Rx for Readers: The old man is...

Despite what most people think, the main source of snoring is the throat.

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June 18, 2010 19:26
4 minute read.
rx for readers 88

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My 56-year-old husband, who occasionally snores but does not suffer from sleep apnea and is not overweight, got a cold a month ago and since then has been snoring like a tractor every night, through much of the night, even though most of his cold symptoms have disappeared. It is making me sleepless unless I go to bed in another room. Is there any treatment for snoring such as some ointment inside the nose? He snores not only on his back but also on his side, so putting a tennis ball in a pocket on the back of his pajamas to wake him up will not help.
    – S.N., Jerusalem



Dr. Jean-Yves Sichel, head of the ear-nose-and-throat department at Jerusalem’s Shaare Zedek Medical Center, responds:

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Despite what most people think, the main source of snoring is the throat. The noise of snoring is created by vibrations of the soft palate. When a person is awake, the muscles in the throat leave the area open. But during sleep (especially deep sleep), the muscles relax. If the passageway is narrow due to enlarged tonsils or adenoids; if the palate is long and thick; if the tongue is large; or if excess weight makes the open area smaller, the passageway will be smaller, causing negative pressure and vibrations of the soft palate. This is snoring. If it continues and worsens, the snorer can develop sleep apnea, in which he stops breathing for short periods many times during the night, which causes sleep to be less deep. Serious illness can result. But you said your husband does not have sleep apnea.

A narrowing or blockage of the nasal cavities can worsen the situation, but most of the time is not part of the problem. Only rarely is the nose itself to blame for snoring. In your husband’s case, an experiment can help. We do not recommend the chronic use of vasoconstricting nose drops, but they can be taken before sleep for a few days to see if they improve air flow. In any case, he should be examined by an otolaryngologist (ENT specialist), even though an examination while he is awake is less effective than in a sleep lab. The results can lead to recommended treatment, either invasive or not.

I have heard that it is most healthful to go to sleep on one’s left side because of the position of the heart. Is this true? What is the explanation? And is that the best position for a pregnant woman as well?
    – T.S., Haifa


Prof. Peretz Lavie, president of the Technion-Israel Institute of Technology and one of the country’s leading sleep medicine experts, replies:

It is usually good to sleep on one’s side, but nobody has studied scientifically the question of whether one should lie on one’s left or right side. It is an urban myth that has not been proven. A pregnant woman is best not sleeping on her stomach; she should sleep in a position that is comfortable with several pillows under her body if she prefers.



I am a 78-year-old woman and suffer from what is called “hammer toe.” I visited an orthopedist who told me only surgery would solve the problem. He prescribed an insole for which I paid NIS 1,700 and I received no promise of any improvement; I was told it would stop the condition from worsening – but I believe it is getting worse. Recently I saw on the Internet a video of a hammertoe operation, in which the surface of the bent part of the bone was cut. After straightening the toe by breaking the bone and removing a tiny piece of it, a “smart toe” – a tiny device meant to keep the bone from bending again – was inserted. All was done under local anesthesia, and there is no need to remove the device, the video said. Is this procedure being done in Israel? Is it performed under local anesthesia?
    – R.K Tel Aviv


Dr. Ofer Elishuv, an expert in orthopedics of the feet at Hadassah University Medical Center in Jerusalem, answers:


Hammertoe is a deformity of the proximal interphalangeal joint of the second, third or fourth toe causing it to be permanently bent and looking like a hammer. It most often results from wearing poorly fitting shoes (too narrow or short for the foot or with very high heels) that push the toe into a bent position. This causes the muscles to shorten into a hammertoe. It can also be caused by nerve, muscle or joint damage resulting from various medical conditions. Hammertoe can be treated conservatively by wearing high-toe boxy-shaped shoes.

Operations are done in Israel under local anesthesia and are very successful. We don’t use permanent fixation but wire that is pulled off the toe in the outpatient foot clinic a month after surgery. You can come to our clinic to be examined and discuss a possible solution to your problem.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com.

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