Snoring and Sleep Apnoea Treatment in Izmir

What is snoring and what is sleep apnoea?

Snoring is the sound produced when relaxed structures in a narrowed airway – the soft palate, uvula, tonsils and base of the tongue – vibrate during sleep. A blocked nose, large tonsils, a long or floppy soft palate, excess weight, sleeping on your back and alcohol are the main factors that make snoring worse.

Obstructive sleep apnoea (OSA) means that the upper airway repeatedly narrows or closes completely during sleep. During these pauses the oxygen level in the blood drops and the brain briefly wakes you, usually without you noticing. You may spend the whole night in bed, yet your sleep is fragmented and unrefreshing.

Not everyone who snores has sleep apnoea, but most people with sleep apnoea snore. The first step in treating anyone who comes to us with snoring is therefore to find out whether sleep apnoea lies behind it.

Sleep apnoea symptoms: when should you get checked?

Symptoms of sleep apnoea are often noticed first by a partner or family member. We recommend an assessment if you have:

• Loud, regular snoring
• Pauses in breathing observed by someone else
• Waking up gasping or choking
• Getting up frequently at night to pass urine
• Morning headaches, a dry mouth and waking unrefreshed
• Excessive daytime sleepiness, nodding off in meetings or while driving
• Problems with concentration and memory, or irritability
• High blood pressure that is difficult to control

A thick neck, excess weight, male sex, being post-menopausal and a family history of sleep apnoea are further risk factors.

Why sleep apnoea matters for your health

Simple snoring is mostly a social problem that disturbs a partner's sleep. Sleep apnoea, by contrast, affects the whole body. Repeated drops in oxygen and repeated awakenings throughout the night have been linked with high blood pressure, heart rhythm disorders, cardiovascular disease, stroke and insulin resistance.

Daytime sleepiness reduces performance at work and increases the risk of road and workplace accidents. For people diagnosed with sleep apnoea, treatment is therefore about protecting general health, not only about quieter nights.

Diagnosis: examination, sleep study and sleep endoscopy

At the first consultation we listen to your symptoms, sleep habits and any other medical conditions. We then examine the entire upper airway, from the nose to the larynx:

1. Nasal examination: looking for causes of obstruction such as a deviated septum, enlarged turbinates, nasal valve collapse or polyps.
2. Mouth and throat examination: assessing tonsil size, the shape of the soft palate and uvula, and the position of the tongue base.
3. Endoscopy: a thin endoscope is used to view the back of the nose, the throat and the tongue base while you are awake.

Whether you have sleep apnoea, and how severe it is, is determined by a sleep study (polysomnography). It measures the number of breathing pauses and reductions per hour of sleep – the apnoea-hypopnoea index (AHI). As a rule, 5–15 is considered mild, 15–30 moderate and 30 or more severe sleep apnoea.

When surgery is being considered, drug-induced sleep endoscopy (DISE) adds valuable information. An examination while awake does not always reflect what happens during sleep; DISE shows whether the airway collapses at the level of the nose, palate, tonsils, tongue base or epiglottis, and in what pattern.

If you are travelling from abroad and already have a recent sleep study, please bring the full report; it may save time during your stay.

Non-surgical treatment options

We plan treatment in steps. For many patients the first steps do not involve surgery:

• Lifestyle changes: losing weight, avoiding alcohol and sedatives in the evening, stopping smoking and keeping regular sleep hours.
• Positional therapy: for people who snore or have apnoeas mainly when lying on their back, methods that encourage side sleeping.
• Treating nasal congestion: medical treatment of allergic rhinitis or nasal inflammation if present.
• Oral appliances: custom-made devices, fitted by a dentist, that move the lower jaw slightly forward during sleep to widen the airway. They are an option in mild to moderate sleep apnoea.
• CPAP (continuous positive airway pressure): air pressure delivered through a mask keeps the airway open. It is one of the most effective and standard treatments for moderate to severe sleep apnoea, but it needs to be used every night.

Snoring and sleep apnoea surgery: what are the options?

Surgery is considered when there is a clear anatomical cause of obstruction, when a patient cannot use or tolerate CPAP, or to make CPAP easier to use. Because the site of narrowing differs from person to person, the operation is planned accordingly; sometimes more than one level is treated, either in the same session or in stages.

Nasal surgery

Nasal surgery on its own rarely cures sleep apnoea, but by improving nasal breathing it can reduce snoring and make CPAP more comfortable. If you are also unhappy with the shape of your nose, functional correction can be combined with rhinoplasty in the same operation.

Palate and tonsil surgery

Modern palate surgery favours techniques that reposition the side walls of the throat and preserve muscle, rather than removing large amounts of tissue. In adults with large tonsils, tonsillectomy can be performed together with palate surgery.

Tongue base surgery

If sleep endoscopy shows collapse at the tongue base, procedures to reduce tissue in this area can be planned. Whether they are needed, and to what extent, depends on the examination findings.

Recovery after surgery

Operations are performed under general anaesthesia at İzmir Özel Gazi Hastanesi and take between 30 minutes and 2 hours, depending on their extent. Depending on the procedure and the severity of your apnoea, you go home the same day or after one night in hospital; for patients with moderate to severe sleep apnoea we usually recommend one night of observation.

• After nasal surgery the nose feels blocked during the first week; most patients return to work within about a week.
• After palate or tonsil surgery pain on swallowing usually lasts 7–14 days; a soft diet and plenty of fluids are recommended during this time.
• The result is assessed once the tissues have healed. For patients with sleep apnoea we usually plan a follow-up sleep study a few months later.

After the first in-person check-up, patients from other cities or abroad can continue follow-up by video call, with care provided in English.

Risks and realistic expectations

As with any surgery, these operations carry risks. They include bleeding (particularly within the first two weeks after palate or tonsil surgery), infection, temporary changes in taste, a feeling of something in the throat, rarely fluid coming back through the nose when drinking, and changes in voice quality.

The success of snoring and sleep apnoea surgery depends on where the narrowing is, how severe the apnoea is, and personal factors such as weight. Surgery can reduce snoring and the severity of apnoea, but it does not eliminate them in every patient, and symptoms may return with weight gain. We therefore make the decision together, based on your examination, sleep study and, where needed, sleep endoscopy, and discuss all risks in detail as part of the written consent process.

Snoring in children

In children, the most common cause of snoring and sleep apnoea is enlarged adenoids and tonsils. Children who snore regularly, sleep with their mouth open, sleep restlessly or have attention problems during the day should be seen by an ENT specialist. Treatment in children differs from adults and is planned according to age and examination findings.