Category: ENT (otolaryngology)

“Doctor, how do I stop snoring?” This is one of the most frequent questions in the office. Or rather, the most frequent question is: “How do I get my husband (or my wife) to stop snoring?” Almost always, the person who booked the appointment is not the one who snores, but the one who sleeps next to them.

The answer begins with a question: why does this person snore? Snoring has several possible origins, and each origin has a treatment of its own. There is a path of investigation and a ladder of treatments, from the simplest to the most advanced. In this article, we explain how to follow that path with clear criteria.

First of all: what is snoring?

Snoring is the sound of the throat tissues vibrating when air passes through a tight space. It works like a flag in the wind: when air moves freely through a wide space, nothing vibrates; when it has to squeeze through a narrow passage, it speeds up and makes the soft tissues (the soft palate, the uvula, the walls of the throat) vibrate. That vibration is the snore.

Snoring now and then, during a cold or after a dinner with wine, happens to almost everyone. The snoring that deserves attention is loud, frequent snoring that bothers the person sleeping next to you, or snoring that comes with pauses in breathing.

Why do you snore? The answer is in the airflow.

In the office, we usually sum the mechanism up as a simple combination: a narrow upper airway + tissues that relax too much. Each side of that combination has its own causes.

What narrows the upper airway:

• A blocked nose: rhinitis, a deviated nasal septum, enlarged turbinates (the spongy structures inside the nose), nasal polyps
• An elongated soft palate or a bulky uvula
• Enlarged tonsils
• A bulky base of tongue, which falls backward when we lie down
• Excess weight, which deposits tissue around the throat and the neck

What makes the tissues relax too much:

• Sleep itself, especially in the deeper stages
• Alcohol at night, which acts as a muscle relaxant for the throat
• Some sedative medications
• The passing years, which naturally reduce muscle tone
• Menopause, a period in which hormonal changes increase the chance of snoring and sleep apnea in women (Young et al., 2003)
• Sleeping on your back, a position in which the tongue and the palate tend to fall backward

Each person snores because of a different combination of these factors. That is why the right question is not “what is the treatment for snoring?”, but “why does this person snore?”. Investigating before treating is what separates a consistent solution from a shot in the dark.

When snoring stops being just snoring: sleep apnea

Not all snoring is a disease. There is what we call primary snoring, in which the person snores but breathes well all night long. And there is snoring that is a symptom of obstructive sleep apnea (OSA), a condition in which the throat closes completely, over and over again, causing pauses in breathing (apneas), drops in oxygen, and arousals that fragment sleep.

Is this common? More than people imagine. The EPISONO study, which assessed the adult population of the city of São Paulo with sleep studies, found obstructive sleep apnea syndrome in 32.8% of the adults evaluated (Tufik et al., 2010). Most of them did not know they had it.

The signs that raise the suspicion of sleep apnea, in addition to loud snoring:

• Pauses in breathing witnessed by the person who sleeps next to you
• Waking up choking or with a feeling of suffocation
• Sleep that does not restore: waking up tired even after enough hours in bed
• Sleepiness during the day, at work or at the wheel
• Morning headache, dry mouth on waking
• High blood pressure that is hard to control

The STOP-Bang questionnaire: how these questions can help you

One tool we use to organize that suspicion is the STOP-Bang questionnaire, published by Chung et al. in 2008. It brings together 8 simple questions and works as a screening instrument, not a diagnostic one. It gives clues about who should be investigated.

The 8 questions, in plain language:

1. Do you snore loudly (louder than talking, loud enough to be heard from another room)?
2. Do you often feel tired or sleepy during the day?
3. Has anyone ever observed you stop breathing while you sleep?
4. Do you have high blood pressure, or are you being treated for hypertension?
5. Is your body mass index (BMI) above 35?
6. Are you over 50 years old?
7. Is your neck circumference greater than 40 cm?
8. Are you male?

In the original study, three or more positive answers indicate an increased risk of OSA (Chung et al., 2008). The questionnaire points to who should be investigated; the diagnosis comes from the consultation and from a sleep study (polysomnography), which measures how many times breathing is interrupted per hour and how far blood oxygen falls. We explain this path in detail on the page about sleep apnea.

Did you answer yes to three or more of them? Bring your answers to the appointment: they help direct the investigation from day one. Book a Consultation and let us find out where your snoring comes from.

The treatment ladder: what works at each step

Snoring has a treatment, and the right treatment depends on where the narrowing is. That is why the ladder below runs from the simplest to the most advanced, and why the examination comes before the choice.

