Sleep apnea, which means that breathing stops and becomes shallow during sleep, can recur throughout the night. This ailment, which can cause problems such as waking up tired in the morning and inattention, can turn into fatal pictures if not treated.

WHAT IS SLEEP APNEA?

Sleep apnea is one of the most important diseases caused by snoring and can be expressed as cessation of breathing during sleep. During sleep apnea, the muscles that keep the upper airway open to relax. Not being able to breathe for at least 10 seconds due to the root of the tongue or soft palate or overgrown tonsils blocking the airway is called sleep apnea. Although respiratory effort continues during sleep apnea, this effort, which increases after a while, stimulates the brain, opening the airway. The person who snores until his breathing stops continues to breathe and snore again with a loud grunt. It is known that when the necessary precautions are not taken, sleep apnea causes carelessness, increasing the risk of traffic accidents 7-8 times and causing work accidents. Even though the incidence of sleep apnea is 1-4%, it can be better understood how important a problem it is if it is considered that diabetes mellitus is 3%. The frequency of asthma is approximately 5%.

WHAT ARE THE SYMPTOMS OF SLEEP APNEA?

One of the most important symptoms of sleep apnea is the cessation of breathing during sleep. Other sleep apnea symptoms can be listed as follows:

• Restlessness during sleep
• Snore
• Do not urinate frequently
• Sweating
• Dry mouth
• Reflux
• Witnessed respiratory arrests

In addition, headache, forgetfulness, concentration disorder, depression, inability to wake up in the morning, being extremely sleepy, and fatigue are among the daytime symptoms of sleep apnea. People with sleep apnea symptoms may encounter many severe conditions during the day. Sudden death, stroke, heart attack and heart failure during sleep, difficulty in losing weight if the patient is obese, respiratory failure, sexual reluctance and impotence in lung patients, uncontrolled diabetes can be given as examples of these negativities. In addition, sleep apnea can cause traffic and work accidents as it will cause constant fatigue and lack of concentration during the day.

WHAT CAUSES SLEEP APNEA?

The cause of sleep apnea is that the muscles in the throat relax to close the space through which the air will pass. Strictures in the upper airway can cause wear and tear of the airway from childhood, leading to sleep apnea syndrome. Being overweight, having large tonsils and adenoids can also be shown among the causes of sleep apnea. Sleep apnea can occur not only in adults but also in children. Snoring in people with sleep apnea syndrome occurs 3-4 times more often, very rudely and loudly. In addition to snoring, shortness of breath, frequent sighing, trying to wake up with fluttering movements, regular and long-term pauses in breathing, waking up tired in the morning are also seen in people with sleep apnea syndrome. Although not the exact cause of sleep apnea, 30-50% of patients with sleep apnea syndrome have hypertension.

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WHAT CAUSES SLEEP APNEA?

Respiratory arrests during sleep; It causes sudden death in sleep due to irregular heartbeat and rhythm disorder in advanced ages. This; causes frequent urination at night, excessive sweating at night, waking up tired and sleepy in the morning, reluctance during the day, distress and tension. Daytime sleepiness leads to traffic accidents. Long-term sleep apnea syndrome; also causes serious problems such as high blood pressure, heart attack, and strokes due to cerebral vascular occlusion. The low oxygen level that occurs during the night in patients with respiratory arrest during sleep causes a load on the heart and vascular system of the patient, causing cardiac enlargement and hypertension in almost half of the patients over time. It is known that hypertension is seen at a rate of 30-40% in these patients and even up to 50% in some studies. When the patients’ heart rhythms are examined, bradycardia occurring during apnea is followed by tachycardia during wakefulness. Sometimes can add different rhythm disorders to this rhythm disorder called Brady-tachy-arrhythmia. Diseases in heart rhythm sometimes even cause the patient to be lost in sleep.

HOW IS SLEEP APNEA DIAGNOSED?

The sleep apnea test is the most crucial step in the detection and treatment of the disease. The sleep apnea test called “polysomnography” is how brain activity and respiratory events are recorded all night long. Along with this test,   can check eight parameters such as electroencephalography (EEG), electrooculography (EOG), electrocardiography (ECG), electromyography (EMG), respiratory effort including chest and abdominal movements recording, airflow recording from nose and mouth, oxygen saturation, body position during the night. Hourly follow-up is provided. Polysomnography, a sleep apnea test, is based on measuring brain waves, eye movements, airflow from the mouth and nose, snoring, heart rate, leg movements, and oxygen levels during sleep. To have a sleep apnea test, patients must stay in a sleeping room for one night. During the trial, the signals received with cables connected to various body parts are transferred to the computer outside the room. By examining these records taken until the morning, many parameters such as how many times breathing stops during sleep, how long it stops, how oxygen values ​​and heart rate are affected when it stops, and whether or not to fall into a deep sleep can be looked at.

HOW IS SLEEP APNEA TREATED?

