Sleep disorders in adults are common disorders. There are about a hundred diseases that cause them. The most important of these is sleep apnea. It can even be said that apnea is the most common sleep disorder. Sleep apnea is when your breathing stops and starts again while you sleep.
Interruption of breathing for 10 seconds or longer during sleep is called apnea. Slowing of breathing is called hypopnea. If the number of breathing interruptions during sleep is above 5 per hour, obstructive sleep apnea syndrome is in question. Partial cessation of breathing during sleep occurs as snoring, while its complete cessation causes apnea.
The importance of sleep apnea is that it can sometimes lead to death and is insidious. The quality of life of the patient with sleep apnea deteriorates. He can sleep anytime, anywhere, even asleep at the wheel.
The high intensity snoring of the patient with sleep apnea disturbs the environment. Sometimes even the patient himself wakes up from the sound of snoring. He goes to work tired and has trouble concentrating. The enjoyment of work is spoiled. He returns home very tired and begins to fall asleep in front of the television. Communication with his family and surroundings is impaired.
People with sleep apnea may not be aware of the symptoms because they cannot monitor their own sleep. For this reason, the determinations of someone watching him are important. If you have sleep apnea, you usually have the following symptoms:
- Stopping and restarting your breathing while you sleep
- Waking up frequently
- Loud snoring
- Feeling very tired during the day
- Having changes in your mood
- Inability to concentrate on your work
- Feeling a headache when you wake up
Untreated sleep apnea increases your chances of hypertension, infarction, and heart rhythm disturbances. It even increases your risk of getting into a traffic accident. That’s why it’s so important to diagnose and treat sleep apnea.
Although it is possible to treat sleep apnea, the main problem is the diagnosis. It has been calculated that 80-90% of sleep apnea patients in the world have not been diagnosed yet. The diagnosis can be made after living with this disease for an average of 10 years. The fact that the disease is a very common, dangerous, insidious and unknown disease makes the diagnosis difficult.
If snoring is present alone, it is only a social complaint and its treatment is also social. People who are tired, drink alcohol and smoke can also snore.
What Causes Sleep Apnea?
Sleep apnea is a condition that occurs when breathing stops and starts again due to obstruction in the airways or other diseases in the central nervous system. The obstruction can occur anywhere along the upper airway from the nose to the epiglottis. Upper respiratory tract lesions that can be corrected with surgery are classified below.
- Septum deviation, hypertrophic turbinate, polyp, tumor may cause obstruction.
- Adenoid vegetation, cyst, stenosis, choana atresia, choana polyp, tumor, after opharyngeal surgery, cleft palate repair can be seen in the nasopharynx.
- Tonsil hypertrophy in the oropharynx may be caused by macroglossia (Down Syndrome, acromegaly), retrognathia (Pierre Robin Syndrome, achondroplasia), hypertrophy of the tongue tonsil, tongue cyst, neoplasm, uvula and soft palate laxity.
- It may occur due to laryngotracheomalacia, vallecula cyst, neoplasm, cord paralysis, glottic web, papillomatosis, stenosis, hemangioma in the hypopharynx.
- Craniofacial anomalies; It can be seen in diseases related to the central nervous system such as Crouzon, Apert, Treacher Collins and Down Syndrome.
- Neuromuscular causes; neonatal anoxia, cerebral palsy, Down Syndrome, myotrophic dystrophy, Arnold Chiari malformation, syringomyelobulbia and vocal cord paralysis can be seen in central and peripheral nervous system diseases.
- Other reasons; congenital myxedema, Hogdkin, Prader Willi Syndrome, endogenous or exogenous obesity, sickle cell anemia and laryngopharyngeal reflux can be counted as causes.
Symptoms of Sleep Apnea
- Snore
- Shortness of breath
- Morning tiredness
- Morning headache
- Desire to sleep during the day
- Attention deficit disorder
- Influence of social life
- Here is the failure
- Increase in traffic accidents
- Heart problems and hypertension
- Gastroesophageal and laryngopharyngeal reflux
- Symptoms such as sexual reluctance should suggest obstructive sleep apnea syndrome.
3 questions that the physician will ask you will help to diagnose sleep apnea:
- Is there any snoring?
- Do you have trouble breathing while sleeping?
- Do you have a desire to nap during the day?
How is sleep apnea diagnosed?
Depending on the number and duration of breathing during sleep, the oxygen level in your blood decreases and the carbon dioxide level rises. This causes you to wake up by stimulating your brain.
Feeling rested when you wake up in the morning depends on your ability to enter the deep phases of your sleep. However, when you wake up frequently due to shortness of breath, you cannot enter these resting phases. Because of this, you may experience morning fatigue, headaches and drowsiness throughout the day. Sleep apnea patients often attribute their discomfort to work and stress during the day. These patients usually apply to the doctor upon the complaint of their spouses.
The following methods are used for diagnosis:
- The process he told about what he experienced and the findings of the examination
- Epworth Sleeping Scale
- Müller Maneuver
- Determination of sleep disorders score (Friedman classification + tonsil volume + body mass index)
- Polysomnographic examination
- Calculation of tongue volume, posterior pharyngeal wall surface, floor of mouth surface by cephalometric analysis and, if necessary, magnetic resonance
After these evaluations, the treatment method of the patient is determined. However, the definitive diagnosis is made by polysomnography, that is, a sleep test. The patient sleeps one night in the sleep laboratory and is monitored throughout the night.
The following parameters are recorded in polysomnography:
- Electroencephalography
- Electrooculography
- Electrocardiography
- Electromyography
- Respiratory effort (recording chest and abdominal movements)
- Airflow (nose and mouth airflow recording)
- Oxygen saturation
- Sleeping position
Sleep apnea caused by obstructive causes is divided into 3 classes according to the frequency of breathlessness:
- 5-15 apnea-hypopnea/hour: Mild
- 16-30 apnea-hypopnea/hour: Moderate
- >31apnea-hypopnea/hour: Severe
Determining the cause and level of obstruction of sleep apnea caused by obstructive causes also determines the surgical intervention method and necessity in the treatment.