1. Behavioral measures

Losing weight when there is excess weight, avoiding alcohol at night, taking care of the sleep routine, and training yourself to sleep on your side. This is the base of the ladder and it is part of every patient’s plan: on its own in mild snoring with no anatomical obstruction, and added to the other steps when there is a point of narrowing to treat or when the sleep apnea is moderate or severe.

2. Treating the nose

Poorly controlled rhinitis, a deviated nasal septum, and enlarged turbinates narrow the air intake right at the door. Treating the nose, with medication or surgery depending on the case, reduces the effort it takes to breathe with the mouth closed and improves tolerance to the other treatments. It is part of the plan for every person who snores and has nasal obstruction, and it can be combined with other surgeries within the same surgical plan.

3. CPAP

The continuous positive airway pressure device (CPAP) keeps the airway open with a gentle flow of air during sleep. It is the standard treatment for moderate and severe sleep apnea: the American Academy of Sleep Medicine guideline recommends positive airway pressure for the treatment of OSA in adults, with a strong recommendation when excessive sleepiness is present (Patil et al., 2019). It acts on the nights when it is used, and that is why adaptation weighs as much as the indication. A blocked nose is one of the most frequent reasons for giving up on it, and that is where the otolaryngologist (ENT) comes in even when the treatment is medical rather than surgical.

4. Oral appliance

The oral appliance (mandibular advancement device, or MAD) moves the lower jaw slightly forward during sleep, opening up space behind the tongue. It is a good choice in primary snoring and in mild to moderate sleep apnea, with follow-up by a dentist qualified in dental sleep medicine, and it depends on the teeth and the joint being in condition to support the device, which is assessed before it is indicated.

5. Barbed reposition pharyngoplasty (BRP)

A palate repositioning surgery: it repositions and tightens the tissues of the palate and the pharyngeal walls using threads with micro-anchors, without removing large volumes of tissue. It treats retropalatal collapse, that is, the collapse that happens behind the palate. The indication combines clinical history, ENT examination, and polysomnography; drug-induced sleep endoscopy (DISE) can be useful in some cases. Details of the procedure on the page about barbed reposition pharyngoplasty.

6. Fotona laser (NightLase protocol)

A non-surgical protocol in which laser energy promotes contraction and firmness of the palatal tissues, without incisions and without general anesthesia. It is an alternative for people with primary snoring who want an option without surgery. In the protocol we use in our office, treatment is delivered as an initial course of sessions, generally 4, followed by 1 maintenance session every 6 to 12 months. We explain the indications on the page about the Fotona laser.

7. Transoral robotic surgery (TORS)

Surgery performed with the robot, which makes it possible to reach and treat with precision deep regions of the throat that conventional instruments reach only with difficulty.

Robotics is the route of access, not a single technique. Through it, we treat three territories of the upper airway: the base of tongue, the lateral pharyngeal wall, and the palate. It is through the robotic approach, for example, that we perform expansion sphincter pharyngoplasty (ESP), the lateral wall technique we use most often. It is done in a hospital setting, with postoperative follow-up, and it can be combined with barbed reposition pharyngoplasty and with septal surgery within the same surgical plan. Learn more on the page about TORS.

How we choose the right step

No step of the ladder fits everyone, and that is what the consultation resolves. Three things define the choice, and all three come before any decision:

Where the narrowing is. The nose, the palate, the lateral pharyngeal wall, or the base of tongue. Examining the nose and the throat identifies the point, and it is the point that separates the person who improves by treating the nose from the person who needs the throat treated. Treating the nose alone usually improves breathing and adherence to CPAP, and the snoring itself arises more often in the throat.

The severity. Primary snoring and mild sleep apnea open room for the oral appliance and for the laser; in moderate and severe sleep apnea the standard treatment is CPAP, and the laser does not take that place. In the heavier cases, behavioral measures come added to another step, not on their own.

Your own conditions and your own preferences. Surgery involves a postoperative recovery and patient selection; the oral appliance requires dental conditions; CPAP requires living with the device. We take that into account together with you, because a treatment that does not hold up in your routine does not treat.

Be wary of anyone who promises a single solution for snoring before examining you. The ladder exists precisely because the right answer changes from person to person.

The bridge between the nose and sleep

Here is a point that often goes unnoticed: the nose and sleep are a single system. Nasal obstruction worsens snoring, aggravates sleep apnea, and gets in the way of adherence to CPAP, because breathing under pressure with a blocked nose is like drawing air through a crushed straw.

