Sleeping disorders
Memorial Hospital Neurology Department Assoc. Dr. Turan Altay, gave information about sleep disorders.
Since an adult sleeps on average 7-8 hours a day, one third of our life spends asleep. As can be understood from this, sleep is an indispensable need for the organism such as food, water, breathing and has very important functions. It is not possible to live without sleep. Therefore, having an adequate amount of quality sleep is an indispensable necessity for both maintaining our health and performing our functions during the day. However, unfortunately, attention has not been paid until recently; It is thought that sleep is a passive process that starts as a result of fatigue of the body due to the daily activities and energy consumed and the elimination of external stimuli such as light and noise at night. With the development of technology, the increase in the number of sleep laboratories and the spread of sleep-related research, important information has been gained about the biological mechanisms, structure, functions, diseases and treatment of sleep in the last 50 years, and our knowledge of this important function of the brain, which has so far remained “in the dark her days are increasing rapidly. Today, 85 separate sleep disorders or sleep-related diseases have been identified.
Unfortunately, we still need a significant proportion of physicians nor need what people in other countries, Turkey has sufficient information about sleep related disorders. However, some of these disorders not only affect the quality and duration of our sleep negatively but also reduce our intra-day performance, and more importantly, they cause very important complications that are life-threatening. Since patients are not aware of what is happening during sleep, their relatives' observations are also very important. Therefore, the problems related to sleep should not be neglected, they should be evaluated by the experts in the related centers (sleep laboratories), and if necessary, all night sleep examinations should be performed and their treatment should be provided.
In recent years, the number of physicians and sleep laboratories interested in sleep has been increasing rapidly. In our country, now more than 100 sleep centers (laboratories), which are located in university hospitals, state hospitals and private health institutions, are established or are in the process of being established.
Here are a few important basic information about sleep, and some examples of sleep disorders that may cause the most common or important health problems.
Is sleep really a passive and uniform process?
Studies on sleep are not a passive process that begins as a result of fatigue as expected, but the release of a number of sleep-inducing biochemical substances and hormones in which the body's biological clock (rhythm) plays a regulatory role, and the special centers in the brain become active in a sequence and order. active function.
The order and distribution (rhythm) of some body functions in the organism (meanwhile sleep) within 24 hours are regulated by our biological clock. This is dependent on the hours at which the substances or hormones that induce sleep-inducing or reverse alertness are released. One of the most important factors guiding our biological clock is “light.. The light perceived by our eyes (retina layer) reaches the relevant center in the brain, which sends stimulatory or preventive messages to the centers that secrete substances and hormones that provide sleep-inducing or wakefulness (in other words, sleep-inducing) depending on the amount of light (day-night). Therefore, there are periods in which we tend to sleep within 24 hours, or we cannot easily sleep if we wish: for example, a person who is not sleeping all night and is very tired cannot easily fall asleep between the morning and noon, or even appear surprisingly lively and talkative. On the other hand, melatonin, which is one of the sleeping hormones, is secreted more after the evening hours and makes it easier for us to sleep at night.
One of the factors that regulate our biological rhythm in terms of sleep is body temperature. During periods of low body temperature, we are more prone to sleep. Body temperature drops twice a day. The most significant of these decreases is in the morning hours and the other one is around 14.00 in the afternoon (the deprivation that we put in the afternoon and usually associated with lunch is actually due to the decrease in body temperature, so that “noon sleep“ is possible).
What are other proofs that sleep is not a passive and uniform process?
Sleep is not a process of constant and uniform sleep (level of consciousness). There are different periods of repetition and repetition of sleep in a certain order. Sleep is mainly divided into REM (Rapid Eye Movements) with rapid eye movements and NREM (non-REM) with slow or disappearing eye movements. The NREM period itself is divided into four parts, depending on the depth of sleep.
