Snoring and sleep apnea is a disease that affects people deeply. In fact, most people do not think that snoring is a disease, they describe it as an uncomfortable noise, or most people with sleep apnea do not know that the fatigue they experience during the day, sweating of the neck, or being irritable during the day are symptoms of the disease.
Most people cannot be treated because there is not enough awareness and consciousness.
Snore; It is a rough, noisy sound generated by the vibration of the soft palate, small tongue and surrounding soft tissues during sleep.
Sleep apnea; It is a cessation of breathing for 10 seconds or more. Hypopnea; For the same period of time, it is called a decrease in air flow by 50%, decrease in oxygen level in the blood (desaturation) or awakening.
Apnea Hypopnea Index (AHI); It is the hourly average of apnea and hypopneas during the entire sleep.
Upper Airway Resistance Syndrome; Due to the increase in upper respiratory tract resistance, Apnea is defined as frequent sleep interruptions and awakening episodes (arousal) without Hypopnea and Desaturation, and daytime sleepiness.
Snore; Although it often occurs during breathing, it can also occur during exhalation. In other words, snoring can be seen in some people with their mouth closed. Continuous snoring is seen in 44% of men and 28% of women between the ages of 30 – 60. Snoring is an indicator of increased resistance in the upper respiratory tract.
In cases where resistance is further increased, it is seen with sleep apnea. In fact, almost all patients with sleep apnea snore more or less, while most people with snoring may not have sleep apnea.
In people with snoring, narrowing of the upper respiratory tract, obesity, nasal obstruction, disproportion in the face and jaw, hypothyroidism, acromegaly, tonsil and nasal enlargement can be seen. Snoring without sleep apnea is called “primary snoring”, “simple snoring”. People with snoring often do not mind this situation. Often the person or household with whom he sleeps complain about this situation.
It has been found that the average snoring sound is 60 decibels. Some people measure 80-82 decibels, and a small part of them 90 decibels. Snoring is often heard only in the room where the person is sleeping, sometimes it can be so severe that it can be heard in all rooms of the house. It can even cause social problems that result in spouses separating their beds.
Risk factors in snoring;
- Having a family history
- Genetic factors
- Poor physical activity
- Alcohol and Smoking
- Frequently recurring upper respiratory tract infections
- Trauma to the nose, face and throat
can be counted as. Daily headaches are more common in people with snoring.
Possible causes of snoring;
- Elongated and sagging soft palate and small tongue – Large tonsils and adenoid (especially in children)
- Swelling of the nasal and mucous membranes (especially in allergies)
- Anatomical problems in the nose; Deviation, valve failure, concha hypertrophy, polyps etc. – lying position; Snoring is more common especially when lying on the back.
- Alcohol, sedative and tranquilizing drugs
What are the Causes of Sleep Apnea?
Sleep apnea is when breathing stops for 10 seconds or longer during sleep. In the meantime, the oxygen level in the blood drops, sleep interruptions occur. Sleep has different stages in itself. The period in which we rest the most is deep sleep and sleep apneas occur most frequently in this period. When the person enters apnea, they switch from deep sleep to superficial sleep, often not fully awakening and unaware that they are entering apnea.
As the duration of deep sleep decreases with recurrent apneas, they wake up unreserved and daytime sleepiness occurs. Since the oxygen level in the blood decreases during apnea, many vital organs, especially the brain and heart, remain without oxygen during the apnea period and many risks, including sudden death, arise.
What Are the Risks Increased by Sleep Apnea?
Hypertension; While it is seen in 20% of the society in general, 50% of those with sleep apnea have high blood pressure. In fact, when sleep apnea improves in some of those with high blood pressure with sleep apnea, blood pressure returns to normal.
Ischemic Heart Disease; Although it varies according to the severity of sleep apnea, the risk of heart attack is 4-6 times higher than normal.
Arrhythmia; Heart rhythm disturbance is more common in OSAS.
Nervous system; Especially the risk of paralysis-stroke and headaches at night increases in OSAS.