In everyday practice, this means that treating rhinitis, correcting a deviated nasal septum, or reducing the turbinates acts on sleep along two routes: it reduces the nasal share of the snoring, and it allows CPAP or the oral appliance to work the way they should. We often see patients who “did not adapt to CPAP” and find that the problem was never the device. It was the nose.

Frequently asked questions

References

1. Chung F, Yegneswaran B, Liao P, et al. STOP Questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812-821.
2. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study (EPISONO). Sleep Medicine. 2010;11(5):441-446.
3. Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2019;15(2):335-343.
4. Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. American Journal of Respiratory and Critical Care Medicine. 2003;167(9):1181-1185.

If snoring is part of your nights, or of the nights of whoever sleeps next to you, the first step is to find out where it comes from. Book a Consultation at the Morumbi, Itaim Bibi, or Alphaville locations, and we will examine your nose and your throat to find the right step for your case.

Dr. José Eduardo Marcondes, otolaryngologist (ENT physician). CRM-SP 107.711 (Brazilian medical license) | RQE 43.840 (specialist registration). This content does not replace a medical consultation.

“Doctor, can sleep apnea be cured?” This is one of the most frequent questions in the office, and the answer is: it depends on the cause and the severity. Sleep apnea always has effective treatment and, in specific situations, a real cure. In other cases, the goal is full control of the problem, which already transforms sleep, energy, and the health of those who live with it.

In this article, we explain the types of apnea, what leads a person to develop the problem, how to know whether you have it, when the condition is considered severe, and, above all, in which situations we can speak of a cure and in which the path is control.

What sleep apnea is

During sleep, the muscles of the throat relax. In people with a narrower airway or more lax tissues, this relaxation can close off the passage of air for a few seconds, several times a night. Each pause forces the brain into a micro-arousal to resume breathing. The result is fragmented sleep, blood oxygen swinging up and down, and a body that never truly rests.

This is obstructive sleep apnea, the most common form of the disease. It is far more frequent than people think: in the EPISONO study, carried out in the city of São Paulo, about one third of adults (32.8%) had sleep apnea to some degree. If you want to understand in detail what the pauses do to the body, it is worth reading the article on the physiology of sleep apnea.

What are the three types of apnea?

There are three types of sleep apnea, distinguished by the mechanism that interrupts breathing during the night:

Telling the types apart matters because the treatment changes. Polysomnography, the sleep study, is what makes that distinction.

What leads a person to have sleep apnea?

In obstructive apnea, the problem comes from a simple equation: a narrow airway plus tissues that relax too much during sleep. Several factors feed into that equation:

• Excess weight. It is the most important risk factor and one of the most reversible. Fat in the neck, tongue, and abdomen narrows and overloads the airway. We explain this mechanism in detail in the article on sleep apnea and obesity.
• Anatomy of the face and throat. A receding chin, large tonsils, a bulky tongue, and a low palate reduce the space through which air passes. That is why lean people can also have apnea.
• Nasal obstruction. A deviated septum, enlarged turbinates, and rhinitis make breathing through the nose harder and push the person toward mouth breathing, which destabilizes the airway during sleep.
• Age and sex. Apnea becomes more common with age, as muscle tone is naturally lost. Men are more affected, but the difference narrows after menopause, as we show in the article on sleep apnea in men and women.
• Alcohol, smoking, and sedatives. They relax the throat muscles further or inflame the airway.
• Hormonal factors. Hypothyroidism and other hormonal changes can also contribute.

What makes apnea worse?

Even in people already diagnosed, some habits worsen the breathing pauses: gaining weight, drinking alcohol at night, smoking, taking sleeping pills on your own, sleeping on your back, and leaving the nose obstructed without treatment. The good news is that all these points can be worked on, and each of them improves the outcome of any treatment.

How do I know if I have sleep apnea?

The most common signs appear at two moments. At night: loud, frequent snoring, breathing pauses noticed by a bed partner, choking or a smothering sensation, restless sleep, and repeated trips to the bathroom. During the day: waking up tired even after hours in bed, morning headache, sleepiness, irritability, and a decline in memory and concentration.

When these signs are present, the way forward is an evaluation with an otolaryngologist (ENT), who examines the nose and throat (usually with flexible nasolaryngoscopy) to identify where the obstruction lies. The diagnosis is confirmed by polysomnography, the sleep study, which can be done in a lab or, in selected cases, at home.

When is apnea severe?