From wakefulness to sleep, the NREM I period is passed. The muscles begin to relax. This period is very short, a little deeper and brain waves are slower, and also some sleep-specific wave patterns in the brain electrode NREM II period begins. After a while, sleep deepens, brain activity (brain waves) slows down, pulse and respiratory rate decreases, arterial pressure and body temperature decreases, muscles relax well. Therefore NREM III and IV are also called deep (slow) sleep). Deep sleep is the most relaxing period of sleep. The first REM period is 90 minutes after falling asleep. REM sleep is the period in which most of the dreams occur, and both the central nervous system and other systems and metabolism are active, sometimes even more active, near alertness. The speed of the brain waves approaches the alertness, the pulse and respiration rate increase from time to time, the metabolism of the brain accelerates. Eyes move quickly. Interestingly, during this period, all muscles except the eye and respiratory muscles completely lost their tension and we were in a physiological “paralysis ((otherwise we would move during the dream, in other words we would“ play üy our dreams!). What happens to everyone from time to time, and when we wake up, we cannot make a sound, we cannot move any place, the so-called “nightmare arasında among the people; It represents the period during which REM awakens and muscle tone has not yet returned to normal.
The REM cycle completes the first cycle of sleep. The NREM is then switched back and a normal, undivided night's sleep consists of 4-6 similar cycles.
The sleep periods mentioned must comply with this order and to a certain extent. Furthermore, while the duration of deep sleep takes up more space to ensure rest in the first half of sleep (first cycles), REM periods are prolonged in the second half of sleep (especially in the morning). As you can see, sleep has an “architectural” structure. A sleep that has been divided, superficialized, the rates of sleep periods deteriorated, in short its architecture damaged, will not perform its function no matter how long it sleeps, the person will get out of bed without resting.
What are the functions of sleep?
Studies include resting the body's sleep and preparing it for the next day, saving energy (accumulating energy), growth (growth hormone secreted most during sleep and growth in children), cell renewal, repair of the organism, memory, programming of genetic memory for learning specific characteristics information-making it permanent, and especially in some living things to adapt to the environment and protection from hazards (eg hibernation). Sleep also has an effect on our immune system; we have all experienced that we are more easily caught by poor quality or inadequate sleep.
What is the duration of uyku adequate sleep??
Adequate sleep time varies from person to person and is essentially a genetic (innate) trait. In adult humans, this period ranges from 4 to 11 hours; everyone knows that the 7-8 hour period is an average value. However, considering the information we have given above about the structure of sleep, we should state that the quality of sleep is as important as the duration of sleep, even more than that. Many people are able to adapt to their functions by reducing their usual sleep time. However, various sleep disorders / diseases, adverse conditions in the sleeping environment, drugs used for various reasons and so on. many factors may interfere with the quality of sleep by disrupting the rate of sleep periods. In such cases, one can sleep as much as he wants, does not feel rested and has difficulty in performing his / her functions during the day, cannot concentrate, or even sleep at every opportunity.
We can also say: The amount of sleep (time) that a person feels rested and vigorous when he wakes up in the morning and which he can perform during the day without lack of concentration and fatigue, is sufficient for him.
Does “Sleep Disorder” mean only insomnia?
Insomnia is the complaint that one is aware of and most disturbing about sleep. Therefore, the majority of patients admitted to physicians, who complain of insomnia. On the other hand, excessive sleepiness (tired up and sleepiness during the day) is neglected by most patients and their relatives and even normal. It is connected to the hustle and bustle of daily life, stress, difficulties of business life, traffic, age or laziness of the person. However, because of the work or traffic accidents they cause, and other life-threatening illnesses, physicians dealing with sleep medicine give more attention and importance, almost always need sleep examination and require treatment without delay. would. Therefore, although insomnia causes more discomfort to the person, it constitutes only a small portion of the more than 80 sleep disorders defined and the more vital or urgent disorders can be omitted in terms of its consequences.
What is insomnia and in what situations does it occur?
Insomnia is the most common and common complaint related to sleep in the world and especially in developed countries. Studies in different countries indicate an average incidence of about 35% in the community for insomnia of any type, and 10-15% of these include moderate or severe cases. Although it is small and narrower, studies in our country give similar results. The incidence is higher in women and increases with age.
