Laser Surgery Lets Snorers and Their Mates Rest Easy : Health: A new technique that quiets with less pain and quicker recovery is used by a few Orange County doctors. But some are still skeptical.
In the dark, with a pillow pulled tight to her ear, a weary Denise Reale glared at her snoring husband before trudging to the living room couch. Another sleepless night with The Bear.
“It’s sooo loud,” she said of the nocturnal rumblings created by Thomas, her husband of 14 years. “Our daughter has friends come over for slumber parties sometimes, and the next morning they giggle and ask about the bear upstairs. It’s sort of funny, but it can create a lot of stress, too.”
The Anaheim Hills couple are not alone in their nightly ordeal. One in four Americans is a habitual snorer, and the problem worsens with age. For some it is a symptom of a more serious ailment, sleep apnea, but for most it is a nettlesome, frustrating wedge between them and their sleeping partners.
“I really can’t sleep with him,” Denise Reale, 37, said. “If it was once in awhile it’d be one thing, but every night. . . . I just can’t take it.” Luckily for the Reales, the bear has gone into hibernation--a quiet hibernation at that.
The help came in the form of a laser surgery devised in Europe in 1989 and now used by a handful of Southland doctors. The technique, called laser-assisted uvulopalatopharyngoplasty, involves surgical removal of some tissues in the throat to open the airway that causes blockage.
The laser beam is used during three or four outpatient visits to gradually shave down the excess tissue that, in effect, acts like the reed of a musical wind instrument when the snorer sleeps.
For Thomas Reale, 41, a single treatment several weeks ago has yielded dramatic results. He still snores, but not as often nor as loud. “It’s great, just great,” his wife said.
Reale’s surgeon, Al S. Aly, has performed the surgery on about 15 patients at his Santa Ana and Beverly Hills offices.
“This technique is infinitely better than the procedure that preceded it,” Aly said. “For the patient, it’s like a visit to the dentist, but certainly less painful.”
And less painful then the approach most commonly used to reduce the snore-producing tissue. That procedure, where a scalpel is used to carve out the area, leaves the patient with intense pain during recovery. “Imagine your worst sore throat, and multiply by 20,” Aly said.
Less pain, faster recovery and visible results: It isn’t difficult to see why there is a waiting list for the process. But the procedure isn’t without controversy.
“It’s still a new and unverified procedure. I think it will be validated, but right now it has more publicity than factuality,” says Martin L. Hopp, an ear, nose and throat surgeon affiliated with the Sleep Disorders Center at Century City Hospital.
The hype has surgeons eager to learn more about the procedure, said Dr. Yona Tadir, medical director of the Irvine-based Beckman Institute for laser surgery, a branch of the UCI Medical Center in Orange.
“It’s spreading like a fire,” said Tadir, whose institute has performed the surgery on about 50 patients. “It’s amazing to see how many doctors are interested in adopting this surgery. It’s a very promising procedure.”
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Some experts, however, are concerned that the quick-fix laser process might inadvertently encourage people not to investigate the reason they snore--a sometimes important medical determination.
Loud snoring is sometimes a symptom of sleep apnea, a serious condition in which the sleeper stops breathing for dangerous lengths of time.
While the new procedure is billed as way to help people with sleep apnea, several doctors said they are concerned that patients may request surgery without first getting a thorough evaluation at a sleep disorders clinic to see if they have sleep apnea. Those doctors, still skeptical, also want to see more studies verifying the procedure.
“There are studies in France, but we want to see it under our hands. Until we do that, I’m not comfortable recommending it, “ says Dr. Jeffrey N. Hausfeld, medical director of the Sleep Disorders Center at Washington Hospital in Washington, D.C.
Studies by French researchers show a high success rate for people with simple snoring and apnea, although the studies have involved only a few apnea patients. Side effects--such as bleeding, infection and swallowing and voice problems--have been minimal, the French researchers say.
The French studies boast of a 95% improvement rate among 620 patients, and results from a survey of 199 New York patients who have undergone the procedure found improvement in 80% of cases by the third visit.
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Snoring is a common problem that has long defied easy solutions. There are more than 300 devices registered in the U.S. Patent and Trademark Office as cures for snoring, according to the American Academy of Otolaryngology. But, the academy notes, “99% of them work by keeping the snorer awake.”
