Snoring and Sleep Apnea Treatments

The Pillar Procedure

The minimally invasive Pillar Procedure is the first and only FDA-cleared implant system that treats the soft palatal causes of snoring and mild to moderate sleep apnea. In 80% of patients, the soft palate contributes to snoring sounds and the obstruction of the airway in obstructive sleep apnea. It is typically performed in approximately 20 minutes in our office using only local anesthetic. The procedure is extremely safe, very effective, and much less painful than traditional surgical treatments. Best of all, most patients return to their normal activities almost immediately after the procedure and typically experience results in less than six to eight weeks.
 
The Pillar Procedure procedure offers significant benefits over other available treatments (LAUP, UPPP):

• Patient is fully awake throughout the procedure;
• Outpatient procedure;
• Local anesthesia administered to uvula and palate;
• Surgeon does not cut or burn excess tissue;
• Entire procedure usually takes less than 20 minutes
• Recovery time after The Pillar Procedure is usually as short as one day and most patients require only over-the-counter medication.

How does the treatment work?

As throat muscles relax during sleep, unsupported tissues in the back of the mouth and the throat may stretch and collapse. This reduces the size of the airway and obstructs breathing. It can also cause the soft palate to vibrate or undulate, causing snoring sounds. (Studies estimate that nearly 80% of all sleep apnea and snoring may be caused either entirely or in part by the soft palate.) The inserts stiffen the structure of the soft palate to help reduce both the vibration that causes snoring and the ability of the soft palate to obstruct the airway during sleep. 

Is it painful?

Because tissue is not removed or damaged, discomfort is minimal. Some patients use an over-the-counter pain reliever after the procedure and most are able to resume normal activities and diet the same day.

Is this procedure for me?

If you snore loudly and frequently and have mild obstructive sleep apnea the Pillar Procedure may be the solution for you.

How long does the procedure take?

The procedure takes one, short visit to the surgeon’s office.

How does the Pillar Procedure differ from other treatments?

There are several key differences:

Minimally invasive treatment. The treatment is done in one brief office visit. Some other treatments require a series of visits or an operating room procedure.

Minimal discomfort. Palatal restoration does not require chemical agents, heating or removing tissue. Therefore, the procedure causes minimal discomfort and most patients resume normal diet and activities the same day.

Results. Many patients report a noticeable improvement within 6 to 9 weeks, and because the implant is designed to be permanent they have the potential of experiencing a lasting effect.

How do I know if the Pillar Procedure will work for me?

Success with the Pillar Procedure can be influenced by tongue position, tonsil size and other factors. Your doctor will do a physical exam to determine if your palate is the likely cause of your snoring or sleep apnea and if you are a good candidate for the Pillar Procedure.

What kind of results can I expect?

Most patients report a noticeable and lasting reduction in snoring. Some patients see improvement within 6 to 9 weeks, while others take up to three months to realize the full benefit of the Pillar Procedure. In long-term (one year) clinical studies, sleep apnea was reduced in 81% of patients; for patients suffering from disruptive snoring, sleep partner satisfaction ranged from 67% to 100%. Patients also experienced less daytime sleepiness.

How long does the effect last? Is it permanent?

The inserts are designed to be permanent and to provide a long lasting effect. Once in place the inserts cause a natural tissue response, which secures them within the palate. The stiffening of the palate changes its response to airflow. Our clinical studies show that patient and sleep partner satisfaction with the procedure remain high after one year.

How are the inserts placed in the soft palate?

Each patient receives three or more Pillar inserts. The inserts are preloaded into a specially designed delivery tool. Each insert and its delivery tool are provided in a sterile package to the surgeon. The surgeon places each insert into the soft palate using a specially designed delivery tool. The palate tissue is not removed.

How big is the insert? What does it look like?

Each highly engineered, tiny woven Pillar insert is approximately 18 mm (0.7 inches) in length and has an outer diameter of approximately 2 mm (0.08 inches). The inserts are woven from a polyester material that has been used for more than 50 years in implantable medical products.

Will I notice the inserts in my palate?

You should not be able to see the inserts in your palate. A small percentage of patients report feeling a minor foreign body sensation after the procedure. This sensation is temporary and should subside after a short time.

Will there be any change in my voice or will I have any difficulty swallowing?

Surgeons have not reported that patients have experienced any long-term changes in voice or difficulty swallowing.

What kind of complications have you seen?

Since the procedure does not involve removing or damaging tissue, the risk of complication is extremely low. There have been no reported major adverse events.