Insomnia is an important disorder that causes fatigue, exhaustion, lack of cognitive functions, difficulty in concentration, excessive nervousness and some other psychological symptoms due to decreased and / or poor quality night sleep. Insomni has negative effects on the social and professional life of the person with these features and may even cause more serious events such as work and traffic accidents. Patients may describe their complaints as unsatisfactory or unresponsive sleep, difficulty falling asleep, difficulty maintaining sleep (multiple short or long-term awakenings), early waking or various combinations of these.
In terms of duration, insomnias can be divided into three parts: acute or transient if the duration of insomnia is not longer than one week, subacute or short term if it is between one week and three months, and chronic insomnia if more than three months. Acute and subacute insomnias represent extremely common forms of disease that almost everyone can encounter at least once in a period of their life. There is often a transient incompatibility and reaction to identifiable environmental conditions or psychological stressor factors that are temporally related to insomnia. Complaints diminish as the stressor factor adapts and is generally not a significant problem.
However, available data suggest that insomnia is usually a chronic condition; 80% of patients with severe insomnia indicate that the onset of symptoms is more than one year ago, and 30-80% of patients with moderate or severe insomnia do not show significant improvement over time. This shows that although chronic insomnia is very common and presents serious problems, it is not taken seriously by both patients and physicians, it is insufficient to determine the type of insomnia and the underlying causes, and most of the time, proper and effective treatment is not provided.
There are many causes of insomnia. It was stated above that the complaints of insomnia increased with advancing age. Indeed, in old age, the total duration of night's sleep is reduced, the time to fall asleep is prolonged, wakes up earlier, deep sleep decreases, and the number of nighttime wakens increases. Sleep, like infancy or childhood, becomes polyphatic; in other words, sleepiness begins during the day. In addition to these “physiological” changes brought about by normal aging, the quality of sleep can be deteriorated by the effects of chronic diseases and various medications that are frequently used in the elderly. Sleep disorder is more pronounced in elderly people with dementia and creates a major problem for both patients and their relatives.
The most common cause of insomnia is psychiatric disorders. Affective disorders, especially depression, psychoses, anxiety disorders, panic disorders, abuse of alcohol and other substances frequently cause insomnia.
Can insomnia be learned?
The most common type of insomnia after psychiatric disorders is psychophysiological (learned) insomnia. The patient, who did not have a significant sleep problem before, usually becomes unable to sleep at night after an event that causes tension. If this persists for a long time, even if the stress factor that initially caused the insomnia has disappeared or has lost its importance, the anxiety of not being able to sleep and the excessive effort the patient makes to sleep becomes the cause of the insomnia itself. So much so that as the bedtime approaches, the tension of the patient increases, his mind locks whether he can sleep that night, and when he goes to bed he wakes up every minute of tension and distress; now the patient is fighting to sleep in his bed. As the nights go on like this, the patient becomes hostile to the sleeping environment and bed. Thus, this vicious circle becomes chronic, learned insomnia.
What other causes of insomnia?
Insomnia due to improper sleep hygiene is responsible for habits that prevent quality sleep. Failure to comply with the appropriate hours and rules for sleeping, intertwining rest and working hours, drinking excessive food before drinking or drinking stimulatory drinks such as tea and coffee, using the bed for non-sleep (watching TV, reading books, writing, etc.), insomnia is an example of faulty habits that create. By giving up these habits, sleep can easily regain its order in a short time.
Sleep perception disorder is a term used in cases where the patient's subjective insomnia complaint is incompatible with the objective findings in the sleep examination. The patient claims that he did not sleep at all, or slept very little, even though he slept normally at night; in other words, the estimate of the patient's sleep time does not match the objective sleep time. Investigations have shown that these patients do not differ significantly from normal in terms of falling asleep time, total sleep time, and sleep pattern. In some cases, even if a few wakefuls occur during the night and sleep is partially divided, patients may perceive these wakings as too long. The cause of this rare disorder in young adults and especially in women is not well known.
