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What is Snoring, Sleep Apnea? How is it treated?
October 28, 2023

Dr. ozbarsut

Sleep can be defined as a cerebral behavior in which our communication with the environment is interrupted and our body functions are differentiated. Although it varies from person to person, it covers an average of 7-8 hours. It is a period in which we are unconscious but brain activities continue, both the mind and the body are renewed and prepared for wakefulness.

NonREM sleep continues in circulations in two parts and consists of 5 cycles of approximately 90 minutes per night. NonREM sleep also includes I, II, III. The III: period is the period of deep sleep when brain waves expand and slow down.

THE IMPORTANCE OF SLEEP

If a quality sleep is not realized in terms of duration and sleep periods, a number of problems may occur when waking up. These problems can be divided into short-term and long-term problems. The next day after a bad night’s sleep, many problems can arise, ranging from lack of concentration, irritability, learning disorders and communication deficits. In the long term, recurrent sleep problems can affect both the quality and duration of life.

SLEEP BREATHING PROBLEMS

Sleep apnea is the most common and well-known sleep apnea. Apnea is when breathing stops for more than 10 seconds during sleep and is accompanied by a decrease of at least 4% in oxygen levels.

FINDINGS

Long-standing snoring, daytime sleepiness (can be at very different levels depending on the degree), witnessing of relatives to breathing stops during sleep
When you deal with sleep apnea for a long time, one of the most important clues when you encounter the patient as a physician is the patient’s eyes. Although it is not possible to define this finding exactly, the phrase “there is no light in your eyes”, which is widely used in Anatolia, is an ideal definition to describe it.

RISK FACTORS

Weight is the most important risk factor that can be kept under control. Increases in neck diameter due to weight gain increase both the apnea and its degree by narrowing the respiratory tract. Most of us remember from mathematics lessons that the area of the circle was obtained by multiplying the square of the radius by the number pi. Therefore, even a few millimeters increase in neck diameter can cause unexpected narrowing of the respiratory tract.

Gender: Although it is more common in men than women, this difference closes in women after menopause.

Genetic characteristics: Naturally, the anatomy of people varies, and the diameter of the respiratory tract can be directly affected by these factors. Factors such as the height of the palate, a shorter than ideal neck, and a flattened face can pose a high risk for apnea. One of the factors here is acquired facial changes. Adenoid and tonsil size that obstruct the respiratory tract in childhood, nasal obstructions secondary to allergies can also increase the dome of the palate and cause permanent changes in the face and increase the risk of apnea in later years.

Smoking also contributes to the risk and severity of apnea through its negative effects on lung capacity.

Alcohol, drugs and narcotics that affect the nervous system are serious risk factors as they reduce tissue resistance.

Especially low and supine positions can obstruct the respiratory tract by falling back organs such as the soft palate and tongue.

DIAGNOSIS

Sleep abscess is diagnosed with a sleep test called polysomnography. Many different parameters can be analyzed in the test, from brain waves to pulse changes, oxygen levels, leg and jaw movements, and many functions can be analyzed. Ideally, the person requesting the sleep test should evaluate the test page by page. During the evaluation, brain waves, changes in heart rhythm and the relationship of other parameters can be made more objectively.

TREATMENT

Even if it is not enough for the patient to lose weight, it always reflects positively on the person. It may also be recommended not to use alcohol, smoking and psychotropic drugs and substances.
As a result of the sleep test, devices called CPAP may be the best alternative in suitable patients. However, there may be difficulties in use given the difficulty of use, adaptation difficulties and the heat of the Mediterranean climate, especially in the summer period.

SURGICAL

Apnea surgery has been evolving and changing over the last 20 years. The procedures applied in the early periods are almost not performed anymore and new surgical methods are on the agenda every day.

The main purpose of apnea surgery is to expand the narrow airway area within the limits of the limits. Therefore, it should be personalized instead of a standard surgical procedure. In order for the correct intervention to take place, it is necessary to support a good history and physical examination with a sleep test.