If there is obesity, the first thing to do in treating sleep apnea is to overcome this situation. If there is significant anatomical stenosis in the upper respiratory tract, the patient should be evaluated for surgical intervention by an otolaryngologist. The Celon method, the bipolar radiofrequency thermotherapy method, and the surgical treatment with plasma methods are some of them. The success of the surgical treatment for snoring and sleep apnea depends on the determination of the patient suitable for surgery and the devices used in the surgery. It is essential that the instruments used in surgery do not cause much damage to the tissue and that the patient’s pain is less in the postoperative period. In addition, sleep apnea devices are also used in the treatment. In the treatment of advanced sleep apnea, positive air pressure (CPAP – sleep apnea mask) therapy should be applied. According to the treatment effect and the patient’s preference, the patient should follow the patient by adjusting to the automatic settings or switching to a constant pressure device. In cases that have difficulty using the CPAP device, also known as a sleep apnea machine, or in mild cases, the lower jaw can be brought forward with an intraoral appliance to prevent the tongue from falling back and obstructing the upper respiratory tract. The specific treatment of sleep apnea is provided by using devices that deliver compressed air to keep the airway open all the time. PAP (positive airway pressure) devices, colloquially, sleep apnea mask, prevent sleep apnea by keeping the upper airways open during sleep. These devices, which deliver compressed air with a silicone mask that fits tightly to the face during the night, may seem uncomfortable for the patient at first. Despite this, patients who wake up in the morning rested, and sleepy easily accept the device. Should spend a second night in the sleep laboratory to determine which device is suitable for the patient and see that the apneas have disappeared or decreased to a minimum. After the sleep apnea treatment with the device, the quality of life of people who get rid of the sleep apnea problem increases again.

What is Sleep Apnea Surgery?

Sleep apnea surgery; is based on the discipline of eliminating physiological problems that cause sleep apnea. In this case, the larger than usual tonsil that causes sleep apnea can be removed, and the removal or reduction of loose and excess tissues at the root of the tongue can be performed. Of course, before the surgery planning, the patient’s general health status is evaluated; The factors causing sleep apnea are determined, and conservative treatment methods and CPAP treatment (positive air pressure) applications are carried out.

If cannot cure sleep apnea with conservative treatments, sleep apnea surgery is applied. It should accurately convey the detailed answer to the operation process and sleep apnea to the patient. In this process, it is also decided which surgical method should be applied.

How is Sleep Apnea Surgery Performed?

There is no definitive treatment for sleep apnea. Treatment is carried out taking into account many factors. Weight loss, smoking, and alcohol restriction should be applied first. Medications that may exacerbate sleep apnea should be reduced. Various non-surgical treatments are available. Among them is the option of a soft silicone mask that is placed on the patient’s nose. Some patients may pull the tongue and mandible forward, and an intraoral device is used to dilate the airways during sleep.

Under Which Conditions Can the Surgery Be Applied?

During sleep endoscopy, the level of upper airway obstruction is determined. Many surgical options provide widening of the upper airways in patients with sleep apnea. Nasal operations are the most frequently performed operations. Nasal surgeries are effective in patients with snoring and mild sleep apnea. This results in a reduction in complaints in patients with moderate to severe sleep apnea.

Soft palate contraction and formation, removal of large tonsils, change in the shape of the pharynx, and contraction methods applied to the root of the tongue are the most common procedures for sleep apnea. Nose and tonsil surgeries are the most common operations performed on children.

Recovery Process After Sleep Apnea Surgery
Sleep apnea surgery can be performed with three different surgical methods. These are as follows;

• Open surgery
• Endoscopic surgery
• Transoral robotic surgery
• The recovery process after sleep apnea surgery continues comfortably and comfortably, especially with the operations performed with endoscopic and transoral robotic surgery. This process should not exceed the doctor’s recommendations, and the use of prescription drugs should not be interrupted. At the same time,   should pay attention to the sleeping position.

Sleep apnea surgery cost

Many factors determine the cost of sleep apnea surgery. The surgical method to be applied and the type of anesthesia is among the most critical determining factors. At the same time, there may be differences in fees depending on the choice of doctor.

FREQUENTLY ASKED QUESTIONS ABOUT SLEEP APNEA

What is apnea?

The temporary cessation of breathing is called apnea. It is commonly known as sleep apnea.

How to prevent sleep apnea?

Can prevent sleep apnea by taking simple precautions. The most important modifiable risk factor for the disease is obesity. Sleep apnea can be reduced by 50% by losing weight. Also, avoiding alcohol and sleeping pills, quitting smoking, and not sleeping on your back minimize discomfort. Sprays or elastic bands that reduce snoring and provide nasal opening are not sufficient for treating sleep apnea.

How do I know if I have sleep apnea?

The symptoms of sleep apnea are challenging to be noticed by the patient. In this regard, accurate information should be provided by the spouse, parents, children, or relatives who know the person’s sleep status. It is essential to answer three critical questions to talk about the existence of sleep apnea. Do you have snoring, sleep apnea, and increased daytime sleepiness? If the answer to these three questions is “yes,” it will mean facing sleep apnea. For this,   should consult a specialist doctor as soon as possible.

Do children have sleep apnea?

Children’s sleep, especially at night, should be closely monitored. Whether the child sleeps with his mouth open, snoring, or wheezing should be checked periodically. Should keep in mind that conditions with large adenoids and tonsils can lead to sleep apnea. Before going to the doctor, videotaping the child’s sleep moment is essential in terms of diagnosis. Since sleep apnea, which is experienced as a result of enlargement of the nasopharynx and tonsils, does not occur suddenly, careful parents can notice the problem in the first place. Along with sleep apnea, lung and heart problems can also be seen in the child. Apart from diseases that can go up to lung diseases and heart failure, there may be some changes in the child’s facial structure.

What to do with sleep apnea?

All patients are generally recommended to lose weight, quit smoking and alcohol. Diagnosis and treatment of sleep apnea syndrome are of great importance in people at high risk for diseases such as diabetes, hypertension, high cholesterol, and obesity.

What causes sleep problems?

Sleep apnea disrupts healthy sleep. However, sleep is a period in which mental functions are renewed and preparing the ground for bodily rest. For a healthy body and a quality day, it is more important to increase the quality of sleep rather than its duration. Chronic insomnia, daytime attention deficit, concentration difficulties, extreme irritability, decreased work performance, depression, high blood pressure, and metabolic disorders can cause many problems.