Idiopathic (unknown) insomnia is an objective, rare sleep disorder that can sometimes be familial, starts in childhood and generally lasts for life, sleep time can go down to 4-5 hours every night, sleep is prolonged and wakefulness increases. Although the cause is unknown, based on all these features, various pathophysiological processes originating from the central nervous system are held responsible.
What is Restless Legs Syndrome?
Restless Legs Syndrome (RLS) is a common cause of insomnia which is quite common but can be easily missed if sufficient information is not obtained from the patient. Patients complain of sensations in their legs, resting and especially when they lie down, which are well-defined, which are not well defined, but which create an extremely uncomfortable and irresistible need to move. They try to express this feeling, which they cannot localize well, in different terms such as burning, withdrawal, tingling, prickling, pain, ache, numbness, electrification from the deep. RLS is a condition that makes it extremely difficult to fall asleep. It is noteworthy that patients move their legs in bed continuously and irregularly, rubbing, shaking violently, and even walking out of bed in order to be able to rest and relax. In fact, massage and movement greatly relieve patients. When the detailed history is taken, it can be learned that patients need to move their legs continuously during the day, it is not possible to sit in the same position for a long time and therefore they have difficulty in long journeys. Since the diagnosis is mainly based on history, it is important to recognize the disease and to ask appropriate questions; This is because patients cannot express their discomfort well and may not even consider insomnia.
There is usually a genetic (familial) feature. However, RLS may also occur due to other conditions: pregnancy, iron deficiency anemia, folate deficiency, peripheral neuropathy, diabetes, kidney diseases (uremia and dialysis patients), rheumatoid arthritis, discopathy, spinal cord lesions, may cause. RLS symptoms may improve when these are detected and cause-directed treatment is performed. It is thought that a substance (dopamine) related disorder in the nervous system is responsible for cases of unknown origin (genetic characteristics).
Periodic leg and arm movements (UPBH) during sleep are often associated with RLS. The pathophysiological mechanisms of both diseases are considered to be the same. UPBH is a movement that occurs at intervals of 5-90 seconds (approximately 15-40 seconds) during NREM sleep, and may rarely involve arms and trunk. It may sometimes have a bouncing character, but it is usually in contractions that can last up to 5 seconds. Typically, the toe is bent backwards, with flexion of the ankle, knee and hip. In fact, although it leads to excessive daytime sleepiness and the complaints of insomnia are not in the foreground, it can also be manifested by the complaint of insomnia by causing wakings in situations where movements in sleep are frequent and severe. Therefore, if one of these two diseases is suspected, the other should be investigated carefully.
What is the treatment of insomnia?
The main principle is to plan for the etiological factor. Some patients benefit significantly from the regulation of sleep hygiene (habits) only. Regardless of the cause, all insomnia patients should be informed about some rules.
What should I pay attention to in the treatment of insomnia?
If the complaint of insomnia is of psychiatric origin, treatment should be applied according to the cause. Sleep medications (hypnotics) may be used for temporary or short-term insomnia for a period not exceeding one week. In principle, there is no indication for hypnotic use in chronic imsomnia! If necessary, they can be administered under the supervision of a physician for the shortest time possible and not to exceed 4-6 weeks in order to break the vicious circle and the tension that the patient enters. Tolerance develops over time (increasing the dose required for the same effect) over time, and insomnia returns more severely when discontinued.
What does hypersomnia mean?
Hypersomnia means meaningful sleep and the need to sleep in inappropriate environments and times. Many sleep disorders cause this symptom; but here you will be informed about the most important ones.
