Snoring is not always a sign of disease; if it comes with pauses in breathing during sleep and daytime sleepiness, obstructive sleep apnoea is investigated. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, assesses the airway from the nose to the larynx with an endoscope; whether apnoea is present, and how severe it is, is determined by a sleep study. In moderate and severe apnoea, CPAP is the first-choice treatment; in selected patients with marked anatomical narrowing, operations on the nose, tonsils, palate or base of the tongue are considered, which Op. Dr. Kumbasar also performs.
When is snoring a problem?
Snoring is the sound made when the soft palate, uvula and throat wall, relaxed during sleep, vibrate in a narrowed airway. It is common in adults and on its own is not always a sign of disease. If snoring comes with pauses in breathing during sleep, excessive daytime sleepiness or morning tiredness, the possibility of sleep apnoea should be assessed.
What is sleep apnoea?
Obstructive sleep apnoea is the repeated partial or complete closure of the upper airway during sleep, which reduces or stops breathing. Each episode can lower the oxygen level in the blood and fragment sleep. Untreated moderate or severe apnoea has been linked with high blood pressure, heart rhythm problems and road accidents caused by sleepiness.
What are the symptoms?
- Loud, regular snoring, with pauses in breathing noticed by others
- Waking up with a choking feeling
- Excessive daytime sleepiness and problems with attention and memory
- Morning headache and dry mouth
- Frequently needing to pass urine at night
Excess weight, a thick neck, alcohol and sedatives, sleeping on your back, a blocked nose, large tonsils and a set-back lower jaw all increase the risk.
How is it diagnosed?
At the consultation, Op. Dr. Süleyman Kumbasar assesses the airway from the nose to the larynx: nasal blockages such as a deviated septum and enlarged turbinates, the structure of the soft palate and uvula, the tonsils and the base of the tongue are examined with an endoscope. Whether apnoea is present, and how severe it is, can only be determined by a sleep study: polysomnography in a sleep unit or, in selected patients, a home sleep test. In patients where it is considered necessary, drug-induced sleep endoscopy shows at which level the narrowing occurs.
How are snoring and sleep apnoea treated?
Treatment is planned according to the result of the sleep study and the level of the narrowing:
- Lifestyle changes: weight loss, avoiding alcohol and sedatives in the evening, and positional measures to sleep on your side
- Positive airway pressure (CPAP): the first-choice treatment for moderate and severe apnoea; it keeps the airway open during sleep.
- Oral appliances: these bring the lower jaw forward and widen the airway; they are an option for mild and moderate apnoea and for patients who cannot use CPAP.
- Nasal surgery: improves nasal breathing and can make CPAP easier to use; on its own, however, it does not usually cure sleep apnoea.
- Sleep apnoea surgery: operations on narrowing at the tonsils, soft palate and uvula or base of the tongue; considered in selected patients with marked anatomical narrowing (see below).
In children, the most common cause of snoring and pauses in breathing during sleep is large tonsils and adenoids; details are on the adenoids and tonsils page.
Who is sleep apnoea surgery for?
Op. Dr. Süleyman Kumbasar also performs surgery for sleep apnoea. Surgery is considered for patients whose apnoea has been confirmed by a sleep study and who have marked anatomical narrowing of the airway on examination. It is usually considered for patients who cannot use or do not tolerate CPAP, or to make CPAP easier to use.
The operation is planned according to the level of the narrowing:
- Nose: correction of a deviated septum and enlarged turbinates; improves nasal breathing and can make CPAP easier to use.
- Tonsils and soft palate: removal of large tonsils and widening of the narrowing in the area of the soft palate and uvula.
- Base of the tongue: in selected patients where the narrowing is at this level, procedures targeting this area.
Narrowing often occurs at more than one level; the areas treated are decided on the basis of the examination, endoscopy and sleep study and, if needed, the operations are done in stages. The effect of surgery varies from person to person; to assess the result, the sleep study is repeated a few months later. For patients with excess weight, weight loss remains a key part of treatment.
What precautions should I take if I am sleepy?
People with excessive daytime sleepiness should avoid driving and work with machinery that needs attention until treatment has started and the sleepiness has improved. If sleep apnoea is suspected, sedatives and sleeping pills should not be taken without medical advice.
Frequently asked questions
Does everyone who snores have sleep apnoea?
No. Snoring is common and on its own does not mean sleep apnoea. If there are pauses in breathing, waking up with a choking feeling or excessive daytime sleepiness, a sleep study is recommended.
Can the sleep study be done at home?
In adults with a high suspicion of apnoea and no other serious sleep, heart or lung conditions, a home sleep test can be used. In other cases, polysomnography in a sleep unit is needed.
Does nose surgery stop snoring?
If nasal blockage contributes to snoring, nose surgery can reduce it and make CPAP easier to use. However, because snoring and apnoea are usually caused by narrowing at more than one level, nose surgery alone is not always enough.
Is sleep apnoea surgery suitable for everyone?
No. Surgery is considered for selected patients whose apnoea has been confirmed by a sleep study and who have marked anatomical narrowing on examination. In moderate and severe apnoea the first-choice treatment is CPAP; surgery is usually considered for patients who cannot use CPAP or to make it easier to use. The effect of the operation is assessed with a repeat sleep study a few months later.
Is CPAP used for life?
CPAP works while it is used; if it is stopped, the apnoeas return. After weight loss or surgery, the need for the device can be reassessed with a repeat sleep study.
Does losing weight reduce sleep apnoea?
In people who are overweight, losing weight can reduce the severity of apnoea and ease snoring. For people with sleep apnoea, it is recommended alongside other treatments.
Is it normal for children to snore?
Occasional snoring during a cold is common. In children who snore every night, have pauses in breathing, sleep with their mouth open or have attention problems during the day, the tonsils and adenoids should be assessed.
Related treatments
Sources
- Kapur VK et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 2017.
- Patil SP et al. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure. Journal of Clinical Sleep Medicine, 2019.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.