Snoring and Sleep Disorders – Sleep Apnea

Snoring is a hoarse or harsh sound produced when air flows through the nose and throat during sleep. It can be occasional and not disturb daily activities or the sleep of others. However, if it is severe and long-lasting, it can significantly impact the quality of life of the snorer and their household members. In some cases, snoring is a symptom indicating an underlying health condition or sleep disorder.

What causes snoring?

Snoring occurs when muscles relax during sleep, allowing soft tissues in the nose and throat to vibrate or flutter when inhaling. The speed of airflow and the anatomy of the structures through which air passes affect the vibration of these soft tissues, especially the soft palate. Various anatomical abnormalities in the airways can affect airflow and cause loud vibration of the soft tissues.

Factors and health conditions associated with the risk of snoring:

• male gender
• age over 50 years
• increased body weight
• alcohol consumption or sedative use before sleep
• chronic nasal congestion
• abnormal airway structures (deviated septum, enlarged soft palate, enlarged lateral pharyngeal walls, large tonsils)
• tongue and jaw abnormalities (macroglossia, micrognathia, retrognathia)
• Pregnancy

When should snoring be treated?

If snoring is occasional, it may be harmless and only cause minor discomfort to the partner. However, in some cases, it significantly impacts the quality of life of the snorer and their household. Signs that indicate a need to see a doctor include:

• breathing stops during sleep – usually noticed by others
• frequent waking or gasping for air during sleep
• chronic sleep deprivation
• difficulty concentrating
• morning headaches
• irritated throat upon waking
• chest pain during the night
• very loud and continuous snoring that disrupts others’ sleep
• in children: difficulty maintaining attention and learning

How is snoring treated?

If snoring is occasional and does not affect quality of life, sometimes small lifestyle changes can reduce it:

• weight loss
• avoiding alcohol and sedatives several hours before sleep
• sleeping on the side or with the upper body elevated on a pillow
• using nasal decongestant drops

If snoring is chronic and significantly impacts the quality of life, it is necessary to check for an underlying health condition. Snoring can be a symptom of a sleep disorder called obstructive sleep apnea syndrome (OSAS). Given the potential consequences and complications of long-term and severe apnea, treatment should be approached seriously, which includes various methods, including surgical options.

What is sleep apnea?

Sleep apnea is a sleep disorder where a person repeatedly stops breathing during sleep, long enough to disrupt sleep, reduce oxygen levels, and increase carbon dioxide levels in the blood.

Reduced oxygen levels in the blood signal the brain to wake the person up to re-establish breathing. Breathing cessation and resumption can occur up to 30 or more times per hour, repeating throughout the night. As a result, the person wakes up tired in the morning, unaware of their frequent brief awakenings during the night.

There are two main types of apnea: obstructive apnea, caused by excessive relaxation of throat muscles during sleep, preventing normal airflow through the airways, and central apnea, caused by a brainstem disorder—the part of the brain that controls breathing. Obstructive apnea is more common than central apnea, and both types have an increased risk in older men.

What are the symptoms of sleep apnea?

The symptoms of sleep apnea are usually first noticed by the person sleeping next to the affected individual. The most common symptom of obstructive apnea is snoring. In addition, choking, repeated breathing cessation, and sudden awakenings can be observed during sleep.

For central apnea, the characteristic symptom is not snoring but an irregular and interrupted breathing pattern during sleep. People with apnea are often unaware of their breathing interruptions and repeated awakenings during the night but frequently exhibit symptoms that impair their quality of life:

• sore throat and dry mouth upon waking
• extreme sleepiness and frequent need for naps during the day
• difficulty concentrating and memory problems
• psychological issues, such as irritability, anxiety, and depression
• morning headaches
• Nocturia (nighttime urination)

Long-term severe sleep apnea can lead to cardiovascular diseases—high blood pressure, coronary artery disease, heart arrhythmias, heart attack, heart failure—and stroke.

Measuring sleep apnea at home using polygraphy

Sleep apnea is measured using polygraphy, a diagnostic test that monitors various physiological parameters during sleep.

During polygraphy, the patient wears special equipment that includes sensors and electrodes placed on specific body parts to record sleep parameters.

When apnea occurs, the sensors will detect interruptions in breathing during sleep. In obstructive apnea, breathing may be completely or partially stopped due to airway blockage. In central apnea, breathing interruptions occur due to a temporary cessation of brain signals controlling breathing.

After polygraphy, experts analyze the collected data to diagnose and assess the severity of apnea and determine an appropriate treatment plan. Depending on the results, treatment may include CPAP (continuous positive airway pressure), lifestyle changes, weight loss, or other therapies to improve sleep quality and reduce apnea symptoms.

How is sleep apnea treated?

Sleep apnea treatment depends on the severity and cause of the sleep disorder. In mild cases, lifestyle changes to reduce contributing factors are recommended. A healthy diet and regular physical activity to reduce body weight, avoiding alcohol and sedatives, and quitting smoking are advised.

If an underlying health condition causes the sleep disorder, treatment focuses on addressing the cause, which may include surgical intervention in cases of structural airway abnormalities. The use of a CPAP machine (Continuous Positive Airway Pressure) and oral appliances such as mandibular splints and tongue retaining devices are also common and effective for mild to moderate apnea cases. The devices have proven effective in cases of mild to moderate apnea.

Surgical and laser treatment of sleep apnea

Surgical and laser approaches to sleep apnea treatment correct or remove structural abnormalities that obstruct airflow through the upper airways, causing sleep disturbances and snoring. The decision on the type of treatment is made by an ENT specialist, considering the severity and nature of the condition, especially if other treatments have not been effective.

• Septoplasty, turbinate reduction, and sinus surgery

Deviated septum, turbinate hypertrophy, and sinus problems (inflammations and polyps) are common causes of nasal breathing difficulties, leading to mouth breathing to intake sufficient air. Constant mouth opening or exclusive mouth breathing during sleep can cause snoring and restless sleep, resulting in sleep deprivation. Improved nasal patency can be achieved through septoplasty, laser or surgical turbinate reduction, and laser endoscopic sinus surgery.

• Tonsillectomy and adenoidectomy

In some people, large tonsils (tonsils) can block the airways, leading to sleep apnea. The solution in such cases is tonsillectomy. Tonsil problems are common in children and do not always require surgical treatment. However, if a parent notices interrupted breathing during a child’s sleep, it is necessary to check for apnea and whether enlarged tonsils are the cause. For children, adenoids (adenoid glands) can also partially block the airway and cause snoring and sleep apnea. If confirmed, adenoidectomy is performed.

• Uvulopalatopharyngoplasty (UPPP) with laserest

Uvulopalatopharyngoplasty is a minimally invasive method for addressing snoring and sleep apnea. The procedure involves laser resection of the uvula and excess soft tissue and reconstructing tissue to enlarge the nasopharynx and oropharynx, widening the pharyngeal entrance. Tonsillectomy and adenoidectomy may be performed during the procedure, but UPPP combined with tonsil removal shows better results in obstructive apnea cases. Laser use ensures greater precision and faster recovery.

• Tongue base reduction with laser

Excess tissue in the tongue base or significantly enlarged tongue—macroglossia—can narrow the airway, causing obstructive apnea. In such cases, laser resection of the central part of the tongue base is indicated to enlarge the hypopharyngeal space. Laser use results in less bleeding and edema, allowing greater precision during the procedure.

Cost of sleep apnea treatment

You can check the current price list for the cost of the procedure. Contact us by phone at +385 1 5005 970 or email info@sinteza.hr for more information.

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