OUR SNORING AND SLEEP APNEA EXPERIENCES

Since 2004, I have both witnessed and accompanied the developments and changes in sleep apnea, which is the subject I have been intensely interested in, both in the approach to the apnea patient and in the treatment. Apnea, a syndrome whose importance was not fully understood until the 1990s, gained an important place in otolaryngology after the 2000s. Again in 2004, I was one of the first physicians to receive Radiofrequency on the basis of the practice, although it was not very common in Turkey. All the effort was to apply a method with few side effects to eliminate snoring, which is a social problem.Over time, I perceived that snoring and apnea syndrome could not be solved with such simple interventions, and the need for an analytical approach to be handled within the framework of a certain system and for a more professional approach, I passed a 2-month sleep laboratory training at the Gulhane Military Medical Academy Psychiatry Clinic in 2008.In the same year, I established a 3-bed sleep laboratory and tried to take my work further. Until today, we have reached significant numbers in a difficult area such as snoring and apnea by performing surgical interventions on over 1300 patients with snoring and apnea syndrome. Our success has always been above the world averages for each surgical procedure performed periodically and we have not experienced any serious problems to this day.

The success may vary depending on the person’s interest in the subject, self-development on behalf of the subject and experience.The main mistake is to make surgical recommendations to the patient without taking a good history, without adequate physical examination, and most importantly, without performing a sleep test.The patients who apply to us are mainly the statements such as “I have snoring, I went to a doctor, he said it would pass if we do a nose surgery” or “your small tongue is too long, we need to cut it”. Based on my experience, I can easily say that nasal airway narrowing is usually not the most important focus in snoring and apnea.When we ask my patients to report any change in their nighttime respiratory events, which they use by recommending sprays that shrink the nasal flesh before going to sleep to see the share of nasal congestion in sleep apnea and snoring, no significant change is often seen. again, surgeries on the small tongue are also unnecessary interventions.Sleep apnea is a highly complicated disease and if there was a treatment by cutting the small tongue, what was the need for so much work on the subject! The small tongue, which we call the uvula, is actually the victim and it is an extremely optimistic idea that the intervention to be made to the victim is a solution without eliminating the cause or causes.

SUMMARY

Sleep apnea is not a simple phenomenon and cannot be solved with simple interventions.

There are responsibilities on the patient as well as the responsibilities of the physician (weight loss)

Polysomnography (sleep test) is a must.

Sleep test + a good physical examination + physician experience + patient compliance are essential for a successful outcome.

Apnea; stopping breathing for more than 10 seconds during sleep, oxygen level decreases by 3% and
can be defined.
It is more common in people with a high body weight index, increased neck thickness, and defined as obese.
Although it is more common in men, it can sometimes be seen in thin people.
However, the rates equalize at the end of menopause.
In studies, the prevalence rate in the community is reported to be 5%, but in my opinion it is higher.
As for its importance; we can summarize the results that will affect the whole life of the person under 2 headings.

  • Next day effect: Interruption of sleep integrity due to nocturnal respiratory arrest
    deterioration and the resulting fatigue, lack of concentration and attention, no matter how much sleep
    problems such as disorganization, communication defects, etc. The main complaints that bring the patient to the physician are the following
    This is what we call the day effect.
  • Long-term effects of apnea: As a result of breathing interruptions, the heart uses the low oxygen
    In order to compensate, it tries to increase its speed and the pressure (blood pressure) it applies to the vessel.
    As a result, high blood pressure is associated with increased right heart pressure, nocturnal urination, metabolic
    It is at the background of many systemic diseases such as diabetes, neurologic problems and cardiac problems due to changes.

Since the respiratory events occur during sleep, the person is not aware of them.
Referrals to the physician with the warning of the environment such as spouse, friends, family who usually witness sleep
Excessive sweating in the head, frequent tossing and turning, inability to fall asleep no matter how much sleep the patient gets, again.
is included in their complaints.
From sleeping at a red light at a traffic light to falling asleep wherever he sits
in a format as heavy as this one.
Patients who seem to sleep a lot seem to have an ideal sleep.
Because they are unable to realize this, they are constantly trying to sleep, they are always longing for sleep.
Apnea can both reduce the duration and impair the quality of life.

Solution; The so-called polysomnography (PSG) test must be done to see the severity of the problem.
As a result of the test, the disease is classified as simple snoring, mild, moderate, severe apnea, and the patient and
alternative treatment methods are evaluated.

Treatment: Weight loss is always a positive contribution to the solution, but sleep apnea
weight loss is more difficult for people with apnea due to the metabolic problems caused by apnea.
it can happen.

  • Respiratory support devices: It is the gold standard in treatment, but due to the difficulties of use, many
    the patient cannot tolerate it.
  • Surgery: The main aim is to widen the narrow parts of the respiratory tract and increase tissue resistance.
    principle.8 OUR SUCCESS in surgical interventions we perform around 1300 per year
    is above world averages.