Severity is measured by the AHI, the apnea-hypopnea index, which counts the breathing pauses per hour of sleep: up to 5 is considered normal, 5 to 15 is mild apnea, 15 to 30 is moderate, and above 30 is severe.

The number, however, is not everything. The drop in oxygen during events, the degree of daytime sleepiness, the person’s occupation (think of someone who drives or operates machinery), and the presence of conditions such as high blood pressure, diabetes, and arrhythmias also weigh on how and how urgently to treat.

So, can sleep apnea be cured?

Now for the full answer. Sleep apnea can be cured in specific situations, when there is a well-defined cause that can be corrected:

• In children, the most common cause is enlargement of the tonsils and adenoid, and surgery resolves the large majority of cases.
• In adults with mild apnea linked to excess weight, consistent weight loss can normalize the sleep study.
• In selected cases, snoring and apnea surgery corrects the points of airway obstruction (nose, palate, pharyngeal walls, and base of tongue) and can bring the AHI down to normal levels. The result depends greatly on patient selection and the site of obstruction, which is why a detailed evaluation matters so much.

In most moderate and severe cases, the term we use is not cure, but control. CPAP, for example, eliminates the breathing pauses while it is in use, with an excellent effect on symptoms and quality of life. It is similar to what happens with high blood pressure: treatment does not make the predisposition disappear, but it restores health and keeps complications away. And control done well, in practice, means sleeping and living like someone who does not have the disease.

Be wary of any promise of a guaranteed cure for apnea. Serious medicine works with individual assessment, and the right treatment for one person may be wrong for another.

What are the treatments for sleep apnea?

The plan is always individual and, often, combines more than one front:

• CPAP. A device that keeps the airway open with air pressure. It is the treatment of choice for severe apnea and very effective when well tolerated.
• Oral appliance. It slightly advances the lower jaw and widens the space in the throat. Useful in mild to moderate cases and for those who do not adapt to CPAP.
• Treating the nose. Correcting a deviated septum, enlarged turbinates, and rhinitis improves breathing, snoring, and adaptation to CPAP.
• Speech therapy (myofunctional therapy). Exercises that strengthen the muscles of the tongue, palate, and pharynx.
• Fotona laser. The NightLase protocol, a laser treatment with no cutting, tones the tissues of the throat in selected cases of snoring and mild to moderate apnea.
• Surgery. From nasal procedures to pharyngoplasty and robotic base-of-tongue surgery (TORS), indicated according to the point of obstruction identified during the evaluation.
• Weight management. A central piece in people with excess weight, with diet, physical activity, and, in selected cases, weight-loss injections, which reduced the severity of apnea in recent studies.

Frequently asked questions

The first step is to investigate

If you snore every night, wake up tired, or have caught a family member pausing their breathing, do not wait for the problem to charge a higher price. Sleep apnea has effective treatment for every degree, and a cure in specific situations. The sooner you find where the obstruction is, the greater the chances of a complete result.

Dr. José Eduardo Marcondes is a PHYSICIAN and otolaryngologist (ENT) (CRM-SP 107.711 | RQE 43.840), working in nasal surgery and in the treatment of snoring and sleep apnea, seeing patients in Morumbi and Itaim (São Paulo) and in Alphaville (Barueri). If it makes sense for you, book a consultation so we can investigate your sleep and talk about the best path for your case.

References

1. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the São Paulo Epidemiologic Sleep Study. Sleep Medicine. 2010;11(5):441-446. doi:10.1016/j.sleep.2009.10.005.
2. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046-1053. doi:10.1016/S0140-6736(05)71141-7.
3. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. New England Journal of Medicine. 2005;353(19):2034-2041. doi:10.1056/NEJMoa043104.
4. Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the treatment of obstructive sleep apnea and obesity (SURMOUNT-OSA). New England Journal of Medicine. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881.
5. McEvoy RD, Antic NA, Heeley E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea (SAVE). New England Journal of Medicine. 2016;375(10):919-931. doi:10.1056/NEJMoa1606599.

This content is informational, does not replace a medical consultation, and does not supersede the plan of care defined by your own physician.

Sleep apnea and excess weight often go hand in hand, and this is no coincidence. The two conditions feed each other: extra weight favors apnea, and apnea, in turn, makes losing weight harder. It is a true vicious cycle, and understanding it helps explain why treating only one side often fails to solve the problem.

In this article on sleep apnea and obesity, the goal is educational: to show how obesity worsens apnea, how apnea worsens obesity, and why breaking this cycle requires looking at both problems at the same time. At the end, we discuss the available treatments and why the so-called weight-loss injections (GLP-1 medications) have become an important tool against both diseases.

