Snoring and sleep apnea treatment

Snoring affects almost 30% of the adult population. Though snoring is usually harmless and won’t cause any health problems later on, it can be a burden on the people sleeping next to the affected person. Snoring can be dangerous when it appears as a symptom of something called obstructive sleep apnea syndrome or OSAS which affects up to 5% of those who snore.

When OSAS becomes severe breathing may stop 5 or more times per hour at night, and may lead to long-term health problems such as high blood pressure, poor cerebral circulation and even heart attacks.

If you suspect sleep apnea you should consult a doctor, especially if you experience fatigue, memory loss or frequent headaches. In these cases your doctor will likely order a thorough examination including sleep endoscopy.

If snoring happens infrequently or has a rather obvious cause (like eating too much for dinner, drinking alcohol, or the common cold) you do not need to worry, a doctor’s appointment is not necessary.

If your snoring is mild, does not bother you or your environment, does not cause fatigue and problems with concentration, it is not considered dangerous to your health.

Snoring can often be reduced or even stopped by simple lyfestyle changes.

However, if you snore all the time, regardless of your sleep position and experience fatigue and other symptoms it is important to consult your doctor sooner rather than later. Especially because the effects of sleep deprivation may lead to road and workplace accidents and cause strokes and heart attacks.

Sleep apnea is not a life-threatening condition, but in the long term it can have very serious consequences. During periods of shortness of breath, blood oxygen levels drop, while carbon dioxide levels increase. This in turn enhances adrenaline production, resulting in increased heart rate and elevated blood pressure.

This repeated nighttime “stress response” can lead to persistently high blood pressure, which is a risk factor for serious cardiovascular complications such as a heart attack or stroke.

According to research, in patients with sleep apnea the risk of a heart attack is up to seventy percent greater compared to the general population. Sleep disturbances may cause symptoms in the daytime:

• Physical and mental fatigue
• Elevated blood pressure
• Cardiac arrhythmias
• Sensory impairment
• Reduced sex drive
• Psychological problems

According to a study, people suffering from snoring or sleep apnea cause five times more accidents – apparently due to persistent fatigue and poor concentration.

If you suffer from sleep apnea, your doctor will decide whether surgery is an option for you based on the severity of your symptoms.

In our hospital we use sleep endoscopy (DISE) to discover the exact cause of snoring. This allows doctors to examine your sleep apnea and symptoms while you are in a state of drug-induced sleep. While you are asleep an endoscope is used to inspect the upper section of your respiratory tract so your doctor will know whether your problems are caused by a swollen tonsil, the shape and size of your tongue, or a deviated septum. Once the root cause has been found, the doctor proceeds with the type of surgery which is most appropriate for your particular condition, avoiding unnecessary interventions.

As surgery is usually performed under general or local anesthesia there are a few exams and tests to be done beforehand, such as a blood test, ECG and a chest X-ray. Based on the results your internist will determine whether or not surgery is safe for you.

LAUP surgery is performed under general anesthesia. During surgery a laser diode is used to reduce the size of the uvula or the soft palate (sometimes both).

When radiofrequency or coblation is the chosen method, your doctor either uses a coblation or radiofrequency electrode to shrink your uvula and soft palate, these techniques are usually performed under local anesthesia.

If you are diagnosed with a deviated nasal septum, inferior turbinate hypertrophy, nasal polyps, swollen tonsils or a large base of tongue, your doctor will recommend a treatment appropriate for those conditions.

The above mentioned surgical techniques usually reduce and often completely eliminate snoring, while treating the sleep apnea as well.

The key to success is a thorough examination beforehand, preferably a sleep endoscopy. It’s important to note that sometimes snoring iscaused by a combination of several factors (e.g. obesity, old age, lifestyle, medications, tobacco etc.) Some of these factors obviously cannot be corrected by surgery, it might be necessary to make lifestyle changes too.

The negative side effect of surgery is an approximately 10 day pain, which you might experience during swallowing. This however can be eliminated with painkillers given you by your doctor.

If the surgery was performed under local anesthesia you can leave the hospital a few hours after treatment. If general anesthesia was used, you can leave to recover in your home the day after.

You should rest as much as possible in the two weeks after surgery, you need to avoid any activity that elevates blood pressure because this can cause bleeding. You need to drink as much fluid as possible and eat only soft foods. Alcohol should not be consumed.

If there are no complications you can get back to work 14 days after surgery, however the complete healing process takes approximately 3 weeks. Heavy exercises can be done from the 4^th week post-surgery.

Even though LAUP, RAUP and coblation surgeries are relatively risk-free, they are only performed when deemed necessary by a specialist.

There are certain cases when surgery (or general anesthesia) is not recommended due to a health condition or other risk factors. In these cases – if possible – local anesthesia is used or the patient is advised not to undergo surgery at all. Your doctor will let you know whether or not surgery is recommended in your particular case based on your test results.