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Medical Treatment of Snoring and Sleep Apnea

Treatment of patients with snoring and sleep apnea problems involves different approaches based on the severity of the disease and the location of the blockage of the air passage.

Non-surgical treatment procedures can be investigated under the following titles:

  • General measures;
  • Special treatments;
    • Medications
    • Face masks that provide compressed air (CPAP and BPAP devices)
    • Mouthpieces (oral appliances)

General measures:

The majority of patients with snoring and sleep apnea syndrome are considerably above their normal weight. Especially decreased oxygen intake that accompanies sleep apnea causes weight gain because of the fact that it both decreases calorie consumption by slowing down the metabolism, and decreases activity by causing fatigue all day long. And weight gain increases the severity of the disease by increasing the volume of soft tissue in the neck and tongue base areas. Therefore, weight loss is one of the most important elements of the treatment. In all patients above their normal weight, first whether they have a metabolic and/or hormonal problem that causes weight gain should be investigated. In order to ensure the treatment to give lasting results in patients, who have no additional pathological conditions, weight loss should not be targeted by only dieting, instead, daily activities should be increased and this lifestyle should be adopted as a standard. At this stage, especially patients with severe weight problems should get professional help for regulating their diet.

In patients who use sedative or alcohol, the symptoms of snoring and sleep apnea syndrome progress more severely. Patients should be advised to abstain from alcohol and drugs with sedative and soporific effects.

The fact that the symptoms increase in the supine position (sleeping on the back) is established during sleep tests intended for the determination positions and is also expressed by bed partners of patients. The lateral position (sleeping on a side) is the position recommended to sleep apnea patients. Besides apparatuses and pillows specially produced to get rid of the supine position, there are also certain methods used for this purpose, such as sewing a tennis ball into the back of the pajamas.

Nasal obstruction is an important problem that increases snoring and apnea. Diseases that can be healed with medical treatments such as allergies, sinusitis and vasomotor rhinitis should be investigated in patients who have nasal obstruction. For patients, whose lower nasal turbinate swell due to structural or different reasons when lying, it would be useful to support the head with a pillow, in such a way as to keep it more elevated than the hearth. Internal problems that may cause sleep apnea or accompany it should be identified and treated. Since diseases such as acromegaly and hypothyroidism can be the main causes of apnea, their treatments are important.

Special Treatments

Medications (Medical agents): Today, there are some drugs used in the treatment of patients with snoring and sleep apnea however, treatment with drugs is not a preferred approach due to the side effects observed in their long-term use. In patients with mild sleep apnea who are not eligible for surgical interventions and CPAP devices due to various reasons, certain medications can be used, which are intended to prevent loss of muscle tone by shortening the duration of REM phase during sleep, when a significant muscle relaxation occurs.

In patients with only snoring problem, herbal medications intended for lubrication and decreasing the surface tension are used in the throat, soft palate and tongue base regions as well as on the mucosa, where the vibration occurs, in order to reduce the volume of the created sound during snoring. Such medications sprayed into the mouth before going to bed reduce the friction and the volume of the noise by lubricating the throat region. These medications can easily be used for mild snoring problems but have no significant effects on sleep apnea.

CPAP (Continuous Positive Air Pressure) device: It is the most important alternative to surgery in patients with sleep apnea syndrome.

In sleep apnea patients, the relaxation that occurs in the muscles on the wall of the respiratory tract especially during REM sleep causes collapse of the upper airways and blockage of the air passage, due to the negative pressure that occurs during breathing. The CPAP application is intended for balancing the negative pressure, which causes collapse of the airways, and keeping the air passage open, with the help of positive pressure provided by means of a CPAP device. CPAP should be used in patients who do not accept surgery, who could not adequately benefit from surgery, or who are inoperable. CPAP can also be used temporarily in patients preparing for surgery.

Patient's compliance is the most important factor limiting the usability of CPAP. Since CPAP is a device delivering compressed air through the nose, its use cannot be possible in cases of problems that cause serious obstruction in the nose. Using the device every night on a regular basis may cause edema, dryness and bleeding in the nose, despite the moisturizer used. With the addition of such daily problems caused by CPAP, patient's compliance remains between 60-80%. The necessity of using the device every night makes the adaptation more difficult especially in patients who have an active lifestyle, who frequent travel, and especially who are in younger age groups.

With intent to increase the compliance of patients who have problems with breathing compressed air, BPAP (Bi-level positive airway pressure) devices have been produced, which deliver high compressed air during inhalation and reduce the pressure during exhalation; however, generally significant differences have been found in compliance of patients for treatment with such devices.

Mouthpieces (oral appliances): A great number of mouthpieces in numerous varieties begun to be used in recent years are primarily classified in two types as tongue-retaining devices and lower jaw-retaining devices. Taking the lower jaw forward increases the volume of the throat and tongue, whereas taking the tongue base forward widens the airway in the tongue base, throat, and rear palate areas. 73-100% of patients with mild snoring have been found to benefit from such mouthpieces.

Jaw joint disorders that appear after long-term use, and teeth alignment problems caused by the resultant teeth shifts are the most important problems in addition to early-period side effects such as increased salivation, dry mouth, and adaptation difficulty. Due to these long-term problems, the procedure is recommended to be used by a dentist. The use of mouthpieces is difficult in patients with a high and too arched palatine vault, a long tongue, and large tonsils.