Sleep Disorders Clinic Helps Chronic Snorers : The Search for a Silent Night

Joe Girillo was sitting in a tiny laboratory at the San Gabriel Valley Medical Center, having himself wired for sound.

The 28-year-old Temple City bachelor joked as he was fitted with electrodes, a motion sensor and the other paraphernalia he would wear as part of a medical program to find out why he snores. But Girillo was serious when he said that his snoring is no laughing matter.

“Snoring makes me feel like a social leper, and I might like to get married some time. I have been accused of snoring just to aggravate people.

“Because of my snoring, I don’t get a lot of sleep at night so I get very tired in the middle of the day.”

Girillo is one of 16 snorers who have sought help from the San Gabriel center’s sleep disorder clinic since it opened May 15. It is the only clinic of its kind in the San Gabriel Valley and one of the few in California that tests on an outpatient basis.

Testing Conducted at Home

Girillo was being wired so he could be tested while he slept at home and would not have to spend time at a hospital.

“Outpatient testing is more comfortable for the patient,” said Don Johns, a respiratory therapist who runs the clinic. “We all sleep better in our own homes, while in a hospital, especially the first night, patients sometimes sleep poorly.”

Testing at home is also cheaper, costing about $340, compared to $1,000 to $1,200 for testing in a hospital where an overnight stay is required, Johns said.

Johns said that although the clinic, which can take one patient a day, accepts patients by physician referral only, he gets inquiries from individuals, and most callers are wives describing their husbands’ symptoms.

“We are not only saving a few lives, we are saving a few marriages,” said Johns. “The husbands deny they snore, and it is the wives who have the true insomnia.”

The clinic’s principal purpose is to determine whether snorers suffer from a serious disorder called sleep apnea, or are what Johns calls social snorers, those who have the problem because of advanced age, sinus problems or obesity. The difference can be a life-or-death matter.

Patients with apnea actually stop breathing temporarily while they are asleep, depriving the blood of oxygen, which affects such vital organs as the heart and the brain. If the brain is deprived of oxygen long enough, it generally signals the sleeper to wake up, Johns said.

Danger of Death

“Someone who suffers a long episode of not breathing can suffer instant cardiac death or long-term deterioration of the body’s vital organs, including the brain, because of lack of oxygen,” he said.

Apnea is the most common medical sleep disorder, Johns said, and up to 3% of American men, and some women, have the condition.

“We are looking for the life-threatening snorers, not the social snorers,” said Johns, who himself suffers from apnea, a fact he discovered when he tested himself so he could better relate to his patients.

“I fit the (typical apneic) profile of an overweight middle-age man, but I have such a mild case that I believe with weight loss it will cure itself,” he said.

A hospital spokesman said that the program was started because “there is nowhere else in the San Gabriel Valley where people could get sleep apnea diagnosed, so we felt we were meeting a real need in the community.”

Of the 16 patients tested so far, only two have been diagnosed as apneic, and both opted to undergo a simple operation called uvulopalatopharyngoplasty (also known as UPPP), to remove excess tissue that hangs down in the palate, obstructing air passages. This is the

most common problem of apneics, Johns said.

However, apnea also may be caused by sinus problems, nasal polyps or adenoids, which also can be treated surgically. The cost of UPPP, which is similar to a tonsillectomy and usually requires only an overnight hospital stay, is $2,000 to $3,000.

However, Johns said, there are alternatives to the surgery.

Sewing Tennis Balls

“A lot of apneics tend to sleep on their backs, so some sew tennis balls into their pajama backs so they will turn over.”

Some apneics wear a mask that fits over the nose and holds the airway open, but Johns said that it is uncomfortable and many use it only as a stopgap measure until surgery can be performed.

In cases of mild apnea, weight loss or avoiding sleeping pills and alcohol may solve the problem.

“They (sleeping pills and alcohol) subdue the mechanism that allows you to wake up from apnea because they supress the central nervous system,” Johns said.

‘Really Suffering’

One patient who opted for UPPP is Elton Sewell of Monrovia, a severe apneic who stopped breathing 117 times, often for more than a minute, during the night he was tested.

“I have been snoring for more than 30 years, but it only became a major problem in the last year or so,” said Sewell, 59.

“I was really suffering. In the morning I was so tired from improper sleep that it was hard to keep from dozing off when I was driving. And I would wake up with severe chest or head pains.”

Sewell, who is unmarried, decided to tape record himself while he was sleeping to prove to his doctor that he had a serious problem. The tape provided testimony to his extremely loud snoring followed by irregular gasping sounds that indicated his struggle to breathe.

Life-Threatening Situation

“This was a life-threatening situation,” Sewell said.

Sewell underwent surgery in June, and a recording he made after the operation indicates that he is snoring less. More important, he said, he is sleeping better and waking up more refreshed, and no longer has a tendency to doze in the daytime.

In Girillo’s case, the results of the overnight tests, which recorded information on sleep patterns including heart rate, air intake and expulsion, the amount of oxygen in his blood, chest movement and the amount of time between breaths, were fed into a computer and analyzed by Johns.

He concluded that Girillo, who is 5 feet, 10 1/2 inches tall and weighs 215 pounds, is a social snorer and not apneic.

Could Choose Surgery

But since his snoring is caused by excess tissue in the back of the throat, he could choose to have the UPPP surgery, a decision he has not yet made.

UPPP helps about 80% of social snorers, said Dr. Glenn Weissman, an otolaryngologist and chief of surgery at the hospital.

About one in 10 snorers has apnea, he said, and it can be corrected by UPPP or other surgical methods, depending on the cause. In very severe cases, a tracheotomy, an incision into the windpipe through the neck, sometimes is required.

Meanwhile, Johns, who is 6 feet tall and weighs 245 pounds, has begun a weight reduction program in hopes of easing his snoring problem.

‘I Don’t Want to Hear It’

Johns estimates that he will have to lose 70 to 80 pounds to effectively cut down on his snoring, which would please his wife, Sherry.

“He does snore and he is loud and he snores frequently,” she said, “and I don’t want to hear it.”

The Johnses have been married five years and his snoring has grown worse as he has put on more weight, his wife said.

“There is a difference between a little snoring and very loud snoring,” she said.