Snore No More: Cutting-Edge Surgery Ends Sleepless Nights

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Snoring is annoying, but it is not a bad habit. Dr. Peter Zonakis explained it is due to the formation of the palate and base of the tongue. When there is too little space between the two -- because of the thickness of the base of the tongue -- air flow is restricted and snoring results. Surgery has been an option to address the problem for a number of years, but it was not a pleasant choice.

"In the old days it involved cutting and stitching. It was very painful and the person would be out of work for 10 days to two weeks," Zonakis, an allergy, eyes, nose and throat specialist, said. It also meant time in the hospital.

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When the upper airway is partially or totally obstructed by tissue in the back of the mouth, throat and/or nose during sleep, apnea or hypoapnea occurs.

Then laser surgery for snoring came into practice, he said. This could be done at a doctor's office, but it still resulted in a lot of pain and put the patient out of circulation for 10 days to two weeks.

Now there is radio frequency surgery, called "Uvula Palatoplasty and Partial Glossectomy" or "somnoplasty." This is a relatively new procedure and uses special equipment at the hospital.

"With the patient asleep, a small probe is put into base of the tongue. It is connected to a dedicated computer reading the temperature, energy and time needed. When the probe goes in, it will heat up the tissue, causing it to regress in bulk and size. The result is less tissue blocks the airway" (eliminating the cause of the snoring), Zonakis explained.

"Most patients will take a fraction of the pain meds and go to work in a few days and be eating regular food in a couple of days," he said.

There is no incision, no cutting, no bleeding, no sutures. "It takes only a short time and is much easier and cleaner operation," Zonakis said.

The doctor came to Payson last August after see an Internet announcement for someone in his field, placed by Payson Regional Medical Center. He left his practice of 22 years in Valparaiso, Ind., and came to the Rim country.

When he came here, none of the specialized equipment he needed to do the radio frequency surgery was at the hospital.

"I requested PRMC purchase this highly technical equipment and they responded very well. I was hardly here and made a pretty bold request for equipment," he said.

Zonakis said the hospital administration showed very good faith in him when it made the acquisition, proving how much it supports bringing advances to Payson.

Since coming to Payson, Zonakis has done about eight of the procedures, during the two years the operation has been in practice, he has done about 30. Only about one-third of all the specialists in his field do the radio frequency surgery, either because they don't have the training or they don't have the equipment available to them.

"The personnel in the operating room -- because they work with me on a regular basis -- have become extremely knowledgeable and skilled in this work. I've been impressed beyond my expectations about the expertise and work ethic of the personnel in the operating room. Having practiced in the Chicago metropolitan area for 22 years, the level of care is the same," the doctor said.

How does it work?

Kay Chasse, RN, works at both Zonakis' office and at the hospital. She said she sees both sides all the time.

"There is a night and day difference from the old procedure," she said.

After seeing the success of the first few radio frequency surgeries the doctor did, she said, "I'm next."

Actually it was her husband, Bob, who was next.

Before the operation, there is a two week process of preparation, Chasse said. There are insurance things to take care of, and the patient must participate in a sleep study. The sleep studies are done by lung specialist Simran Galhotra, MDThe medication necessary for pain control is minimal she said, in fact, "Two days later (after the procedure) he was out on the ATV for five hours with no mask and he was back to work the next week. He's sleeping better -- I'm sleeping better. Except it was hard to get used to. I'd wake up and not hear him and have to get up to see if he was OK. His energy level has improved," Chasse said of her husband.

Bob Chasse did not have any real concerns about the Zonakis' work going into the hospital, "Peter explained the procedure very well to me. You're always worried about the pain you're going to have. It was painful, but nothing unbearable. It was like a sore throat for about three weeks afterward."

A teacher at the Rim Country Middle School, he had the procedure done during a week's break, "When I went back to teaching, I explained to the kids what had happened and told them I wasn't going to be raising my voice for awhile. It was not that bad."

He said within a week to two weeks he noticed he had more energy, but as part of his recovery he spent the first week after the procedure sleeping in his recliner in order to keep his head elevated. It was a position the doctor recommended because the initial swelling could cause problems with sinus drainage, he said. For a couple of more weeks, he slept in the guest room, still keeping his head elevated, but after that he was able to sleep normally.

More about Somnoplasty

The Somnoplasty procedure was developed not only for snoring, but for other breathing disorders such as sleep apnea and chronic stuffy nose.

It uses low-power, low temperature radio frequency energy to treat a well-defined area of the tongue.

The procedure takes place under local anesthesia and typically takes 30 to 45 minutes.

The radio frequency energy is delivered beneath the surface of the tongue. The treated tissue is heated just enough to create an area of coagulation.

Over the next three to eight weeks, the treated tissue is naturally removed from the body, reducing the volume and stiffening the area to keep the airway open during sleep.

It is a new minimally invasive treatment.

Other approaches to the problem include: nasal continuous positive airway pressure, which requires wearing a facial mask every night; and conventional surgery to enlarge the airway.

For more information, contact Zonakis at 474-0500.

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