Not long after Laureen and Lewis Newberg got married last December, the bride began to consider sleeping in a different bedroom.
"It was very, very rough," recalls Mrs. Newberg. "We were newlyweds and I thought to myself, 'What have I gotten into?' "
Her husband snored. Loudly. So loudly, she had trouble sleeping. So loudly, the couple's children from previous marriages complained about The Noise.
"They would say they couldn't hear the TV, and they were downstairs," she says.
But the Newberg house slumbers peacefully these days thanks to a new and increasingly popular laser procedure to treat snoring -- a problem that afflicts an estimated 30 million Americans.
Dr. Newberg, an ear, nose and throat specialist at Harbor Hospital in Baltimore, was so impressed with the results of his own laser surgery eight months ago, that he now performs it on others with a sinus operation, which he also had to get rid of his snoring.
In the medical profession, the surgery is known as laser-assisted uvula-palatoplasty, but often referred to simply as LAUP.
The procedure is being advertised heavily in the Baltimore-Washington area as the solution to snoring woes. The Center for Snoring and Sleep Disorders, a Baltimore and Owings Mills practice, for instance, touts the procedure in newspaper ads as "The cure for the snore."
The procedure's main focus is the uvula, the area of the mouth commonly associated with snoring problems. The uvula is the fleshy punching bag-shaped structure at the back of the mouth near the throat.
Snoring occurs when either the tongue or the throat muscles collapse and strike against the uvula as air passes through the airway. Lack of muscle tightness in the tongue and throat or bulky throat tissue are common snoring causes, say experts.
Using a laser tool, which fires a hair-thin carbon dioxide beam, the surgeon burns away portions of the uvula. Each burn is no larger than an ink dot, which allows the surgeon great control in shaping the uvula,
Before LAUP, those with severe snoring problems could undergo a painful and bloody traditional operation to have the uvula trimmed. Those with moderate snoring problems were advised to change their sleeping position or consider using oral devices developed to inhibit snoring.
But today LAUP provides an alter native for both moderate and severe snorers -- the majority of whom are men. And plenty are signing up for it. Though no one knows how many people have had the surgery since it was introduced here from Europe two years ago, about 1,500 U.S. surgeons are now offering the procedure, says the American Academy of Otolaryngology, Head and Neck Surgery.
While doctors and researchers say the laser surgery appears very effective in reducing snoring, it is not without drawbacks.
Not covered by insurance
The insurance industry considers the procedure cosmetic surgery and does not usually cover it. That means patients must pick up the cost, averaging $2,000 to $3,000 in the Baltimore-Washington area.
Possible side effects from the procedure include bleeding and voice changes -- and pain.
"It can really be painful. Anyone who tells you it doesn't hurt, hasn't had it done to them," said one man, who like several others interviewed did not wish to be named because they were embarrassed about their snoring.
Also, some physicians, such as Dr. Newberg, believe the procedure must be coupled with surgery to correct existing nasal blockages or sinus conditions for an effective reduction in snoring.
After Dr. Newberg underwent the LAUP procedure, his wife said his snoring was reduced by about 80 percent. But Dr. Newberg noticed a nasal blockage, and after consultation with experts, he decided to have an operation to correct a sinus problem.
Other surgeons who have been performing the LAUP procedure say they are finding the procedure alone results in significant snoring reduction among their patients.
Dr. Michael Weiss, a head and neck specialist who is a partner in the Snoring Institute, an Owings Mills-based practice, says the patients he has been treating with LAUP report snoring reductions of between 75 and 100 percent.
Dr. Weiss and his partners in the Snoring Institute are among the few surgeons in the Baltimore area who have added the laser procedure to their practice.
"One of the main benefits of the procedure is that the patients can come into the office, have it done, and then usually go right to work that day," said Dr. Weiss.
During the entire procedure the patient is awake and alert.
Like many surgeons who offer the surgery, Dr. Weiss has patients come for the procedure three to four times. Each time he trims and shapes a portion of the uvula.
"By doing a little bit each time the patient's discomfort is kept at a minimum and this way allows the physician to shape the uvula just enough that it reduces the snoring," said Dr. Weiss.
Dr. Harold Pillsbury, an ear, nose and throat specialist at the University of North Carolina Hospital, has been conducting a study comparing patients who have undergone the LAUP procedure and those who have had traditional surgery to shape or remove the uvula.
Dr. Pillsbury said he has found that LAUP patients report discomfort after the procedure, ranging from a mild sore throat-like throb to severe throat pain. Their discomfort usually lasts 10 days to two weeks, he said, about the same amount of recovery time for the patients who underwent the traditional one-operation surgery.
"One of the big questions with the LAUP is just how often adults are willing to have that kind of discomfort for 10 days," said Dr. Pillsbury, who expects to publish his findings early next year in a medical journal.
Worth the cost, discomfort
But some snorers say discomfort and shelling out the full cost are worth it.
"My husband was threatening to stop sleeping in the same room with me," said a young woman undergoing the procedure, who refused to be identified. "The costs seemed a small price to pay to head off any more tension in the family."
In fact, the most common reason people seek help for a snoring problem, say physicians, is because a relationship with a spouse or companion is suffering from the noise.
Snoring can also rob a sleeper of the deep, restful sleep necessary for alertness and energy during waking hours. That can result in a loss of productivity at work, lack of interest in sex, and mood changes.
Not all people who snore are candidates for the procedure, says Dr. Weiss and other experts.
"We really see this procedure as best benefiting people with a moderate snoring problem," Dr. Weiss said.
People with severe snoring problems usually also suffer from sleep apnea -- a serious and sometimes life-threatening condition in which the airway can become blocked during sleep.
For those with a serious sleep apnea, other therapies are often recommended, including cumbersome air pressure devices that keep a normal breathing pattern going during sleep, and oral devices to prevent snoring.
As a last resort, radical surgery may be suggested.
Lifestyle changes
Dr. Weiss and other experts in the field say they first try to address a snoring problem by recommending lifestyle changes.
Most snorers are overweight. Diet control and weight reduction are often recommended for them; regular exercise also can help.
Often, one of the simplest remedies works best: getting snorers to sleep on their side instead of their back, say experts.
Sleeping on one's side prevents the tongue and neck tissue from folding back and striking the uvula. Doctors often recommend sleeping with a tennis ball tucked into a pocket sewed onto the back of a shirt or pajamas as one way to break the flat-on-their-back sleeper of the habit.
Said Dr. Weiss, "The main thing for people who snore to keep in mind is that most people can be treated successfully.
"There's no point in keeping it a secret -- unless, of course, you live alone."