Snoring & Sleep Apnea

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea and is the gold standard for treatment, however many people cannot tolerate use of this cumbersome mask and machine. For this treatment, you wear a mask over your nose during sleep. The mask blows air into your throat at a pressure level that is right for you. The increased airway pressure keeps the throat open while you sleep.

If you are one of the many who cannot tolerate CPAP for one reason or another and you have mild to moderate sleep apnea you may be a candidate for one of the surgical treatment options we utilize listed below, which include in-office procedures.

This is a procedure utilized by Dr. Cohen in appropriate candidates as a treatment for snoring and mild to moderate sleep apnea. During this in-office procedure a rim of soft palate containing the uvula is removed using the laser. In the past the laser used was the CO2 laser which was associated with significant pain for up to 2 weeks following the procedure. However Dr. Cohen utilizes the cold laser or radiofrequency energy (aka Coblation) to obtain the same result with significantly less discomfort which consists of a mild to moderate sore throat for approximately one week. Most patients state that the discomfort is manageable and after 24-48 hours they can resume normal activities, although a soft diet is recommended for one week. In carefully selected patients this procedure as a stand alone procedure or in combination with in-office Balloon Sinuplasty and/or submucous resection of the turbinates provides tremendous improvement in snoring and sleep apnea symptoms. Call Dr. Alen Cohen serving the Los Angeles and Thousand Oaks areas to schedule a consultation to discuss if you are an appropriate candidate for this revolutionary procedure.

When children under the age of 13 are diagnosed with severe snoring or obstructive sleep apnea, this is often due to enlarged adenoids and tonsils. As a result these children would benefit from adenoidectomy and tonsillectomy if warranted by their history and physical exam. Dr. Cohen which serves the Los Angeles and Thousand Oaks areas, routinely performs tonsillectomy and adenoidectomy in children and young adults with severe snoring and obstructive sleep apnea. Many parents will return months after the procedure and report that their children are much more calm and doing better at school since they are now getting restful sleep nightly.

Uvulopalatopharyngoplasty (UP3/UPPP) in general is the most common and oldest procedure for the treatment of obstructive sleep apnea (OSA) in the United States. This procedure, introduced by Fujita in 1981, consists of tonsillectomy, reorientation of the anterior and posterior tonsillar pillars, and excision of the uvula and posterior rim of the soft palate. This is quite an invasive procedure that entails a general anesthetic and involves removal of the tonsils, uvula, and part of the soft palate. In some patients, however, with moderate to severe OSA who cannot tolerate CPAP it is necessary.

The hardest part is not the surgery itself, but the recovery from this procedure. There is significant pain for 10-15 days, as the area in the back of the throat heals, requiring pain medication regularly and a liquid or soft diet for that period. This procedure is at times combined with tongue base reduction surgery when indicated. Dr. Cohen performs uvulopalatopharyngoplasty (UP3/UPPP) in patients with moderate to severe obstructive sleep apnea that are noted on exam to be good candidates and have failed CPAP treatment.

This is a procedure often used in combination with other procedures when a patient is in the operating room. The most common method used to treat a large base of tongue is to use coblation. In this procedure, radiofrequency energy is used via a coblation wand to target 3 to 4 points within the base of tongue and subsequently shrink them. The results are seen over months as the tissue heals and scars causing some reduction in bulk.

This is one of the most common procedures performed to improve nasal obstruction when necessary. The septum is made of bone and cartilage and is the dividing wall between the two nasal passages. Often times it can be deviated to one side or another causing unilateral obstruction or be S-shaped causing bilateral obstruction in patients. One may be born with these deviations or it can be acquired due to nasal trauma. During a septoplasty no cuts are made on the face but a small incision is made inside the nose and the deviated portions of cartilage and bone are either removed or straightened in order to improve nasal congestion. Often times our doctors combine this procedure with turbinate surgery to significantly enlarge the nasal airways and improve your breathing. These procedures do not affect the shape and look of your nose as they are functional surgeries on the inside of your nose. However, some patients would like cosmetic changes made to their nose via a rhinoplasty at the same time and this can be accommodated to by our surgeons at your consultation. These changes include dorsal hump removal, fixing a crooked or deviated nose or tip refinement. Dr. Cohen which serves the Los Angeles and Thousand Oaks areas, is a renowned nose & sinus surgeon as well as facial plastic surgeon and routinely performs septum repair with outstanding results.

The turbinates are curved ridges along the sidewall of the nose on each side and are involved in humidification and filtration of the air we breathe in. There are 3 sets of turbinates on each side of the nose. The most inferior set is responsible for nasal congestion and is termed the inferior turbinates. There are various types of turbinate surgery. Dr. Cohen performs a definitive procedure named submucous resection of the turbinates under local anesthesia in under 10 minutes for permanent relief in this condition. During this procedure the bone expanding the turbinates on the inside is shaved down allowing for significant long-term reduction in the size of the turbinates. Often times this procedure is combined with a septoplasty/deviated septum repair and nasal valve repair when necessary to significantly improve nasal obstruction. Our surgeon in Los Angeles and Calabasas will accurately assess the cause of your nasal obstruction and determine if turbinate surgery will significantly improve breathing through your nose.

In-office Balloon Sinuplasty and Lateral Nasal Valve Repair are further options available to address nasal airway obstruction and chronic sinusitis which would affect one’s ability to breathe through the nose and worsen snoring and sleep problems. Dr. Cohen is an expert and will find the underlying cause of your sleep apnea and work to address it once and for all!