Snoring and Sleep Apnea

What are snoring and sleep apnea?

Snoring is the sound produced when structures of the upper airway — the nose, the back of the nose, the soft palate, the uvula, the tonsils and the base of the tongue — relax and narrow during sleep, and the air passing through the narrowed area makes the soft tissues vibrate. It is very common and is not always a sign of disease on its own.

Obstructive sleep apnea is a condition in which the airway repeatedly closes, partly or completely, during sleep, so that breathing slows down or stops for short periods. After each pause the brain briefly wakes up, sleep is fragmented and blood oxygen levels may drop. Most people are not aware of these awakenings, but they wake up feeling unrefreshed.

Not everyone who snores has sleep apnea, but most people with sleep apnea do snore. The first goal of an assessment is therefore to tell “simple snoring” apart from sleep apnea that needs treatment. Untreated moderate or severe sleep apnea has been associated with high blood pressure, heart rhythm problems, accidents due to daytime sleepiness and reduced quality of life.

Who should be assessed?

Anyone whose snoring disturbs a partner’s or family’s sleep, who has been seen to stop breathing during sleep, or who feels markedly tired during the day can benefit from an ENT examination. Excess weight, a thick neck, nasal blockage, large tonsils, alcohol and sleeping pills, sleeping on the back and older age all increase the risk. In women, sleep apnea may become more common after menopause.

When should you see a doctor?

An assessment is recommended if you have one or more of the following:

• Loud snoring every night or almost every night
• Pauses in breathing, waking up choking or gasping (often noticed by a partner)
• Excessive daytime sleepiness despite enough sleep, dozing off in meetings or while driving
• Morning headaches, dry mouth and waking up unrefreshed
• Getting up frequently at night to urinate
• Poor concentration, forgetfulness, irritability and lower performance at work
• Constant nasal blockage and mouth breathing

Snoring in children

In children, the most common cause of regular snoring is enlarged adenoids and tonsils. Sleeping with the mouth open, pauses in breathing, restless sleep, sweating, bedwetting, attention problems during the day and slow growth may be seen. The approach in children is different from adults; details are on the Pediatric ENT and Tonsils & Adenoids pages.

Examination and diagnosis

The assessment starts with a detailed conversation: how long the snoring has been going on, whether breathing pauses have been noticed, daytime sleepiness, weight changes, alcohol and medication use, and other health conditions. Observations from a partner or someone who shares the home are very valuable.

During the ENT examination the inside of the nose, the septum (the central wall of the nose), the turbinates, the back of the nose, the soft palate, the uvula, the tonsils and the base of the tongue are examined. When needed, a thin endoscope is used to look at the nose and nasopharynx to understand where the narrowing is.

If sleep apnea is suspected, a sleep study (polysomnography) is requested. It records breathing, oxygen levels, sleep stages and body position overnight and shows whether apnea is present and how severe it is. It is usually done in a sleep laboratory, and in some cases with more limited home devices. Treatment decisions are based on this result together with the examination findings.

Treatment options: non-surgical first

Treatment is planned individually according to the cause and severity of the snoring or apnea. For many people the first step is not surgery.

Lifestyle changes are the foundation: losing excess weight, avoiding alcohol and sedatives in the evening, stopping smoking, keeping regular sleep hours and encouraging side sleeping can reduce snoring considerably.

If the nose is blocked, treating allergy and inflammation inside the nose with nasal sprays and saline rinses can open the airway. Clearing the nose alone may not treat apnea, but it can improve sleep quality and make other treatments easier to tolerate.

In moderate and severe sleep apnea, the first option for most patients is a CPAP (positive airway pressure) device. It keeps the airway open through a mask worn during sleep. Settings and follow-up are usually managed together with sleep medicine specialists. An ENT examination is also important to detect nasal problems that make CPAP harder to use.

In mild to moderate sleep apnea or simple snoring, oral appliances that bring the lower jaw forward may be considered for suitable patients together with a dentist.

When is surgery considered?

Surgical options are discussed when the examination shows a clear structural cause contributing to snoring or apnea. The aim of surgery is to widen the narrowed area and improve airflow. Depending on where the narrowing is, different procedures may be planned alone or together:

• Septoplasty: straightening a deviated nasal septum
• Turbinate reduction: reducing enlarged turbinates inside the nose
• Tonsil and/or adenoid surgery: especially with large tonsils and in children
• Procedures on the soft palate and uvula: in selected patients, to tighten lax, redundant tissue

The procedure

These procedures are usually performed under general anesthesia. The duration depends on how many procedures are done; nasal procedures alone often take around an hour, while operations addressing several areas can take longer. Whether you go home the same day or stay one night depends on the procedure, the severity of sleep apnea and your general health. In patients with severe sleep apnea, spending the first night in hospital under observation may be preferred. The exact duration is determined at the examination.

Operations are performed at Medical Park Antalya Hospital. Blood tests and an anesthesia assessment are completed beforehand; any regular medication, especially blood thinners, must be reported to the doctor.

Recovery timeline

Recovery varies with the procedure performed. The timeline below is a general framework:

1. Day 1After nasal procedures, a blocked feeling and mild oozing are common. After throat and palate procedures, pain on swallowing is expected; painkillers are taken regularly and plenty of fluids are encouraged.
2. First weekResting with the head raised, avoiding heavy lifting and not blowing the nose are advised. After palate and tonsil procedures, pain often increases between days 3 and 7; soft, lukewarm or cool foods are preferred.
3. Week 2Most people return to desk work in this period. After throat procedures the risk of bleeding continues, especially between days 5 and 10, so any bleeding from the mouth should be reported to the doctor or emergency department without delay.
4. 1 monthTissue healing is largely complete. A follow-up examination assesses the effect; for patients with sleep apnea, a follow-up sleep study may be planned if needed.

Risks and how they are reduced

Like any surgery, these operations carry risks: bleeding, infection, pain, adhesions inside the nose, temporary changes in voice or swallowing after palate procedures and anesthesia-related risks are the main ones. In addition, even when surgery reduces snoring, it may not remove it completely in every patient, and sleep apnea can become noticeable again over time, especially with weight gain.

To reduce these risks, the site of narrowing and the severity of apnea are carefully assessed before surgery, and surgery is not offered to patients who are not suitable for it. Blood thinners are adjusted under medical supervision, additional precautions are planned with the anesthesia team for patients with severe apnea, and follow-up visits after surgery are kept.