Pulmonary Hypertension, Right Heart Failure are more common in OSAS and OSAS worsens the course of these diseases.
Hormonal system; Development of insulin resistance and susceptibility to diabetes, sexual reluctance, growth retardation due to a decrease in growth hormone in children.
Traffic and Work Accidents; It has been found that those with severe sleep apnea have 7 times more accidents, especially when driving at night, and most of these accidents are serious-fatal accidents. It is recommended that those with OSAS do not work in jobs requiring attention (lathe, sawmills, press, furnace, casting etc.) using burning, crushing, cutting devices.
Marital problems; Snoring and sleep apnea can sometimes cause problems that can lead to divorce between spouses.
Who Is More Common in Sleep Apnea?
Obesity; It is the most important risk factor. While OSAS is seen in 2-4% of the general population, it is seen in 40% of the obese.
Neck circumference; OSAS over 42 cm in males and 38 cm in females are more common.
Gender; It is 2-10 times more common in men than in women.
Age; OSAS is most common in men aged 40-50. Conditions that constrict the upper respiratory tract;
- Nose problems; Deviation, Concha hypertrophy (Nasal enlargement), Valve failure, Polyp, Tumors.
- Nasal problems; Adenoid growth, Nasal tumors-masses. ? Loose and sagging of the soft palate and small tongue.
- Tongue and tongue base growths
- Increased laryngeal cartilage elasticity, increased soft tissues in the larynx and pharynx.
- It is more common in those with family sleep apnea.
- It is more common in alcohol and cigarette users.
- It is more common in those who use muscle relaxant, sedative and tranquilizing drugs.
- It is more common in those with hypothyroidism, acromegaly and neuromuscular disease.
- It is more common in diseases such as Down syndrome, Marfan syndrome, Amyloidosis.
What Are the Signs and Symptoms of Sleep Apnea?
In OSAS, symptoms differ day and night. The person may not be aware of most of the nighttime symptoms.
- Snoring; It is the most common symptom. It is more common in men. It negatively affects the sleep quality of the spouses.
- Hesitation of breath during sleep; Patients are often unaware that they stop breathing during sleep. Their spouses may observe that noisy and irregular snoring stops intermittently and breathing stops. This condition is called witnessed apnea. Sometimes patients wake up with a feeling of choking and gagging. He rarely wakes up with the feeling of death and runs to the window, feeling the need to breathe deeply.
- Excessive movement during sleep; Movements such as turning over in bed, jumps, periodic leg movements, kicking or even punching the bedmate can be seen frequently.
- Night sleep interruption; It is often seen in the early stages. Sometimes the patient may wake up in the middle of the night.
- Reflux; About half of those with OSAS have reflux.
- frequent urination or incontinence at night; Urinary incontinence is more common in children with sleep apnea.
- sweating at night; Sweating can be seen especially in the head, neck and chest.
- Sleepiness; It is the most common daytime symptom in those with OSAS. They find it difficult to stay awake while watching television, reading newspapers or books, driving on long distances, long meetings, and at the cinema.
- Fatigue, Forgetfulness, Inattention and Concentration Disorder
- personality changes; In OSAS, irritable, angry, intolerant personality structure may develop. In addition, depression and anxiety disorder can be seen.
- Sexual Problems; Low libido, sexual anorexia, sexual dysfunction may develop. With the treatment of OSAS, sexual problems usually resolve spontaneously.
- Morning Headache; Approximately half of those with OSAS complain of pain, especially in the forehead, when they wake up in the morning.
- Dry mouth and sore throat
How is Sleep Apnea Diagnosed?
Sleep apnea is diagnosed with a sleep test called Polysomnography (PSG). In the sleep test, the person lies in the sleep laboratory for one night. By sticking many sensors, is the person breathing through the nose and mouth during sleep, how many times and how long apnea is, at what stages of sleep, apneas center? occlusive (OSAS)? Changes in blood oxygen levels, heart rate and rhythm, chest and abdominal movements, brain waves during sleep, and changes in sleep stages are recorded.
According to the result, the severity of sleep apnea is graded as mild-moderate-severe.
