Snoring and Sleep Apnea

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Snoring is a sound in the form of noise and it emerges when airway narrowing occurs. 45% of the adults snore from time to time, and 25% of them snore constantly. Although snoring is more frequent in males and in overweight people, it can be detected in everyone. Snoring frequency increases with age.

WHY DO WE SNORE?

The region, where base of the tongue, uvula, soft palate and tonsils are attached to the nasal cavity is a self-narrowing region. The air passage gets narrower with the relaxation of muscles in this part during sleep, and the air movement which vibrates the loose muscles,causes snoring.Thick and fatty neck tissues in fat people, and large tonsils and adenoid in children are among the most common causes of snoring. People with nasal congestion create an excessive vacuum in order to be able to breathe. Thus, a person who was not snoring with a clear nose, starts snoring when the nose is blocked. Problems causing nasal congestion such as deviation, enlargement of the nasal concha, and polyps can result in snoring.  The structures such as the soft palate, long uvula, or emerging sags trigger snoring by blocking the air passage. Relaxation of the muscles of the tongue and throat occurs during sleep. Those relaxed muscles cannot prevent the tongue from blocking the back of the throat when lying back. Intake of alcohol or sedatives can increase the amount of muscle relaxation, hence snoring is also increased.

WHY DO MEN SNORE MORE?

The reason for this is that adiposity mainly takes place around the hip region in women, whereas the body fat is mostly concentrated around the neckand abdomen in men. Particularly, the pressure inside the chest of the overweight males increases due to the pressure of the abdominal mass to diaphragm while lying (especially in the supine position). In addition to that, the tongue slides back, and with the relaxation of the soft tissues and muscles around the pharynx, the conditions which paves way to snoring emerge. It is thought that difference in the muscle structure of women also decreases snoring. As a result of hormonal changes after menopause, women’s muscle structure begins to resemble that of men;thus the snoring rate of women approaches to, or even becomes equal to the snoring rate of men after a certain age.

IS SNORING A PROBLEM?

Continuous snoring which is not accompanied by respiratory disorders is referred to as “the simple snoring”. Snoring used to be considered harmless to patient if it does not cause breathing pauses or sleep divisions. However, according to recent researches, even though there are not any breathing disorders (e.g. breathing pauses) during sleep, the simple snoring still may cause physical tiredness caused by the effort spent throughout the night to breath. Thus it also may cause fatigue and sleepiness during the day. In this case, the problems are sleep divisions, and other people, particularly the spouse, being disturbed by the snoring sound. After all, the people with the problem of simple snoring apply to a physician due to insistence of their relatives. Snoring may be considered as a simple and unimportant situation by some people: However, sometimes it might become a major problem disturbing all the people in the house. It is certain that snoring has an adverse impact on quality of life. Snoring is held responsible for the sleepless nights of the other family members. A snoring person becomes an unwanted roommate during vacations and business trips. It is also possible for a snoring person to encounter many medical problems as well. The self-damage is even more important. Some nights are spent without getting any rest. The frequency of high blood pressure among the people who snore much is higher compared to those who do not snore.

CAN SNORING BE TREATED?

Many types of snoring can be treated. Simple snoring can be ameliorated by taking some measures. The following recommendations should be followed by the adults who snore: The ideal body weight should be tried to reach. An active/athletic life style should be acquired in order to have a good muscular tonus. People who snore should not take sleep medications, tranquilizers and allergy medications called antihistamines before sleeping. They should avoid drinking alcohol less than 4 hours before sleeping. They should avoid getting too much food less than 3 hours before sleeping. Excessive fatigue should be avoided. Lying on side should be preferred instead of lying back. As being an old suggestion, sewing a tennis ball to the back of a sleepwear is still an effective method. This way lying on back (supine position) is prevented. Allow those people in your house who do not snore to start sleeping before you. Excess weight is known to be one of the major causes of snoring. It has seen that the snoring problem of 80% of the people with excess weight has been significantly decreased or eliminated once they reduced weight.

  WHAT IS OBSTRUCTIVE SLEEP-APNEA SYNDROME (OSAS)?

Apnea means cessation of breathing. OSAS is a serious disease characterized by the respiratory tract obstruction due to the relaxation of the soft tissues at the onset of sleep, and due to the negative pressure that takes place during breathing. With the respiratory tract obstruction, the air intake through the mouth and nose is prevented for at least 10 seconds, and the body spends enormous effort to breath. Breathing pauses repeat frequently during the night (sometimes up to hundreds). Each pause lasts approximately 20-40 seconds. In severe cases, this duration might be even longer than 2 minutes! The oxygen level in blood significantly decreases during those breathing pauses. Thus, the heart, brain and other organs cannot get adequate amount of oxygen.

HOW CAN OSAS BE DIAGNOSED? WHAT ARE THE SYMPTOMS? HOW CAN I IDENTIFY THE DISEASE?

Since the breathing problems occur during sleep, the patient her/himself is not aware of the situation. Most of the time, this situation is detected by the patient’s spouse or relatives. The most prominent finding is snoring. Almost all of the patients snore very severely. While the patient is snoring continuously, the sound becomes suddenly interrupted. The patient’s relatives first recognize this situation. During cessation of breathing, the movements of abdomen and chest continue. Thus, at the beginning, it is difficult for an observer to understand that the air intake has stopped. In order to beat aforementioned obstruction, the diaphragm contracts more and more. The amplitude of abdominal and chest movements increases.  Once this obstruction is defeated after a certain point with this increased effort of breathing, the patient begins to breathe again by making a more fierce sound compared to the previous one (like roaring, so to speak) . The first and most prominent symptom of the disease is a state of excessive daytime sleepiness. Other symptoms are waking up with severe dryness of the mouth in the mornings,  morning headaches, becoming more nervous and intolerant than in the past, anxiety, difficulty in maintaining concentration, drop in children’s performance at school, forgetfulness, getting up at night to go to the toilet for one or more times even though it was not happening before, night sweats which become more prominent compared to the past and cannot be explained by climatic conditions, decrease in sexual desire (in males), and impotence. How Obstructive sleep-apnea syndrome (OSAS) is treated? The treatment could be simple such as the treatment of allergies or infection, or it might require surgical treatments of tonsils, adenoid or nasal disorders. Successful results are being achieved from snoring surgeries which ensure the fixing of unsteady tissues in throat, and further expansion of the airway.  These surgeries are referred to as uvulopalatopharyngoplasty surgery (UPPP). For the patient, it doesn’t feel any different than the tonsils surgery. Laser-assisted uvulopalatopharyngoplasty (LAUP) is another surgery that can be performed by using lasers. A positive pressure full-face mask called CPAP or BPAP is used in patients whose general health condition is unsuitable for surgery, who cannot go under surgery due to another disease, or who cannot benefit from the surgery due to an acute disease they have.

IS THERE ANY OTHER TREATMENT OPTIONS?

In some mild cases, oral cavity tools might be useful for a while. Snoring problems of the suitable patients are aimed to be reduced by ensuring the rigidity of the soft palate with a special material called PILLAR, which is placed into the soft palate.

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