During Stewart’s first visit, he reported that he had a long history of severe snoring. His wife, who accompanied him, had urged him to see a doctor because she noticed he appeared to stop breathing at times and also gasped for air during the night. At 57, Stewart complained that he would frequently nod off during the day or while watching television. He also admitted he had generalized fatigue and did not feel rested when he woke up in the morning. Morning headaches were also a problem.
Stewart’s Physical Exam
Stewart acknowledged that he had progressively gained weight over the years to reach 225 pounds. Although he denied using alcohol or sedatives regularly, his wife volunteered that his sleep pattern was worse after he socialized and had cocktails. Stewart also had a history of hypertension and was being treated for his high blood pressure.
A physical exam revealed Stewart to be moderately obese, and a nasal exam revealed a mildly deviated septum even though Stewart denied symptoms of chronic nasal obstruction. A throat exam revealed enlarged tonsils, a large uvula, and crowding of the soft tissues at the back of his throat. An exam of the lower part of his throat was normal.
At the conclusion of Stewart’s physical exam, a provisional diagnosis of obstructive sleep apnea was made based on physical findings and his wife’s description of his symptoms during sleep. To confirm the diagnosis, Stewart was referred to a local sleep diagnostic center for an overnight sleep study. Two weeks later, at Stewart’s follow-up visit to review the sleep study results, his respiratory disturbance index was 58—a score that is consistent with severe obstructive sleep apnea. Various treatment options were reviewed and a nasal Continuous Positive Airway Pressure (CPAP) device was recommended.
CPAP Device—the Gold Standard
A CPAP device is a small portable generator that pushes air through the nose and into the upper airways to hold the tissues apart. The generator sends air through a hose and into a plastic mask that covers the nose. The CPAP device is the gold standard for obstructive sleep apnea treatment because of its effectiveness. An appointment was made for Stewart to return to the sleep laboratory to be fitted for a CPAP mask and receive instruction on how to use the equipment.
At a follow-up consultation six weeks later, Stewart described his initial difficulties adjusting to the CPAP device. They eventually subsided, and his wife reported that his sleep patterns were much more normal with almost no snoring. Stewart reported feeling well rested with increased energy during the day. With an increase in energy, he made a commitment to a diet and regular exercise. His goal is to lose weight so that he can discontinue use of the CPAP.
Case Study: The Psychologist’s Therapy
When Manhattan psychologist, Dr. Seymour Pardo was told he had a snoring problem, he was surprised. “My lovely wife was the first one to clue me in that I was snoring, and it was disturbing her sleep. I’d been more fatigued than usual, but thought it was more my busy New York lifestyle,” Dr. Pardo explained.
In addition to his busy practice, Dr. Pardo is also professor and supervisor at Long Island University’s clinical psychology doctoral program. Although it’s common for snorers not to realize their snoring is disturbing their sleep to the point of being the cause of their daytime fatigue, when he started waking up in the morning with bad headaches, he knew it was time to visit his doctor. After a few questions from his general practitioner about his night time sleeping habits, he referred him to snoring specialist, Dr. Volpi of Eos Sleep. At his first consultation, Dr. Volpi became suspicious that Dr. Pardo had some loosening of his upper palate. Dr. Pardo was sent home to do a home sleep study, and the results showed he had mild sleep apnea, and he was waking up to 17 times an hour.
Dr. Volpi’s recommendation was the Pillar® Procedure, which was performed in his office in about 20 minutes. The procedure involved three small implants that were inserted into to Dr. Pardo’s upper palate. These implants, along with the body’s natural fibrotic response over time, provide structural support to Dr. Pardo’s loosened palate.
Although he experienced some discomfort at first, after two days he felt fine, and after two months, his wife is seeing a huge difference in is snoring. Although at this time his follow-up home sleep study is a few weeks away, he’s confident that his palate has become stronger.
“We’re both sleeping more soundly so we are no longer as tired during the day. I’m very pleased to have my energy back so I can jump into my busy days,” Dr. Pardo stated.