+90 539 716 24 01Sleep apnea treatment using CPAP devices, surgical interventions, oral appliances, and lifestyle changes reduces nighttime breathing interruptions, improves sleep quality, and lowers cardiovascular risks.
Sleep apnea is a serious and chronic sleep disorder characterized by repeated narrowing or complete closure of the upper airway during sleep, resulting in breathing pauses lasting at least 10 seconds. These breathing interruptions (apneas) or significant reductions in airflow (hypopneas) can occur dozens or even hundreds of times throughout the night.
According to international studies (AASM, NIH),sleep apnea is quite common in adults, with prevalence rates estimated at approximately 5–10% in the general population. However, factors such as obesity, aging, and lifestyle habits can increase this rate significantly.
In summary, sleep apnea is a serious sleep disorder marked by repeated pauses in breathing of at least 10 seconds during sleep.
There are two main types of sleep apnea:
Obstructive sleep apnea is the most common type. It occurs when the muscles of the upper airway relax excessively during sleep, causing the airway to narrow or close completely.
The interruption of airflow leads to breathing pauses known as apneas, resulting in a drop in blood oxygen levels and reduced oxygen delivery to vital organs. This condition is usually accompanied by loud snoring and excessive daytime sleepiness, because each apnea episode causes brief awakenings as the body restarts breathing. These repeated awakenings disrupt the continuity of sleep, preventing the person from achieving restorative rest.
Common symptoms of obstructive sleep apnea include:
Central sleep apnea occurs when the brain fails to send adequate and regular signals to the muscles that control breathing. In this case, the airway may remain physically open, but the respiratory muscles do not receive timely instructions from the brain, leading to repeated breathing pauses during sleep. These interruptions disrupt the oxygen–carbon dioxide balance and cause physiological stress throughout the night.
Although obstructive and central sleep apnea arise from different mechanisms, their consequences and symptoms are largely similar. Common symptoms include:
Central sleep apnea can be caused by certain sedative medications, heart failure, stroke, brainstem disorders, and specific neurological conditions. Therefore, identifying the underlying cause and planning appropriate treatment is crucial.
The causes of sleep apnea differ depending on whether it is obstructive or central. Obstructive sleep apnea (OSA) occurs due to the relaxation of the muscles at the back of the throat. These muscles normally support the soft palate, uvula, and tonsils to keep the airway open.
When these muscles relax excessively, the airway gradually narrows and can close completely during breathing. As a result, oxygen levels drop, and the brain sends brief arousal signals to wake the person so the airway can reopen. This cycle can repeat approximately 5–30 times per night, preventing the person from experiencing deep, restorative sleep.
Risk factors for obstructive sleep apnea include being overweight, male gender, having a short or thick neck, narrow airways, use of sedative or sleeping medications, alcohol and tobacco consumption, nasal obstruction for various reasons, and a genetic predisposition to sleep apnea.
Central sleep apnea (CSA),which is less common, occurs when the brain fails to properly send signals to the respiratory muscles. In this type, the person experiences brief pauses in breathing and awakens due to the sensation of breathlessness.
Unlike obstructive sleep apnea, the causes of central sleep apnea can include brain tissue infections, stroke, brainstem abnormalities, heart disease, and the use of narcotic pain medications.
If left untreated, sleep apnea can result in the following conditions:
Sleep apnea is diagnosed by a doctor based on the patient’s symptoms, reports of loud snoring, witnessed apneas, or excessive daytime sleepiness provided by the patient or a family member. The patient is usually admitted to a sleep center for an overnight test called Polysomnography (PSG).
PSG is a comprehensive test that records brain activity, respiratory events, and many other physiological parameters throughout the night. If the results show abnormal levels of sleep-related breathing disturbances, a diagnosis of sleep apnea is confirmed.
The parameters measured, recorded, and evaluated during Polysomnography (PSG) include:
During EEG, electrodes placed on the scalp allow visualization of brain wave activity before and during sleep. In EOG, electrodes are placed 1 cm above the right eye and 1 cm below the left eye. These electrodes record every movement of the eyes away from the center.
Evaluation of brain waves and eye movements helps physicians determine which sleep stage the patient is in. During REM sleep, there is reduced muscle tone, muscle immobility, and rapid eye movements, which are identified through these measurements.
For the diagnosis of obstructive sleep apnea, EMG electrodes are placed on the jaw—one above and one below the jawline. EMG records the electrical activity generated by muscle movements. Some relaxation of muscles during sleep is normal, while abnormal activity can be detected through EMG.
ECG is recorded using 12 electrodes to monitor heart rhythm during sleep.
A belt placed around the abdomen measures abdominal movements during breathing, helping to distinguish between obstructive and central apneas.
A position sensor detects the patient’s sleeping posture, which helps identify positional apnea by showing if apneas occur more frequently while lying down.
Additionally, pulse oximetry measures blood oxygen levels. Normal oxygen saturation ranges from 95% to 100%. This small device is placed on areas with good blood flow, such as the fingertip or earlobe. Using infrared LEDs, it evaluates oxygen content in the blood and detects drops in oxygen saturation during apnea episodes.