What obstructive sleep apnea is

During sleep, the muscles of the throat relax. In people with a narrower airway or more lax tissues, this relaxation can temporarily close off the passage of air, interrupting breathing for a few seconds, several times a night. Each pause prompts the brain to react with a micro-arousal in order to resume breathing. Sleep becomes fragmented, the body does not truly rest, and blood oxygen levels swing throughout the night.

This is obstructive sleep apnea. Among the factors that favor its onset, excess weight is one of the most important, and also one of the most reversible.

Focus 1: how obesity worsens apnea

Excess weight works against nighttime breathing through several pathways at once.

• Fat around the throat. Fat that builds up in the neck and along the walls of the pharynx narrows the space through which air passes. A tighter airway collapses more easily when the muscles relax during sleep.
• Fat at the base of the tongue. MRI studies show that people with obesity tend to accumulate fat in the tongue itself, which becomes larger and heavier and falls back over the throat when lying down.
• Abdominal fat. Belly fat pushes the diaphragm upward and reduces the volume of air the lungs can hold, especially when lying down. Less inflated lungs “pull” less on the airway from within, leaving it more prone to closing.
• Inflammation and fluid retention. Excess fat tissue keeps the body in a state of low-grade inflammation and promotes fluid buildup, which at night can shift to the neck and worsen the obstruction.

It is no coincidence that the relationship between weight and apnea is well documented. A landmark population study showed that a change of about 10% in body weight is associated with substantial changes in the severity of apnea: gaining weight worsens it, and losing weight improves the number of breathing pauses per hour of sleep.

Focus 2: how apnea worsens obesity

What many people do not realize is that this is a two-way street. Untreated apnea also pushes the body toward weight gain and makes losing weight harder.

• Fragmented sleep disrupts hunger. Sleep deprivation and fragmentation alter two hormones that control appetite: they raise ghrelin (which drives hunger) and lower leptin (which signals fullness). The result is more hunger, more craving for calorie-dense foods, and more difficulty stopping eating.
• Insulin resistance. Poor nights of sleep and repeated drops in oxygen worsen the way the body handles sugar, promoting insulin resistance, fat accumulation, and the risk of type 2 diabetes.
• Fatigue that reduces energy expenditure. People who sleep poorly wake up exhausted, with less drive to exercise and move throughout the day. Less activity means fewer calories burned.
• Hormonal stress. Poor sleep and oxygen swings activate the stress system and raise cortisol, a hormone that also promotes fat accumulation, mainly in the abdominal area.

In other words, apnea creates exactly the hormonal and behavioral environment that makes gaining weight easier.

The vicious cycle

Put the two sides together and the problem becomes clear. Excess weight narrows and overloads the airway, which causes or worsens apnea. Apnea fragments sleep, disrupts hunger hormones, increases insulin resistance, and drains the energy needed to exercise, which further promotes weight gain. More weight, more apnea. More apnea, more weight.

This is why many people feel “stuck”: they diet, but poor sleep sabotages the effort; or they treat only the sleep, but their weight keeps the airway compromised. Breaking this cycle usually requires acting on both fronts at once, and this is where modern treatment has made considerable progress.

How apnea is treated today

There is no single treatment that works for everyone. The approach depends on the severity of the apnea, the anatomy of the airway, and each person’s associated factors. The main options are:

• CPAP. The device that keeps the airway open with a flow of air throughout the night. It remains the treatment of choice for severe apnea.
• Treating the nose. Correcting obstructions such as a deviated nasal septum, enlarged turbinates, or rhinitis improves breathing and adaptation to other treatments.
• Oral appliance. A device that slightly advances the lower jaw and widens the space in the throat, useful in mild to moderate cases.
• Fotona laser. The NightLase protocol, a laser treatment with no cutting, can tone the tissues of the throat in selected cases of snoring and mild to moderate apnea.
• Surgery. Indicated in specific situations, according to the point of obstruction identified during the evaluation.
• Weight management. As we have seen, it is a central piece. Losing weight reduces the severity of apnea and, in some cases, can even resolve mild forms.

Weight, in fact, has always been on this list, but for a long time it was also the hardest part to treat. It was precisely here that an important development emerged.

Weight-loss injections: one weapon against both conditions

These weight-loss injections are medications from the class of GLP-1 receptor agonists (such as semaglutide) and, more recently, dual GLP-1/GIP receptor agonists (such as tirzepatide). They act on the brain and the digestive system by increasing satiety and reducing hunger, which leads to significant and sustained weight loss.

