Snoring and sleep apnea are encompassed within what is known as sleep disordered breathing. What does this mean? It means that both are disorders that in their origin are translated into an obstacle in the passage of the airway, while we are sleeping.
The two diseases are the alpha and the omega of the same disease. What does this mean? Well, the patient initially begins suffering from what is known as snoring or simple snoring, may, as the years go by, go on to have sleep apnea.
Initially, snoring is a pathology that does not lead or entails any type of affectation in the patient’s body, although it is a problem of social type, especially in those people who have to sleep with the affected person.
In the event that this patient does not receive any type of treatment as time goes by, it is going to lead to what is sleep apnea. And sleep apnea is, basically, we remain without breathing for more than 10 seconds in different episodes while we are sleeping.
And this disease if it translates into a general repercussion, such as heart disease, cerebrovascular disease, and even the latest research shows that it may be associated with cancer.
Signs and symptoms of sleep apnea and rhoncopathy
The fundamental symptom of snoring is fundamentally snoring. And snoring is the sound we make during sleep. This snoring is caused by the vibration of air through the anatomical structures within the upper airway. Basically we have all snored at some time and it does not have to be pathological.
The fundamental symptom of apnea, which is what we are interested in, is that the partner sleeping with the apnea patient visualizes the presence of a respiratory pause. That is, the patient stops breathing completely at night and this should always be a cause for alarm.
The second symptom that is common in patients with apnea is the presence of daytime sleepiness. That is, they are patients who fall asleep anywhere and everywhere, and it is even associated with an increased incidence of traffic accidents. And it is another symptom that is quite prevalent.
Another specific and quite sensitive symptom is the presence of headaches. Headaches associated with sleep apnea are a reason for diagnosis.
On the other hand, it should be emphasized that more than 90% of patients who have hypertension do not know that they have hypertension because it is associated with apnea. It is therefore important to know that these patients who have apnea and have hypertension should see a specialist as soon as possible.
Treatment of sleep apnea
The treatment of sleep disordered breathing, is done in a stepwise manner. That is, we will basically talk about what affects a vital commitment, which is the disease of apnea, ie the presence of apnea.
The treatment of apnea is basically carried out on four basic pillars. The first pillar is the use of CPAP. The CPAP is a nocturnal machine that is placed through the nose, through the nostrils, and releases a continuous respiratory pressure that makes the patient sleep all night long without the airways collapsing at night.
The second treatment we have to treat apnea is mandibular advancement devices. Mandibular advancement devices are used in those patients whose airway compromise is caused by the tongue falling backwards or having a rather wide palate. In these cases, a sporting device made by your orthodontist is used to advance the lower jaw and prevent the upper airway from collapsing.
These devices are used to treat moderate to weak apneas. A severe apnea is an apnea that is greater than 30, a moderate apnea is between 5 and 15, and a mild apnea is below 5.
The third pillar of treatment we have is treatment with surgery. Nowadays there are many surgical alternatives to treat apnea. We have from surgeries, and all of them will depend fundamentally on where the collapse of the airway occurs. If the collapse of the airway occurs in the palate, there will be surgeries dedicated to treat the palate, such as pharyngoplasties, of which we were pioneers in this country and pioneers in Europe with the lateral pharyngoplasty.
If the collapse occurs at the base of the tongue, in this case we have several techniques, such as the possibility of performing tongue base surgery, either with the Da Vinci robot, or with the new techniques, such as the hypoglossal implant or hypoglossal pacemaker, which is a neurostimulator that, by stimulating the hypoglossal nerve, produces a collapse, that is, it produces a stimulation of the hypoglossal nerve and the tongue moves forward avoiding its collapse.
And of course there are also multi-locatable techniques, such as combined surgery, in which we perform surgery on a patient, if in this case he has pharyngeal collapse, in this case he has a collapse at the base of the tongue or there may also be localized collapses at the level of the nose.
It is in this case that we also perform tongue surgery and it is a combined surgery, although surgery must always be the last option and in very selected patients.
In order to select the patient to be operated on, we always perform a videosomnoscopy, in which the patient is put to sleep to observe where the airway collapse occurs, and then we know which technique to use.
And the last procedure we are performing -in which we are also pioneers in this country- is myofunctional therapy. What does myofunctional therapy consist of? Well, it consists of strengthening, through rehabilitation, those muscles that show a lack of tone in the process that are responsible for the collapse of the airway.
In this case, we send specific exercises for those muscles that collapse the airway, and the patient has to perform them, either at home or through an application that will soon be on the market, and that is really very useful because it allows the patient to avoid, in some cases surgery, or in those cases that have CPAP and can not tolerate it allows him to tolerate the CPAP and improve his apnea and quality of life.
What is intended with this application -Apnea Bye- is that the patient has more adherence to treatment in the conventional way, i.e. conventional therapy. This application is installed on the cell phone and the patient interacts with the application and allows him to know perfectly well that the doctor is watching how he is doing the exercises. In that case we have managed to improve their adherence.
Is there any way to prevent sleep apnea?
The main way to prevent and avoid these problems is, first of course, with a healthy lifestyle. That is to say, there is a high incidence, we are talking about these sleep disorders affecting almost 10% of the world’s population from the age of 60 onwards. That is to say, it is a disease that is really prevalent worldwide and is a public health problem. All those people who do not lead a healthy life and who put on weight will have a high chance of developing sleep apnea. However, the best way to prevent the onset of sleep apnea is to see an otolaryngologist on a regular basis, as he or she is the only one who has the ability to diagnose and answer the patient’s questions.