately seventy five percent reduction in the decibel level of snoring in people that use Theravent and in some studies eight out of ten patients’ bed partners reported a reduced level of snoring. So it does require some accommodation period but once patients are used to it there is some benefit in snoring and again that’s counteracted by pretty much minimal-to-no risk in using it.
Doctor I just have to ask you, you have no financial ties to the company?
Dr. Soose: No, No conflict of interest.
How long have you been a sleep medicine specialist?
Dr. Soose: I’ve been a sleep specialist here at UPMC for approximately ten years. I’m dual trained in both otolaryngology head and neck surgery as well as sleep medicine. It’s a unique combination that really allows us to provide the full medical and surgical treatment package for patients.
END OF INTERVIEW
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