Sleep apnea treatment at our hospital in Turkey is approached in three stages:
Lifestyle changes are a fundamental component of sleep apnea treatment according to international guidelines. In patients with excess weight, reducing body weight can significantly decrease the severity of obstructive sleep apnea. Avoiding alcohol and sedative medications helps maintain the tone of the upper airway muscles.
Quitting smoking reduces inflammation in the upper airway, improving airflow. Additionally, sleeping on the side instead of the back, engaging in regular exercise, and maintaining good sleep hygiene can reduce the frequency of apnea episodes and provide significant support to treatment.
Patients diagnosed with sleep apnea on the first night are usually admitted a second night for treatment, especially those with moderate to severe sleep apnea. Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment method. CPAP devices deliver positive air pressure to the patient’s upper airway, keeping it continuously open during sleep and preventing apneas. The device is used via a silicone mask and also helps alleviate snoring.
CPAP provides near-complete relief of symptoms in adult sleep apnea and is considered the most effective therapy. However, some patients may initially experience discomfort while using the device, which can make adherence challenging. Most patients, over time, adapt to the device by adjusting the mask size and straps according to personal comfort. Various types of positive pressure devices are available, and the most suitable device that controls apneas and snoring throughout the night is recommended for each patient.
Uvulopalatopharyngoplasty (UPPP) is a surgical procedure that removes part of the soft palate and the uvula to create a wider airway in the throat. This surgery can also provide a permanent solution for snoring caused by vibrating throat tissues. During UPPP, tonsils and adenoids may also be removed. However, tissue removal is generally considered less effective than CPAP therapy and is not recommended for all patients with obstructive sleep apnea.
Using a technique called radiofrequency ablation, certain tissues in the nasal and throat regions can be reduced in size in selected patients.
In jaw advancement procedures, the lower jaw is repositioned forward relative to the other facial bones. Moving the jaw forward increases the space behind the tongue, widening the airway.
In nerve stimulation therapy, a stimulator is surgically implanted on the hypoglossal nerve, which controls tongue movements. The stimulation helps position the tongue so that it does not block the airway.
In very severe cases, a tracheostomy may be performed to bypass the upper airway obstruction. This procedure is reserved for patients with severe, treatment-resistant obstructive sleep apnea. Surgeons create an opening in the neck and insert a metal or plastic tube to facilitate airflow directly to the lungs, bypassing the obstructed throat.
After treatment, patients experience significant improvements in nighttime sleep. Night sweats, frequent urination, and sleep interruptions are largely resolved. Individuals wake up feeling more refreshed, and daytime sleepiness, poor concentration, forgetfulness, and depressive symptoms are reduced.
Regular treatment also makes weight management easier and improves control of comorbid conditions such as hypertension, diabetes, and hyperlipidemia. Most importantly, the risk of cardiovascular disease and stroke is significantly reduced. Many patients report feeling “reborn” within a few weeks of effective therapy.
There is no single universal cure for sleep apnea; the optimal approach depends on the type of apnea and underlying causes.
According to international guidelines, CPAP (Continuous Positive Airway Pressure) is the most effective and gold-standard treatment for obstructive sleep apnea, keeping the airway open and almost completely eliminating apneic episodes. In some patients, significant weight loss, upper airway surgery, oral appliances, positional therapy, or exercises to strengthen airway muscles may also be effective.
For central sleep apnea, treatment of underlying conditions such as heart failure, neurological disorders, or medication adjustments can control the apnea. Therefore, a definitive solution requires individualized diagnosis, assessment, and appropriate treatment.
Anyone suspected of having sleep apnea should first consult a sleep specialist and undergo a polysomnography (sleep study),as an accurate diagnosis is essential for determining the appropriate treatment.
Once diagnosed, it is critical to follow the treatment recommended by specialists. This may include CPAP therapy, mandibular advancement devices, suitable surgical options, or lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and changing sleep positions.
Proper management of comorbid conditions like hypertension, diabetes, and heart disease also enhances treatment effectiveness.
Yes. Many individuals with obstructive sleep apnea (OSA) can become completely symptom-free with proper treatment. Regular CPAP use significantly reduces apneic episodes and markedly improves sleep quality. For OSA linked to obesity, significant weight loss can completely eliminate apnea in some patients.
Surgical interventions in suitable candidates can also provide lasting results. In central sleep apnea, addressing the underlying condition often leads to substantial improvement. With the right treatment, many patients can return to a normal life.
Common triggers include obesity, alcohol use, sedative medications, smoking, nasal obstruction, genetic predisposition, age, male gender, thyroid disorders, upper airway anatomical narrowing, and heart failure.
Obesity, particularly neck fat, narrows the airway, while alcohol and sedatives reduce throat muscle tone, making airway collapse during sleep more likely. Sleeping on the back can also worsen airway obstruction. Reducing or eliminating these triggers can significantly improve treatment outcomes.
Yes, untreated sleep apnea can lead to life-threatening complications over time. Repeated nighttime oxygen drops and sleep fragmentation significantly increase the risk of hypertension, arrhythmias, coronary artery disease, stroke, and heart failure. Excessive daytime sleepiness also raises the risk of traffic and workplace accidents.
With accurate diagnosis and proper treatment, most of these risks can be controlled, restoring a normal life expectancy.
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Prof. Dr. Elif KüpeliChest Diseases Specialist
Prof. Dr. Elif Küpeli
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