Pillar Procedure: Seeking snore relief

Want to snore no more? Losing weight might help. So might various oral appliances that move the jaw or a special breathing machine, if sleep apnea is the culprit.

Or you could have tiny sticks implanted in the roof of your mouth.

Known as the Pillar Procedure, this surgical treatment uses inch-long polyester rods, and the scar tissue that forms around them, to firm up the roof of the mouth and keep it from collapsing during sleep, which can cause breathing troubles and snoring.

It's not an operation for everyone with sleep or snoring issues. The Pillar Procedure is not covered by insurance, complications are possible, and there's debate about how well it actually works.

Still, it has its fans. "If you have really horrible snoring, it may make it more tolerable," said Dr. Karen Haunss, a Great Neck ear, nose and throat physician. "It definitely helps."

Those who are intrigued by the procedure, however, shouldn't expect their sleep specialist or ear, nose and throat physician to perform it immediately. In fact, said Dr. Lee M. Shangold, an ear, nose and throat physician in Port Jefferson who specializes in sleep medicine, "if you go to an ear, nose and throat doctor and you say, 'I snore,' and they say, 'Let's put in implants tomorrow,' I'd run away as quick as I could. They don't know what they're treating."

Among other diagnostic procedures, he said, sleep monitoring should be done first to help doctors figure out if someone has an ordinary snoring problem or the more serious sleep apnea.

Shangold explained that snoring occurs when something blocks the free flow of air through a person's airway. This can happen when the muscle tone around the airway relaxes, causing a blockage that prevents enough air from getting through.

With sleep apnea, the blockage becomes so severe that people unconsciously wake up as many as dozens of times an hour when their bodies realize they aren't getting enough oxygen, he said. People with the disorder often are exhausted during the day and have an elevated risk for a stroke or heart attack.

HOW IT WORKS

The Pillar Procedure, one type of surgical treatment for sleep apnea and snoring, has been available for several years. It involves insertion of three to five implants, each a few millimeters thick, from front to back in channels that a doctor has created in the soft part of the roof of the patient's mouth, Haunss said. Once the implants are in place, the recipient shouldn't feel them.

Haunss described the implants as essentially a "strong string" that causes scarring that stiffens the upper palate. "It acts like a scaffolding, like the structures of your house." It's designed to prevent the top of the mouth from flopping around and causing vibration, she said.

The in-office procedure takes about 20 minutes and is less painful than a dental operation, Haunss said. Insurance companies and Medicare typically don't cover the procedure because they consider it to be not medically necessary, according to a spokeswoman for Medtronic, the company that developed it.

"That's a big shock to a lot of people," Haunss said. The procedure costs about $3,000, she said.

Medtronic reports that more than 45,000 Pillar Procedures have been performed worldwide, with a complication rate of less than 1 percent. The most common complication, according to the company, occurs when the tip of an implant protrudes from the tissue in the mouth, which could happen if a rod wasn't implanted deep enough or if the body simply tries to push out a foreign substance, like it does with a splinter. The implant would need to be removed and replaced.

Haunss said the Pillar Procedure is best for people with ordinary snoring or mild sleep apnea, adding that "if you have severe apnea, it's not for you."

EFFECTIVENESS

So does it work? Haunss said that a Pillar Procedure might not eliminate snoring, but it often helps. For people with sleep apnea, it might allow them to lower the pressure on their air machines and tolerate using them more easily, she said.

Shangold, though, is skeptical. He said research has not shown it to have much of an effect on snoring or sleep apnea, and that he doesn't believe it would cure snoring or tiredness.

"But the snoring might be 30 to 50 percent better," he said. "For some people, that's good enough."