Minor complications have consisted of partial extrusions that have been readily resolved by the physician removing the insert. A partial extrusion occurs when the tip of the insert can be felt or seen through the surface of the palate tissue. Most patients request to have the insert replaced because they were pleased with the results. Since launching the product in the US, there have been fewer than 1% reported partial extrusions.

Can the inserts be removed?

Yes. An insert can be removed in the surgeon’s office with a simple procedure. A patient can also have a new insert placed at the time of removal.

What is the reimbursement for the procedure?

The treatment of snoring generally is not a condition that health insurance companies cover. Most health insurance policies cover certain procedures and treatments for obstructive sleep apnea. However, many health insurance companies do not yet cover the Pillar Procedure for the treatment of obstructive sleep apnea.

How many people are affected by disruptive snoring and sleep apnea?

According to a report published in the April 2004 Journal of the American Medical Association, approximately 44 million people in the United States suffer from mild OSA and approximately 15 million people suffer from moderate or more severe OSA. In a separate report, the American Academy of Otolaryngology estimates that approximately 55 million people suffer from habitual snoring. Because most people who have OSA snore, the number of people with OSA overlaps significantly with the number of people who snore.

What are the risks if I choose not to have my sleep apnea treated?

Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffer. The consequences of untreated sleep apnea range from annoying to life-threatening. They include symptoms such as depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. Untreated sleep apnea patients are at least 3 times more likely to have automobile accidents. Additionally, it has been estimated that up to 50% of sleep apnea patients have high blood pressure. Also, risk for heart attack and stroke may also increase in those with sleep apnea.

How can I find out more about Restore Medical?

Visit www.pillarprocedure.com.

Is this a permanent cure?

No surgical or nonsurgical treatment can cure snoring 100% of the time due to the multitude of factors that cause snoring.   However, Somnoplasty offers one of the highest success rates of any snoring therapy with minimal discomfort.  While a decrease or elimination of snoring doesn’t last forever in all patients, if re-treatment is necessary a patient need-not fear the procedure, due to its minimally-invasive nature resulting in minimal postoperative pain. 

What type of anesthesia is involved?

The Pillar Procedure is most commonly performed under local anesthesia in an outpatient setting. However, in-office intravenous sedation or general anesthesia is always available for our patients.

Will I be able to drive home after the procedure?

Yes, you can immediately return to your daily activities. However, if intravenous sedation or general anesthesia is chosen you may not drive for 24 hours.

What can I expect post-treatment?

There may be some swelling and discomfort for a few days following the procedure, not unlike the feeling of an oncoming cold.  During the four to six weeks you should experience a gradual decrease in your snoring.  Depending on your level of snoring, additional implants may be needed to achieve your desired result. In addition, other procedures, may be combined with the Pillar Procedure to further decrease your snoring intensity.

When can I go back to work?

You can immediately return to your daily activities.

Will this treat my sleep apnea?

The Pillar Procedure should only be placed to treat obstructive sleep apnea if a patient’s “obstruction” occurs in the palatal region of the airway and it is mild in intensity.

Are there any contraindications?

The Pillar Procedure is contraindicated for the following patients:

Pregnant women, patients with respiratory problems, patients under 18 years of age, immunocompromised patients (AIDS), patients with active oral herpes or oral candidiasis, patients undergoing chemotherapy, patients with compromised wound healing, patients with a short soft palate, and chronic steroid use.

How do I get started?

Please complete our Snoring and Sleep Apnea Questionnaire as well as the Epworth Sleepiness Scale test.  You will then have the option to submit these forms via our website or bring them to your consultation.  Please call our office for a snoring consultation.

Take me to the Online Forms page.

Mandibular Repositioning Appliance (MRA)

Continuous Positive Airway Pressure (CPAP) is considered “the gold standard” to treat most patients with obstructive sleep apnea, however, many find it very difficult to tolerate during sleep. Mandibular repositioning appliances provide a very successful alternative to CPAP. In addition, for those patients that have a diagnosis of habitual snoring (without sleep apnea) MRA’s are very effective. These simple devices hold the bottom jaw (mandible) forward during sleep that in turns keeps patients’ airways open during sleep. These appliances are extremely comfortable and adjustable by patients.

Drs. Nissman and Salin will custom fabricate these appliances based on each individuals degree of snoring and/or obstructive sleep apnea. MRA’s are constructed of transparent hard plastic with a soft liner to remain gentle to your teeth. A protocol to activate/advance the appliance will be given to you by our doctors. Once you remain comfortable wearing the appliance, a follow-up sleep study is required to determine the MRA’s success. During the follow-up study a sleep technician will adjust the appliance as you sleep in order to gain maximal resolution of your snoring and/or sleep apnea.

Thorton Adjustable Positioner, Airway Labs