The interesting point for people with apnea is that these medications target the very root of the vicious cycle: excess weight. And there is direct evidence of this. In 2024, a large clinical trial called SURMOUNT-OSA, published in the New England Journal of Medicine, evaluated tirzepatide in adults with obesity and moderate-to-severe obstructive sleep apnea. The result was a significant reduction in the number of breathing pauses per hour of sleep (the apnea-hypopnea index, or AHI, which measures the severity of apnea), along with weight loss, both in those using CPAP and in those who were not.

In practice, this means that treating weight with these medications may improve the apnea itself, while also reducing risks linked to obesity, such as diabetes and cardiovascular disease. A single line of treatment acting on both conditions at once.

Two important caveats, however. First, these injections are not a miracle and do not, on their own, replace the other treatments: in many cases they are added to CPAP and the other measures rather than eliminating them. Second, they are medications with their own indications, contraindications, and side effects, whose prescription and follow-up are the responsibility of the physician in charge of weight treatment, usually the endocrinologist or an obesity medicine physician.

The best path is team-based care. The otolaryngologist (ENT) evaluates and treats the airway and the apnea; the obesity specialist manages weight loss, with or without medication; and the two work together to break the vicious cycle. Each piece in its place, with a shared goal: to give the patient real sleep and more balanced health.

Frequently asked questions

It’s worth talking about your case

If you live with snoring, unrefreshing sleep, daytime fatigue, or difficulty losing weight, there may be sleep apnea behind it, feeding this cycle. The good news is that the cycle can be broken, and the sooner the origin of the problem is understood, the better the results.

Dr. José Eduardo Marcondes is a physician and otolaryngologist (ENT) (CRM-SP 107.711 | RQE 43.840), focusing on nasal surgery and the treatment of snoring and sleep apnea, seeing patients in Morumbi and Itaim (São Paulo) and in Alphaville (Barueri). If it makes sense for you, book a consultation so we can talk about your case, ideally as part of integrated care alongside weight management.

References

1. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-3021. doi:10.1001/jama.284.23.3015.
2. Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the treatment of obstructive sleep apnea and obesity (SURMOUNT-OSA). New England Journal of Medicine. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881.
3. Spiegel K, Tasali E, Penev P, Van Cauter E. Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine. 2004;141(11):846-850. doi:10.7326/0003-4819-141-11-200412070-00008.
4. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proceedings of the American Thoracic Society. 2008;5(2):185-192. doi:10.1513/pats.200708-137MG.

This content is informational, does not replace a medical consultation, and does not supersede the plan of care defined by your own physician.

In recent years, the laser has gone from a distant promise to a part of the daily routine of otolaryngology (ENT). But there is a common misconception: people talk about “the laser” as if it were a single thing, when in fact there are several types, each behaving differently within the tissue. A laser used to reduce turbinates is not the same as the one used to treat snoring, and neither is the same as the one that cuts and coagulates soft tissue.

In this article, the goal is to explain, in accessible terms, how a laser acts on the body and to present three examples used in ENT: the holmium laser in turbinoplasty, the blue laser in diseases of the larynx and vocal folds, and the Fotona laser in the treatment of snoring and obstructive sleep apnea. The idea is not to say which one is “best,” but to show that each has its own target and purpose.

How a laser acts on tissue: the idea of a target

A laser is, essentially, light of a single wavelength, a single, highly concentrated “color,” even when that light is invisible to our eyes. What makes a laser useful in medicine is the following principle: each wavelength is preferentially absorbed by a different component of the tissue. That light-absorbing component is called a chromophore, and it works as the laser’s “target.”

In practice, two targets matter a great deal in ENT:

• Water, present in almost all soft tissue, absorbs infrared light very well. It is the target of the holmium and erbium lasers.
• Hemoglobin (in blood) and melanin absorb light in the blue and green range. This is what allows the blue laser to act on blood vessels, a property called photoangiolytic.

When the light is absorbed, it turns into localized heat. And depending on the power, the pulse duration, and the mode of application, this heat can produce quite distinct effects:

• Ablation: vaporizing or cutting the tissue.
• Coagulation: sealing small vessels and reducing bleeding.
• Non-ablative thermal effect: simply heating in a controlled way, without cutting or removing tissue, which stimulates collagen.

Add to this the depth that each wavelength reaches: some act more on the surface, others penetrate a little more, and it becomes easier to understand why each laser is chosen for a specific task. This reasoning guides the three examples that follow.