Narcolepsy-Cataplexy Syndrome: During the day, an average of 2-3 hours intervals can not be prevented sleep attacks occur, other than these attacks, the person may feel drowsy or tired, even in the wake of micro-sleep, we call the second period of sleep can be mixed, more adolescence and young adulthood is a disease. In addition to drowsiness, cataplexy is one of the important symptoms that may cause muscles to collapse due to sudden relaxation and cause them to remain inactive for a while. In lighter forms of the cataplex, only the neck or jaw muscles lose tone (relaxation). In this case, only the patient's head falls forward or backward, or his jaw hangs. Cataplexy is often triggered by sudden emotional changes (sadness, fear, laughter, crying). Another symptom is sleep paralysis (sleep paralysis), characterized by unilateral or diffuse, short-term, sudden loss of strength in the limbs and trunk while falling asleep or awakening. Visual hallucinations usually occur when falling asleep or awakening.
What is snoring?
Snoring is the sound produced by the vibration of the soft tissues around it while the air passes through a narrow space during breathing. As the stenosis increases, snoring will naturally intensify. Contrary to popular belief, snoring stenosis is not only associated with a pathology in the nose, but is usually associated with narrowing of the upper respiratory tract behind the tongue and around the pharynx.
Why do men snore more often than women?
This is because fat is concentrated mainly in the hip area in women and around the neck and abdomen in men. Especially in overweight men, this increases intra-chest pressure by the diaphragm pressure of the abdominal mass when lying down (especially in the supine position); slippage of the tongue back and sleep with the soft tissues and muscles around the pharynx loosen the conditions that will give rise to snoring. Differences in muscle structure of women are thought to reduce snoring. After menopause, as a result of hormonal changes, women's muscle structure begins to resemble that of men, after a certain age, their snoring rate approaches or even equals men.
Is snoring a disease?
It is considered that continuous snoring, that is, not accompanied by respiratory disorder, does not cause any harm to the patient if it does not cause sleep disruption. We call this type of snoring simple snoring. This involves disturbing the environment, especially the spouse, and disrupting sleep due to noise. People who have simple snoring already apply to the physician because of the insistence of their relatives.
Simple snoring is initially positional; that occurs in the supine position. As you gain weight, snoring occurs in any position due to increased stenosis in the upper respiratory tract.
However, recent research shows that even if there are no breathing disorders (eg breathing stops) during sleep, simple snoring can cause fatigue in the body due to the power spent on breathing during the night, and consequently daytime fatigue and sleepiness.
Should snoring be treated?
If snoring does not cause respiratory disturbances during sleep, it can be alleviated or even eliminated by some simple measures.
Simple measures such as losing weight, not drinking alcohol before sleeping hours, preferring light meals in the evening, sleeping with high pillows, sticking nose bands are generally very useful. Another method is to lie on your back by tying a ball the size of a tennis ball. Since snoring occurs more often in the supine position, this method, which seems strange at first sight, is often effective. Every time a person comes to sleep in a supine position, he will be uncomfortable with the ball, so that he may turn sideways and sleep without snoring without even realizing it.
In cases of severe snoring where these methods are not effective, other treatment options are used. One of them is the application of an intraoral device which acts by suppressing the tongue (preventing it from going backwards) and widening the oral cavity by pushing the jaw forward. These instruments are made by the relevant dentists by taking appropriate measurements to the mouth of each patient. The snoring person lies down and sleeps by wearing this dental prosthesis-like instrument.
Another treatment option is snoring-relieving surgery. Recently, these surgeries have been performed even with simple and local anesthesia especially by using laser instruments. However, these surgeries should not be performed randomly. First of all, it should be determined whether the discomfort consists of simple snoring or not, in other words, the correct indication should be placed. The best way to do this is to evaluate the snoring person by a sleep laboratory, to perform a sleep examination if deemed necessary and to refer them to the relevant ENT physician only if it is found that there is no serious respiratory problem related to sleep.
What is Obstructive Sleep-Apnea Syndrome (OSAS)?
“Apnea” means breathing stops. OSAS, in the upper respiratory tract (especially around the back of the tongue and the pharynx, such as snoring) in cases of advanced size, soft tissue relaxation with the onset of sleep and breathing due to negative pressure created during breathing, so that the airway through the mouth and nose at least 10 seconds is a serious disease characterized by prolonged inhibition. Breathing stops frequently repeat (sometimes hundreds of times) throughout the night, each lasting an average of 20-40 seconds, in severe cases this may be longer than two minutes! During breathing stops the amount of oxygen in the blood is significantly reduced, so that the heart, brain and other organs cannot reach enough oxygen.
