Catch Some Zs

By Jane Jerrard
Published Friday, February 20, 2009 | From the March 2006 Issue of FireRescue
Getting enough sleep is crucial to overall health. For firefighters, sleep doesn't just provide health benefits, it ensures a level of alertness essential to the profession. The right amount of sleep can mean the difference between life and death at a fire scene, which is why snoring in the bunkroom can be a big problem not just for the snorer, but for an entire shift of firefighters.

The Pillar System

To combat loud snoring or sleep apnea, firefighters might consider a controversial new outpatient surgical procedure that involves inserting three small (18 mm in length) polyester braids, called the pillar palatal implant system, into the back of the throat. The braids reduce the flapping of the soft palate, which is responsible for the chainsaw-like sound of snoring. The braids also reduce sleep apnea by keeping the airway open.

As of November 2005, the pillar procedure had been performed on roughly 9,000 Americans and 1,000 patients in Europe and Hong Kong. Restore Medical, the company that patented the treatment, reports that as many as 75 percent of patients and 90 percent of their bed partners reported decreased snoring after the surgery.

Surgery Under Suspicion

The Food and Drug Administration (FDA) approved the pillar procedure for snoring in 2003 and again in 2004 for mild to moderate sleep apnea. According to the FDA, "The system has been clinically evaluated in support of expanding the current snoring indication to include the treatment of patients with OSA [obstructive sleep apnea]. The clinical results were compared to the clinical results of other products which have an indication for the treatment of OSA."

However, the American Academy of Sleep Medicine (AASM) believes the FDA acted prematurely, saying the clinical trials weren't comprehensive enough. "The studies done on this procedure were funded by the manufacturer-a common thing among pharmaceutical companies," says Alex Chediak, MD, of the AASM. "And the number of patients in these studies [is small] compared to studies of other procedures for snoring. I think the science is weak, and I don't feel comfortable recommending the procedure to my patients."

Dr. Chediak's main concern: treating obstructive sleep apnea. "[The procedure] may turn a noisy, potentially dangerous condition-snoring-into a silent but still dangerous condition," he says.

Food for Thought

If you or someone on your shift is a loud snorer, the pillar procedure might be worth looking into, but others might prefer more proven methods, such as changing sleep position. "When I sleep on my back, I test at 36 [the highest end of the scale] for sleep apnea," says Dr. Chediak. "When I sleep on my side or my stomach, my score drops to zero."

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