Although the field of sleep disorders therapy has blossomed during the past 10 years, there are still no sure-fire treatments for severe snoring or apnea, Hopp says. And patients with the worst problems--an estimated 20 million--are often desperate for help.
“It’s not unusual to have someone come in who says, ‘I’m getting divorced because I can’t sleep with my spouse. I snore too much,’ ” Hopp says.
There have been few remedies for people who snore in quaking tones, experts say. That’s why reports that laser-assisted uvulopalatopharyngoplasty can help have generated so much enthusiasm.
In the laser surgery, done in a series of four to six outpatient visits, the surgeon trims the soft palate and the uvula--the pouch of tissue that dangles from the roof of the mouth--with a precise laser beam.
The laser is useful because it reduces bleeding and swelling and is less painful than traditional surgery. Patients can have a moderate-to-severe sore throat for up to six days and usually miss a day or two of work. About four weeks of healing time is needed between treatments. According to Sharplan Lasers of Allendale, N.J., which manufacturers the laser and teaches the procedure to surgeons, studies in France show a dramatic reduction of snoring in 85% of 345 patients studied.
But Hopp and other sleep experts accuse the manufacturer and the media of hyping the surgery before American studies are completed. The laser is already approved for use in the United States.
An ongoing U.S. study of 300 people indicates that the procedure might benefit both sleep apnea patients and people with benign snoring. At St. Luke’s-Roosevelt Hospital in New York, 85% to 90% of those with benign snoring experienced a drastic reduction in snoring, and about 90% of those with sleep apnea saw an improvement in both snoring and breathing capacity, says Dr. Yosef Krespi, director of the hospital’s ear, nose and throat department.
“In patients without apnea, the loudness of the snoring is diminished to a degree that they can start moving back into their bedrooms,” Krespi says. “In patients with apnea, we see tremendous improvement in oxygen intake during sleep and a reduction in how many apnea episodes they are having per hour.”
Apnea is usually diagnosed after an evaluation at a sleep disorders clinic (the patient is tested during sleep) and is often treated with surgery, including a non-laser type of uvulopalatopharyngoplasty, which is similar to the laser technique but usually involves removing more tissue, Hopp says.
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In a traditional uvulopalatopharyngoplasty, the uvula and soft palate are cut back and the tonsils removed to open airways. The surgery is done under a general anesthetic, and the patient is hospitalized for a few days.
The surgery is about 50% effective, Hopp says.
“In some cases after the surgery, the patient still has blockage at the base of the tongue,” he says. “So we were disenchanted with this operation.”
But the surgery is still performed on patients who are thought to be particularly good candidates for it, he says.
The advantage of the laser surgery, Hopp says, is that doctors can check the patient after each stage of the surgery to see if it’s working, and that patients may experience less pain and fewer side effects, he says.
But until the U.S. studies are published, many surgeons urge caution.
“We’re going to tell our first patients that they are guinea pigs,” says Hopp, who just started offering the procedure at Century City Hospital. St. John’s Hospital in Santa Monica and Cedars-Sinai are expected to offer the surgery after earthquake repairs are made on their buildings.
Others say they will not recommend the surgery until more is known about it.
The potential for scarring that might cause permanent swallowing and speech problems is especially worrisome, says Washington Hospital’s Hausfeld, although the French studies last year showed no problems since.
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Another concern is that the technique will become so popular that patients will demand--and receive--it without first getting a thorough evaluation. Some patients who have sleep apnea may have the procedure and see a reduction in their snoring. But they may still have dangerous apnea, says Dr. Nelson Powell of the Stanford University Sleep Disorders Center.
“If you go in and remove this alarm mechanism--the snoring goes away--and the patient has not been evaluated properly for apnea, then you’ve really done a disservice,” Powell says. But, he says, some patients will hear about the laser surgery, seek treatment for their snoring and will find out they really have sleep apnea.
“In some respects, the (publicity) this has gotten will uncover a lot of people with bona fide sleep apnea. A good head and neck surgeon will do formal study and make sure they are doing the right treatment,” Powell says.
The laser procedure costs from $2,000 to $5,000 and probably will not be covered by insurance unless patients can show they are being treated for severe apnea that endangers their overall health.
For chronic snorers such as Thomas Reale, the price is a reasonable one in exchange for restful nights and a peaceful relationship. If the procedure continues to improve his condition, it could mean the end of The Bear.
“I could rest a lot easier, that’s for sure.”