Who is seen in OSAS?
The incidence of OSAS in the population was determined to be at least 4% in men and 2% in women as a result of sleep laboratory studies. As with snoring, the frequency increases with increasing age; This rate reaches 28% in men after 60 years of age. After menopause, this rate approaches 20% in women.
OSAS was generally known as the disease of short-stoned, fat-bellied, short-necked men. Along with obesity, anatomic features and allergic congestions such as large tongue, high and curved hard palate, drooping soft palate, long and curved small tongue, small jaw structure, large tonsils, adenoid hyperplasia known as nasal flesh among people, which cause narrowing of upper airways prepare the ground for the disease. However, the mechanism of occurrence of the disease is quite complicated and it is not always possible to explain only these factors. As a matter of fact, OSAS can be seen in obese people who do not have breathing stops during sleep and in people who are young, weak and who do not have a significant structural disorder (even in children).
How can I recognize the disease?
As respiratory problems occur during sleep, the patient himself is not aware of the situation. Spouse or relatives of the patient almost always notice the situation. The most prominent finding is snoring. Almost all patients snore very severely. When the patient snores regularly, his voice suddenly stops. The relatives of the patient become aware of this situation first. Abdominal and chest movements continue as the muscle under the lungs, called diaphragm, continues to contract during breathing stops. Therefore, it is difficult for a person watching from outside to understand that the air intake has stopped at the first moment. In order to overcome the above congestion, the diaphragm becomes more and more constricted, and the amplitude of abdominal and chest movements increases, and after this point the congestion is eaten with this increased breathing effort, the patient makes a more severe sound (almost roars) than before. There is a brief wakefulness at this time, but the patient does not remember it because it remains at the electrophysiological level (often only to be understood from records from the brain in the sleep laboratory). When sleep continues, the event resumes after a short time in the same way (as the stenosis becomes apparent); episodes in the form of a vicious cycle of sleep-breathing arrest-resumption-short wakefulness-falling asleep during the night, repeated hundreds of times. The prolonged breathing stops sometimes make the patient's relatives anxious and force him to awaken. Sometimes the patient may wake up with a choking sensation.
Does each snore have OSAS?
No. Almost all of those who have stopped breathing asleep snores, but that doesn't mean that every snore has OSAS! The definite diagnosis is made only by the evaluation of the specialist physicians and the sleep examination in the sleep laboratory.
What is the most important symptom of the disease that can be noticed by the patient?
The first and most obvious symptom of the disease is excessive daytime sleepiness. The patient has a poor quality sleep due to frequent breathing stops throughout the night, divided by numerous brief wakefulness and unable to deepen, thus not relaxing. Since the patient does not remember his wakefulness and is unaware of what is happening at night, he thinks he has slept without holes. But this is not the case.
No matter how long the patient sleeps, he cannot get up rested in the morning. During the day, he is always reluctant, tired, sluggish and has lost his energy. In the beginning, when you are at rest (sitting without doing business, at meetings, reading newspapers or watching TV, etc.), especially in the afternoons and evenings, sleep attacks that you have had difficulty in struggling, and even when you have the opportunity to sleep. These shortcuts take several minutes at first, and may take 1-2 hours when the environment is suitable or over the weekend; however, it is not relaxing regardless of its duration, even when waking up the patient feels dizzy. As the disease progresses, sleepiness increases to such an extent that the patient cannot prevent himself from falling asleep even in unfavorable environments (such as in public places such as cinema-theater, job interview or hospitality, even talking on the phone and most importantly behind the wheel).
