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Snoring – Sleep Apnea

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We have all been accused of snoring, even occasionally, at one point in our lives or another, when we go to bed being tired, or we have eaten late at night and we have possibly consumed some alcohol too.  Certainly, this kind of snoring is not the one we have to deal with.  Some of us, however, snore so regularly and intensely, that we annoy the ones whom we live with, a situation which makes us feel awkward.  When, especially, snoring is also accompanied by episodes during sleep known as sleep apnea, then, from a social problem it becomes a health problem.

The typical patient suffering from apnea is overweighed with a short and fat neck.  Usually, he is urged by his spouse to visit a doctor whom she informs about her spouse’s intense snoring, but also of interruptions in his breathing for some seconds during his sleep.  But he, as well, complains about not enjoying his sleep, waking up tired and being sleepy during the day.  This description is, of course, rather typical and makes the diagnosis quite clear.  Most of the cases are rather unclear and their investigation requires a series of checkups and clinical tests.

The clinical tests look aim at anything which may obstruct the incoming of air through the mouth and nose to the trachea and lungs.  The main examination is the endoscopy of the nose and larynx with the flexible endoscope.  During this examination, especially, the patient is instructed to reproduce his snoring, a fact that gives us an idea of the area, responsible for the production of this annoying sound.

Usual findings from this clinical examination and regardless of the body type described above have to do with the nose (septum deviation, conchal hypertrophy, polyps), the nasopharynx (adenoid hypertrophy), the oral cavity (macroglossia, large uvula, loose soft palate), or the larynx (polyp degeneration of the vocal cords, edema in the arytenoids) and others, without excluding the possibility of finding growths, tumors, in any part of the upper respiratory and digestive track.

The basic clinical test is the overnight staying in sleep study lab.  The patient sleeps in a hospital room and his/her sleep is monitored.  Specifically, we monitor the cardiac and respiratory function and we record the hypopneas and the apneas during sleep.  The study of the sleep is useful, because it verifies the apnea syndrome, evaluates its gravity and constitutes a measure of comparison, in order to evaluate the effectiveness of the treatment method applied.

The treatment of the apnea syndrome is many times difficult.  It requires the active participation of the patient and, maybe, the application of multiple therapeutic methods.  At first, the patient will need to alter some of his/her dietary and sleep habits, adopting a healthier lifestyle.  In addition, he/she will have to try to lose any excess body weight.  In this effort, he/she may need the help of a dietician, or, in difficult cases, to resort to operations for the reduction of the capacity of the stomach.

Surgically wise, we need to restore those clinical findings mentioned above, which block the upper respiratory track.  Their restoration, in addition to the fact that it will improve the apnea syndrome, it will also facilitate any potential application of a respiratory device (CPAP).  Depending on the findings, the surgical restoration may be practiced in one or more stages.  At this point we have to emphasize that, despite what is commonly belief, the emphasis is put primarily on the area of the oral cavity and not the nose.  Thus, the basic operation for snoring and the apnea syndrome is the UPPP.  Of course, the kind of operations suggested for each patient is evaluated individually.

Finally, for those cases of patients who do not want to undergo surgery, or for whom we do not anticipate a significant improvement from it, we suggest the use of the respiratory device during sleep (CPAP).  It is a device which keeps the walls of the respiratory track open, channeling air under pressure.  It is not always well tolerated by the patients, unless we see its benefits in practice.

After the application of the treatment methods and when a certain period has passed for them to work, we suggest re-evaluation of sleep conditions, in order for us to objectively identify the degree improvement.

The apnea syndrome is not related to snoring only.  The apnea patient does not only jeopardize the quality of sleep and his/her well being for next day. In the long-run, he/she aggravates his respiratory and cardiac function.  Thus, treatment and continuous observation of the syndrome is a matter of health and it has to be done promptly and correctly.