A sleep test is recommended for anyone with snoring, witnessed apnea and daytime symptoms.
The sleep test is performed by PSG technicians and the result is reported by the Chest diseases, ENT or Neurology physician at the head of the sleep laboratory.
An ENT examination should be performed on every patient with sleep apnea as a result of the sleep test. In this examination, a detailed endoscopic examination is performed starting from the nose, including the nasal cavity, tongue root and larynx. In addition, the size of the tongue-tongue base, the soft palate and the position of the small tongue, its size, and tonsils are evaluated.
Congestion and strictures in the upper respiratory tract can be detected with ENT examination. Tests such as cephalometry, computed tomography, magnetic resonance imaging, somnofluoroscopy, acoustic pharyngometry, manometer, sleep endoscopy can help support the diagnosis and determine the appropriate treatment option.
In central sleep apnea and other sleep disorders, the neurologist should also see it.
How to Treat Snoring and Sleep Apnea?
Snoring and sleep apnea is a compelling illness. Considering that an average of 8 hours of exposure a day is considered, it is not difficult to understand why many researchers work on this issue. People usually expect an application in the face of an illness and no further treatment is needed in the future.
Surgical interventions (surgeries) theoretically respond to this demand, but from a clinical point of view, their chances of success alone are very limited. In addition, the minimum health conditions must be sufficient for the person to be operated. Uncontrolled diabetes or heart conditions make surgery difficult.
People with sleep apnea generally have weight problems and this causes such diseases to be seen. Apart from this, the success rate of a person with a weight problem without losing weight decreases to almost zero. So what kind of snoring operations are performed in suitable cases.
Types of Snoring Surgery
Nose (nasal) Surgeries
It is done because of the congestion in the nasal passage that contributes to snoring and sleep apnea. These are the correction and opening of the deviation (curvature in the airway), and the reduction of the nasal concha (meats in the nose) by radiofrequency.
Breathing through the nose improves sleep quality. The full effect of these operations occurs after 3-6 months. In fact, we should consider these operations only for the quality of our sleep during the day. Due to continuous breathing through the mouth, the lungs grow more than normal and they cause pulmonary hypertension by putting pressure on the heart.
Ear, nose and throat examination is required for correct diagnosis. In case of permanent swelling of turbinates, allergic effects should also be considered. If there is such a situation, allergy treatment should also be done. However, considering that snoring and sleep apnea occur in the pharynx area, these operations have little effect on reducing the disease.
Soft palate and small tongue surgeries:
The basis of snoring and sleep apnea is that the tissues in the pharynx area obstruct the airway during sleep. The tissues here are small tongue, soft palate and tongue base. With surgical interventions, some of the tissues here are removed and the airway is opened.
Some of these sagging, loosened tissues are removed by laser or radio frequency methods (uvulapalatopharyngoplasty, UUUP). These surgeries have three main complications.
These are: thinning of the voice due to the removal of excess tissue and the loss of food to the nose; inadequate surgery and nasopharyngeal stenosis. In addition, the success rate of these operations is very low and there is a possibility of recurrence.
Shifting the lower jaw forward (orthognathic surgery)
It is especially applied when the lower jaw is congenitally small and behind. The lower jaw is surgically broken into three and the chin is positioned forward. With this operation, the root of the tongue moves forward and the airway is opened. It is very effective and successful. However, the healing process takes about 45 days. Patients are fed with a pipette during this period and may cause problems for the patient.
Tongue and tongue root surgery:
The aim of these operations is to pull the root of the tongue forward. It is a difficult operation to do, the healing process is troublesome for the patient. It is not suitable for patients with weight problems. First of all, it is necessary to lose weight with a diet program.
The purpose of surgical interventions and surgeries is to be treated at once. Unfortunately, this is not always possible. Surgery can sometimes be a risk in itself.
Snoring prosthesis, another alternative treatment method, is more effective and less painful than surgery.
You can call us today to get information about Snoring and Sleep Apnea Surgery! Phone & Whatsapp Number: +905443480787