Snoring, which is the most common symptom of sleep apnea syndrome, is the sound caused by the vibration of soft tissues around the pharynx during breathing. It occurs as a result of narrowing of the upper airway in the area behind the tongue. Snoring increases in proportion to the size of the constriction.
Is snoring a common complaint in society?
42 of every 100 people in our country have complaints of snoring. As the age increases, the complaint rate increases. In 60-year-old men, this rate reaches 60% and in women up to 40%. Anatomically, body fat is concentrated in the waist and hip area in women, in males it concentrated in the neck and abdomen. For this reason, snoring is more common in men due to narrowing around the pharynx. The differences in muscle structure of women also play a role in the lack of snoring. After menopause, hormonal balances change in womens and their muscle structure resembles that of men, and women start to snore in similar shape and frequency.
It is thought that continuous and regular snoring without respiratory disorders does not harm the patient if it does not divide the sleep. This type of snoring is particularly uncomfortable with the patient and tose they live with. Sometimes snoring occurs irregularly, along with respiratory disorders. In this case, the patient takes a lot of effort to breathe. Respiratory irregularities may cause the patient to wake up and badly affect the quality of sleep. Sometimes the patient is unable to realize that he is awake because of his difficulty in breathing. In some cases, these awakenings last for 5-10 seconds and are not noticed by the patient. This time, the patient complains of tiredness and daytime sleepiness.
The most dangerous state of snoring is severe snoring, which is interrupted by periods of silence where breathing stops. Respiratory interruptions or reductions (apnea or hypoapnea) can be repeated hundreds of times during sleep. Very few of them are recognized by the patient or their relatives.The clinical situation of snoring with respiratory arrest is called obstructive sleep-apnea syndrome. The patient wakes up after each breathing stop and can stop the respiratory arrest only by waking up. As a result of these short-term and frequent awakening, the restful phase of sleep is inaccessible, and so the patient is unconsciously sleeping with a sleepless, superficial and short-term alertness. The number and duration of these breathing stops vary depending on the severity of the disease. Respiratory arrest may last from 10 seconds to 1-2 minutes. The frequency ranges from 15-20 to 400-500 per night. It should be considered that the disease progresses severely when breathing stops up to 60-70 times per hour and stops beetween 15-20 seconds. Due to respiratory arrest, the oxygen content of 95% is reduce to 50%. The disturbed respiratory system is also reflected in the heart rhythm and irregularities in the heartbeat. This can lead to sudden cardiac arrest, which is a very dangerous result. Sudden deaths may occur during sleep. Patients often need to urinate frequently during the night. Exerting effort to breathe through the night, the patient suffers from excessive sweat and fatigue, so when he gets up he feels tired and sleepy. Most of these patients want to sleep as much as possible during the day. Sleepiness, which continues throughout the day, leads to a decrease in productivity, and a more tense and distressed demeanor. It has also been reported that sleepiness has led to widespread traffic accidents. In the long term, obstructive sleep-apnea syndrome can cause serious problems such as high blood pressure, heart attack and stroke. Therefore, those who have symptoms of sleep apnea syndrome should be examined in a sleep laboratory by contacting a physician. The results of the examination in the sleep laboratory are more satisfactory.
How are respiratory disorders diagnosed in sleep?
The definitive diagnosis of the disease can be made by observing the patient during the night in the sleep laboratory. For this purpose, patients are examined by placing different sensors in various parts of their bodies. The higher the number and the sensitivity of the sensors, the more detailed and efficient the result is. In order to carry out this very sensitive test, patients should be monitored all night long in the sleep laboratory as close as possible to their home conditions. As a result of the investigations carried out in the sleep laboratory, the number and duration of sleep disorders, the decrease in the amount of oxygen, the irregularities in the heart rhythm and how sleep is affected by these events are revealed. Thus, the path to be followed and duration of treatment is determined. Patients with breathing disorders between 5 and 15 times per night during the night are considered to be mild, patients with 15 to 30 patients are considered moderate level, and patients with more than 30 respiratory disorders are considered to have advanced respiratory problems in sleep.
What are the consequences of respiratory arrest?
In obstructive sleep-apnea syndrome, it is possible to collect complications in two groups.
Complications due to daytime sleepiness:
While some of the patients with sleep apnea do not accept that they are drowsy during the daytime, researches reveal that people with this disease experience certain levels of sleepiness. The daytime sleepiness situation leads to a decrease in the efficiency of the patients, a desire to move away from their social lives and family life, to create a desire for continuous sleep, to disrupt their work.
Several studies have been conducted on the rate of traffic accidents in patients with sleep apnea. All studies have shown that an average of one third of traffic accidents are caused by patients with sleep apnea. Although the patients stated that they did not sleep while driving, EEG recordings and eye blinking numbers were observed and the patients experienced 5-10 seconds of drooping when driving and this was not noticed by the patient. This distraction is enought to cause traffic accidents.
Oxygen deficiency complications:
Patients with sleep disturbances experience 400-500 breathing stops during the night. This lack of oxygen during the night causes an overload of the heart and vascular system, triggering heart growth and hypertension in about half of the patients. Hypertension disease can be seen in up to 50% of these patients. Lung problems can also be seen in 20% of these patients because of overload.
How to treat respiratory arrests in sleep?
The causes, severity, symptoms of disease and physical and mental state of the patient should be considered. Although none of the treatment options are considered easy-to-use methods, patients can at least adapt to one of the options.The most effective treatment of sleep-disorders is a device that provides continuous positive pressure air through the nose, which is 100% effective against the symptoms of the disease. This device, called CPAP (Continuous Positive Air Pressure), has been used successfully in the treatment of sleep apnea since 1990s. Other treatment modalities are successful in some patients but it is not preferred bacause of the risk of recurrence of the disease and the continuation of complications.
Polysomnography: Sleep Test
Patients often say that they cannot sleep in a hospital. However, during a sleep test, thousands of patients have a similar sleep to how they sleep in their homes. Some even say they sleep better than their homes.
What is done during polysomnography?
Patients come to the center a few hours before their normal sleep time with their toiletries.They also take their toiletries. This time is necessary for the patient to get used to the environment. Patients should be alone and not be accompanied by their relatives. Then the patient will be prepared for the test by the technician. When they wants to sleep, they are sent to bed. During this time, the patient is easily accustomed to sleep. Technicians continue to monitor the patient from another room. They help the patient to get up and eliminate their problems when needed.
Patients can wake up frequently because they know they are being monitored during the night and because of the cables attached to the body. However, even in the most negative statements, sufficient information is collected about sleep efficiency of the patient. The evaluation and reporting of polysomnography by an experienced physician lasts approximately 1-2 hours. Afterwards, the physician can easily draw the treatment path by making sure of the symptoms.
Polysomnography is a laborious test for physician but simple for patient.