Snoring & Sleep Apnea

It is common knowledge that snoring, which is often accompanied by sleep apnea, afflicts a very large number of people on a regular basis. Typically, four out of ten men and two out of ten women snore, while six out of ten people report that their partner snores.

What is snoring and how is it caused?

Snoring is a characteristic rough sound, which is produced during sleep due to the oscillation of the soft walls of the pharynx. Almost all people snore sometimes but for some the problem is persistent and chronic. Moreover, this situation may hide some other serious illness, while the inconvenience and discomfort often felt by the partner and the patient’s environment in general should not be underestimated.

What is sleep apnea?

Sleep apnea is a potentially serious sleep disorder. It is characterized by loud snoring interrupted by periods of pause during which breathing stops. These periods can even last several seconds, which can make the patient’s partner worry. Apnea usually causes the patient to wake up. In fact, most of the time this occurs with a loud snoring sound that gives the impression that the person is suffocating. This snoring-apnea cycle can be repeated many times during the night (at least five times in one hour) and gives the patient the feeling of a “light” sleep that does not provide substantial rest.

What are the symptoms?

In cases where, in addition to snoring, the patient manifests one or more of the following symptoms, there is a serious possibility that they also suffer from sleep apnea:

1. Frequent pauses in breathing during sleep
2. Sleepiness during the day
3. Difficulty concentrating to perform mental work
4. Morning headache
5. Irritated throat when waking up in the morning
6. Restless sleep
7. Dyspnea and an impression that the person is “suffocating” during the night
8. Chest pain during the night
9. Loud snoring that wakes up the patient’s partner
10. In children, distractibility, hyperactivity/nervousness, and poor school performance

What mechanisms lead to snoring and sleep apnea?

The mechanisms that lead to snoring and sleep apnea have to do with the relaxation of the muscles at the back of the throat. These muscles normally support the soft palate, tonsils, tongue, and side walls of the pharynx. When they relax too much the airway narrows or even closes completely during inhalation. As a result, the patient cannot get enough air and the oxygen in the blood drops. The brain senses this and reacts by waking the person up so that they can reopen their airway. The awakening is usually so brief that the patient does not remember it. It is most often accompanied by heavy snoring, sighing, or “choking”. This pattern can be repeated from 5 to 30 times or more within an hour. Consequently, the person cannot reach the deepest phases of sleep associated with rest.

What are the causes of snoring and sleep apnea?

Snoring and sleep apnea have several causes and predisposing factors, the most important of which are the following:

• The anatomy of the mouth and pharynx Features of the anatomy like an excessively flaccid soft palate, a large uvula, a narrow pharynx, and adenoid hypertrophy, predispose to the condition.κρεατάκια)
• Relaxation of the pharynx walls due to alcohol or tranquilizers consumption.
• Difficulty breathing through the nose εξαιτίας due to scoliosis of the nasal septumhypertrophy of the inferior turbinates or nasal polyps..
• Obesity
• Male gender
• Older age
• Hereditary history of snoring and sleep apnea
• Smoking
• Insufficient sleep
• Supine sleeping position

What are the complications of snoring?

Snoring, in addition to often being very annoying for the patient’s partner, when combined with sleep apnea can have several complications such as:

• Sleepiness during the day leading to increased risk for road and work accidents
• Irritability and impatience
• Difficulty concentrating to perform mental work
• Increased risk of arterial hypertension, cardiovascular disease, and stroke
• Especially in children, hyperactivity, aggression, and poor school performance

What is the role of the ENT in the diagnosis of snoring and sleep apnea?

The role of the ENT in the diagnosis of snoring and sleep apnea is extremely important. It is necessary for the patient to undergo a thorough oral examination that will reveal the causes of the condition. In specific, the tests you will undergo at the clinic are the following:

• History. The doctor will get information from you and your partner about the nature and severity of your symptoms.
• Clinical examination. The doctor will examine your oral cavity, pharynx, dentures, and tonsils. It will also estimate your neck circumference and body weight.
• Nasal endoscopy. Με την The ENT performs nasal endoscopy to examine the nasal cavity and nasopharynx for the presence of anatomical anomalies that may be responsible for the condition. Such anomalies are allergic rhinitisdeviated septum, nasal polyps, hypertrophy of the inferior turbinates and adenoid hypertrophy.
• Laryngoscopy. Με τη a laryngoscopy. examines the lower parts of the pharynx, the base of the tongue, and the larynx for signs of obstruction. The Muller test is also very useful. During the test, with the use of a flexible laryngoscope, negative pressure is exerted on the oropharynx and hypopharynx, a condition that simulates the pressures of the airway during sleep. In this way, we can locate the area of the blockage and proceed with its restoration.

In some cases, the ENT may refer you for a sleep study.

How are snoring and sleep apnea treated?

Modern otorhinolaryngology provides the doctor with a multitude of possibilities for treating snoring and sleep apnea. Depending on where the anatomical obstruction of the airway is located, the doctor may recommend one of the following operations:

• Tonsillectomy–Adenotomy Τhey are particularly effective in children but also in adults with tonsils and adenoid hypertrophy.
• Restoration of normal airflow in the nose by:
  • Septoplasty
  • Conchoplasty (Turbinoplasty)
  • Functional Endoscopic Sinus Surgery to remove nasal polyps
• Uvulopalatopharyngoplasty(UPPP)with the use of radio frequencies, ultrasound and laser
• Placement of special implants in the soft palate
• Injection of hardening substances into the soft palate

Of course, it is important for the patient to change certain habits, such as quitting smoking, limiting the consumption of alcohol and sedatives, and losing weight.

The use of a continuous positive airway pressure (CPAP) machine has very good results, with the main disadvantage being poor compliance on the part of the patient. Most of them find it inconvenient and, when possible, they would prefer to solve their problem permanently by undergoing surgery. Also, if there is an anatomical obstruction in the airway like those we described above, it must be surgically corrected for the device to function properly.

In conclusion, snoring with or without sleep apnea is a pathological condition that depends on many parameters. The right doctor along with an in-depth otolaryngological examination will reveal the causes of the condition and will lead to the most effective therapeutic approach.