Rx for Readers: The old man is...

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

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-throatdepartment at Jerusalem’s Shaare Zedek Medical Center,responds:
Despite what most people think, the main source of snoring is thethroat. The noise of snoring is created by vibrations of the softpalate. When a person is awake, the muscles in the throat leave thearea open. But during sleep (especially deep sleep), the muscles relax.If the passageway is narrow due to enlarged tonsils or adenoids; if thepalate is long and thick; if the tongue is large; or if excess weightmakes the open area smaller, the passageway will be smaller, causingnegative pressure and vibrations of the soft palate. This is snoring.If it continues and worsens, the snorer can develop sleep apnea, inwhich he stops breathing for short periods many times during the night,which causes sleep to be less deep. Serious illness can result. But yousaid 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 thenose itself to blame for snoring. In your husband’s case, an experimentcan help. We do not recommend the chronic use of vasoconstricting nosedrops, but they can be taken before sleep for a few days to see if theyimprove air flow. In any case, he should be examined by anotolaryngologist (ENT specialist), even though an examination while heis awake is less effective than in a sleep lab. The results can lead torecommended treatment, either invasive or not.
I have heard that it is most healthful to go to sleepon 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 pregnantwoman as well?
   – T.S., Haifa
Prof. Peretz Lavie, president of the Technion-Israel Instituteof 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 studiedscientifically the question of whether one should lie on one’s left orright side. It is an urban myth that has not been proven. A pregnantwoman is best not sleeping on her stomach; she should sleep in aposition that is comfortable with several pillows under her body if sheprefers.
I am a 78-year-old woman and suffer from what iscalled “hammer toe.” I visited an orthopedist who told me only surgerywould solve the problem. He prescribed an insole for which I paid NIS1,700 and I received no promise of any improvement; I was told it wouldstop the condition from worsening – but I believe it is getting worse.Recently I saw on the Internet a video of a hammertoe operation, inwhich the surface of the bent part of the bone was cut. Afterstraightening the toe by breaking the bone and removing a tiny piece ofit, a “smart toe” – a tiny device meant to keep the bone from bendingagain – was inserted. All was done under local anesthesia, and there isno need to remove the device, the video said. Is this procedure beingdone 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 thesecond, third or fourth toe causing it to be permanently bent andlooking like a hammer. It most often results from wearing poorlyfitting shoes (too narrow or short for the foot or with very highheels) that push the toe into a bent position. This causes the musclesto shorten into a hammertoe. It can also be caused by nerve, muscle orjoint damage resulting from various medical conditions. Hammertoe canbe treated conservatively by wearing high-toe boxy-shaped shoes.
Operations are done in Israel under local anesthesia and are verysuccessful. We don’t use permanent fixation but wire that is pulled offthe toe in the outpatient foot clinic a month after surgery. You cancome to our clinic to be examined and discuss a possible solution toyour problem.
Rx for Readers welcomes queries from readers about medicalproblems. Experts will answer those we find most interesting. Write Rxfor Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax yourquestion to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it tojsiegel@jpost.com.