Holmium laser (Ho:YAG) in turbinoplasty

The nasal turbinates are structures inside the nose that warm, humidify, and filter the air we breathe. The problem arises when they swell chronically, something common in rhinitis and allergy, and begin to obstruct the airflow. The result is that feeling of a stuffy nose that does not improve, disrupts sleep, and does not respond to medication alone.

Turbinoplasty is the procedure that reduces the volume of the turbinate to unblock the nose, while taking care to preserve its function. This is where the holmium laser comes in (technical abbreviation Ho:YAG, with a wavelength of around 2,100 nm).

How it works. The holmium is a pulsed laser, absorbed by the water in the tissue, with relatively shallow penetration and good coagulating ability. Applied to the enlarged turbinate, it reduces the tissue responsible for the swelling and, at the same time, coagulates the small vessels, which decreases bleeding during the procedure. Because it acts in a localized way, it seeks to preserve the lining mucosa and the nose’s humidifying function.

An interesting detail: since the holmium’s light is infrared and invisible, the device also projects a green aiming beam so the surgeon can see exactly where it will act. That is why, in surgical images, this laser appears green.

Advantages in this context. Two features stand out. The first is good hemostasis: by coagulating while it reduces the tissue, the procedure tends to involve little bleeding. The second is the durability of the results. In a long-term comparative study, subjective improvement in nasal breathing was reported by about 67.5% of patients treated with holmium and 74.4% of those treated with the diode laser, with objective improvement in airflow at both 6 months and 3 years. [1]

A striking point is that reducing the turbinate does not improve only the stuffy nose. By decreasing the volume of the mucosa that reacts to allergens and of the glands that produce secretion, the procedure tends to also reduce sneezing, runny nose, and itching, that is, the set of symptoms of allergic rhinitis flare-ups. A Japanese group followed patients for up to five years after laser turbinate surgery and observed sustained improvement in sneezing, runny nose, and obstruction, with a large proportion of them remaining off medication. [2] And a 2023 systematic review with meta-analysis, gathering 18 studies and more than 1,400 patients, confirmed that turbinate reduction significantly improves obstruction, runny nose, sneezing, and nasal itching, with the benefit maintained for more than a year. [3]

Despite this reduction of the turbinate and the improvement in obstruction and allergic symptoms, the allergy does not cease to exist. If the rhinitis is not controlled, the turbinate may swell again over time. For this reason, turbinoplasty is usually part of a plan, and long-term follow-up is important.

Blue laser (445 nm) in diseases of the larynx and vocal folds

The larynx houses the vocal folds, delicate structures in constant motion that are responsible for producing the voice. Any lesion there, however small, can alter the voice and requires precise treatment, able to resolve the problem without harming the thin, layered tissue of the vocal fold. It is in this demanding setting that the blue laser (blue light, at 445 nm) has found a prominent role.

Why the target matters here. The blue laser’s main target is hemoglobin, so it acts preferentially on blood vessels. It happens that many vocal fold lesions are either vascular or fed by abnormal vessels. As it is absorbed by hemoglobin, the laser selectively coagulates these microvessels, treating the lesion with little bleeding and seeking to spare the vocal ligament and the deeper layers, which helps preserve the voice. This ability to act on vessels is what is called the photoangiolytic effect.

What can be treated. In the larynx, the blue laser has been used for a variety of lesions, among them [4][5]:

• vascular lesions of the vocal folds, such as varices, ectasias, and hemorrhagic polyps;
• Reinke’s edema;
• laryngeal papillomatosis (HPV-related lesions, which tend to recur);
• leukoplakia and early dysplastic lesions;
• granulomas.

Advantages in this context. Beyond coagulating, the blue laser also cuts, something the classic photoangiolytic lasers, such as the KTP, do not do. In laryngeal surgery, this combination has been described as bringing together, in a single device, the ability to cut and to treat the vessels. [4] Because it is delivered through a very thin fiber, it allows a precise and minimally invasive approach to vocal fold lesions, and the selective coagulation of the vessels improves visibility during the procedure. In practice, the blue laser has already been applied to different vocal lesions, such as polyps, Reinke’s edema, papilloma, and leukoplakia. [5] Because it is repeatable, it is also a useful option when the lesion tends to recur, as happens in papillomatosis.

The same caveat as in the other examples applies: the choice of laser and approach depends on the type of lesion, and the correct diagnosis always comes before the technology.