Major work and traffic accidents can occur! Since the disease is not well known to most of the society and even to many physicians, the referral and diagnosis is delayed. Most patients and their immediate surroundings are familiar with this long-standing condition, almost normal, and accept it as its personal trait. A significant number of patients are accidentally treated for depression due to their weak and unwilling appearance. Moreover, people often do not admit that they are too sleepy; they fear that it will be perceived as laziness and tend to deny it. They try to explain their situation due to the difficulties of living conditions, extreme stress, and exhausting days. However, it is not correct to attribute this continuous situation to the reasons mentioned and it delays the diagnosis of an important disease that will lead to very important problems.
Are there any other findings I might suspect in OSAS, when should I go to a sleep lab?
As noted above, excessive daytime sleepiness with severe snoring is the most remarkable and important finding. In addition, if some or all of the following symptoms are present, it is time to go to a sleep disorders center without losing a minute!
Morning waking up with severe dry mouth
Morning headaches
More frustrated and more intolerant than before
Anxiety
Difficulty in maintaining concentration
Decrease in school performance in children
Forgetfulness
Don't go to the toilet one or more times at night
Night sweats, which became more pronounced and could not be explained by climatic conditions
Decreased sexual desire, impotence.
What are the most important complications of the disease?
Above all, excessive drowsiness reduces school or work efficiency, leads to significant labor loss, leads to significant occupational accidents due to carelessness and lack of concentration, and most importantly to traffic accidents. Research in the USA reveals that OSAS is responsible for almost half of the accidents caused by long-distance and heavy vehicle drivers. Based on this information, it will not be wrong to think that a major part of the traffic accidents in our country lies under this disease!
Depending on the duration of breathing stops, significant decreases occur in the partial oxygen pressure in the blood, which should normally be 97-98% in the blood, and can be even below 50% in severe cases. This means that less oxygen is delivered to vital organs (such as the heart-brain). As a result, the risk of myocardial infarction and especially stroke at night increases. In addition, irregularities in heart rate (even short-term stops in advanced cases), during or after sleep breathing stops, significant changes in pulse rate and blood pressure (elevations), which lead to permanent disturbances over the years. Indeed, the rate of myocardial infarction, stroke and hypertension is higher in patients with OSAS than in other people of the same age group. Recent research shows the presence of OSAS in 30-50% of essential hypertension cases!
In short, the role of this disease in the emergence of vital diseases related to the cardiovascular system and the brain is very important; therefore the diagnosis of OSAS, if any, should not be delayed and must be treated!
How is the diagnosis reached?
The indispensable way for a definitive diagnosis is to have an all-night sleep examination in the patient's sleep laboratory when the complaints are evaluated and suspected of the presence of OSAS. To do this, the patient comes to the laboratory on the night of the appointment, fills in some questionnaires for more detailed information and is prepared for sleep registration. In order to fully monitor and understand what is happening during sleep, many parameters must be recorded during the night. Electroencephalography, eye movements, as well as records of muscle activity from the chin and legs to determine when the patient is awake, when asleep, during which periods of sleep, and their rates during the night; In order to determine the respiratory events, many parameters such as mouth-nose breathing, chest and abdomen breathing movements, blood partial oxygen pressure, heart beat are recorded with electrodes, belts and other sensors placed on the head and body. Although patients initially fear that they will not be able to sleep in this way, they easily adapt to the situation and sleep comfortably. Since the electrodes are very well fixed with special adhesives, the patient can move freely in the bed and lie in the desired direction. This is only a record of data from the patient; the patient does not suffer, nor is he given any medication. However, on the day of the examination, especially in the afternoon, it is requested not to take any stimulant drinks (tea-coffee-cola), alcohol, excessive smoking, any stimulant or sedative medication in order to avoid disturbing the patient's natural sleep. The next morning he always wakes up at the time he wakes up. Short-term tests (20 minutes) can also be performed at two-hour intervals to check whether or not he has fallen asleep during the day in order to objectively reveal excessive daytime sleepiness.
Once the diagnosis is confirmed, a second sleep examination is usually required the next night to adjust the “CPAP” instrument, which will be described in more detail in the treatment section.
How is the degree of the disease determined?
As a result of the sleep examination, the number, duration and level of oxygen depletion (lowest oxygen level) of breathing stops during sleep is determined. In sleep-apnea syndrome, not only breathing stops; superficialities in breathing (hypopnea) also occur, which leads to a reduction in oxygen. To determine the degree of disease, the total number of respiratory disorders in sleep (apnea and hypopneas) is found and the number of respiratory disorders per hour during sleep is calculated. This is called the “apnea-hypopnea index.. If the number of apnea-hypopnea (index) per hour is between 5-15, the disease is mild, between 15-30 is moderate, and more than 30 is advanced.
What does AP CPAP treatment demek mean?
The CPAP device (Continuous Positive Air Pressure) consists of a special nasal mask, a hose that supplies air to this mask, and a type of air compressor that produces continuous positive pressure. When they were first produced, when they were quite large and noisy, they were now able to fit into a bag - comfortable enough to find space on the nightstand and work very quietly. Thanks to their small size, patients can easily take their instruments with them when going on holiday. The size of the masks has also diminished and the nose has been covered.
The CPAP device acts by creating a continuous positive pressure in the mouth, preventing the tissues from loosening and narrowing the airway. Naturally, the air pressure required for this is different in each patient. After diagnosis, the pressure is gradually increased during sleep, starting from the lowest value during the shooting with this device on the second night; at the end, there is a value that eliminates breathing irregularities and snoring at every stage of sleep and at any position. After that, the patient uses his or her instrument with this pressure at night. With the relief of breathing and the relief of snoring, the patient begins to sleep comfortably and uninterruptedly. Patients often notice a positive change in their sleep after the trial night; for the first time in a long time, they say that they sleep so well and get up rested. Within a few days, sleep becomes completely normal, and all the symptoms previously caused by the disease disappear in a short time. This positive development further facilitates patient compliance. 70% of OSAS patients comply with this treatment and use their instruments regularly.
CPAP treatment is the most effective and definitive treatment for all OSAS cases at any level. However, this effect is valid as long as the instrument is used regularly. If the patient sleeps without wearing the device, snoring and breathing disorders continue as before.
Are there other treatment options?
Of course, the simple measures mentioned in the snoring section are important in terms of comforting the patient and at least not aggravating his condition; however, none of them is sufficient.
Diet and weight loss are undoubtedly necessary, but patients with OSAS are unable to lose weight easily due to irregularities in their metabolism and hormonal balance, or gain excess weight back soon. After starting to use the CPAP device, it is observed that it is easier to lose weight. This may be due both to the improvement of metabolic balances and to a more active life due to decreased sleepiness. As a result, the upper airway stenosis decreases with attenuation, so that over time it is possible to use the CPAP device at lower pressures and thus better adapt to the treatment.
In some mild cases, oral means may be useful for some time.
UPPP surgery (uvulo-palato-pharyngo-plasty) is the most common surgical procedure. This surgery is more extensive and serious than those performed in simple snoring. It is intended to reduce the excess of soft tissues in the upper airway and to stretch the tissues, especially the small tongue and soft palate. It was understood that this method, which was previously very successful, did not always give definite results, and that years later, snoring and respiratory disorders could occur again. An important risk of the surgery is the disappearance of a stimulating symptom such as snoring and that the patient's breathing stops may continue silently even though the patient is thought to have recovered. New surgical techniques (such as suspending the tongue, radiofrequency techniques on the root of the tongue, jaw surgeries, etc.) are being tried and applied successfully.
It is best to apply surgical options to save time for young patients with an apnea-hypopnea index of less than 30, who cannot adapt to the CPAP device or who do not wish to use it with aesthetic concerns.
In elderly patients or in patients with an apnea-hypopnea index above 30 regardless of age; In addition, in people with excessive daytime sleepiness, even if the index is low, the first choice should be the CPAP device, unless there is a problem of compliance. As we have already mentioned, this is the most reliable and definitive treatment!
21AXX
Adaptive Sound Technologies Lectrofan Micro2 Sleep Sound Machine & Bluetooth Speaker with Fan Sounds, White Noise, & Ocean Sounds for Sleep & Sound Masking