Fotona laser (Er:YAG) in snoring and sleep apnea

The third example again changes the objective. In the treatment of snoring and obstructive sleep apnea, the problem often lies in the laxity of the throat tissues, the soft palate, the uvula, and the walls of the pharynx, which vibrate (snoring) and, in some people, collapse and obstruct the airflow (apnea). The goal, in this case, is not to cut or remove tissue, but to tone it.

How it works. The Fotona laser, in the NightLase protocol, uses an erbium laser (Er:YAG, at 2,940 nm), in a mode called SMOOTH, with a non-ablative application. It heats the throat tissues in a controlled way, without cutting and without anesthesia. This heat causes the existing collagen fibers to contract and stimulates the production of new collagen over the following weeks. The tissue tends to become gradually firmer, with less tendency to vibrate and collapse during sleep.

Advantages and limits. It is an office-based procedure, painless, without cuts, and with no recovery time. A 2025 systematic review with meta-analysis concluded that the erbium laser is a safe and effective option in the short and medium term for selected patients with snoring or mild to moderate apnea, with benefits that usually last 1 to 2 years. [6] A randomized controlled trial, with a placebo group, also showed a significant reduction in snoring with the NightLase protocol, well tolerated. [7] A 4-year follow-up reinforced this profile over time. [8]

The Fotona laser works best in primary snoring and in mild to moderate apnea, and it does not replace CPAP in moderate to severe cases. The improvement, moreover, is usually clearer in the symptoms reported by the patient and normally requires booster sessions over time.

The three lasers side by side

The table below summarizes why each laser goes to a different task. Note that the logic is always the same: the wavelength defines the target, and the target defines the application.

Note that holmium and erbium have the same target (water) but produce quite different effects because of the wavelength, the pulse shape, and the mode of application. This shows that knowing the target is not enough: the “how” also counts.

Is the laser always the best option?

A laser is a tool, not a diagnosis. It can be a good choice in many situations, but the decision always depends on the cause of the problem. A few examples help to understand:

• If the nose is blocked because of a deviated septum, reducing only the turbinate with a laser may not solve it, because the main obstruction is in the bony and cartilaginous structure.
• If sleep apnea is severe, the treatment of choice remains CPAP or, in selected cases, surgery, not the laser.
• In several procedures, there are non-laser alternatives (such as radiofrequency and conventional surgical techniques), with good results.

For this reason, the right question is not “which is the best laser?” but “which is the best treatment for my case?” The answer comes from an evaluation that understands the origin of the symptom before choosing the technology.

Frequently asked questions

In summary

The laser is not a single technology, but a family of tools that differ by wavelength and by their target in the tissue. Holmium reduces turbinates with good hemostasis, the blue laser treats lesions of the larynx and vocal folds by coagulating the vessels while seeking to preserve the voice, and the Fotona laser tones the throat to help with snoring and mild to moderate apnea. Knowing these differences helps the patient understand the options, but the choice of the best approach always depends on the diagnosis.

If you have questions about nasal obstruction, snoring, sleep apnea, or about which treatment makes sense for your case, the path is an evaluation that identifies the cause before deciding on the technology.

Dr. José Eduardo Marcondes is a physician and otolaryngologist (ENT) (CRM-SP 107.711 | RQE 43.840), working in nasal surgery and in the treatment of snoring and sleep apnea, seeing patients in Morumbi and Itaim (São Paulo) and in Alphaville (Barueri).

This content is informational, does not replace a medical consultation, and does not supersede the plan of care defined by your own physician. References to studies are presented factually and do not constitute a promise of results.

References

Sroka R, Janda P, Killian T, Vaz F, Betz CS, Leunig A. Comparison of long term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates. Lasers in Surgery and Medicine. 2007;39(4):324-331. doi:10.1002/lsm.20479.

Takeno S, Nakashimo Y, Ishino T, Miyahara N, Goh K, Noda N, Hirakawa K. Long-Term Results after Carbon Dioxide Laser Surgery of the Inferior Turbinate for Perennial Allergic Rhinitis. Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology). 2011;50(1):7-12. doi:10.7248/jjrhi.50.7.

Park SC, Kim DH, Jun YJ, Kim SW, Yang HJ, Yang SI, Kim HJ, Kim DK. Long-term Outcomes of Turbinate Surgery in Patients With Allergic Rhinitis: A Systematic Review and Meta-analysis. JAMA Otolaryngology-Head and Neck Surgery. 2023;149(1):15-23. doi:10.1001/jamaoto.2022.3567.

Hess MM, Fleischer S, Ernstberger M. New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties. European Archives of Oto-Rhino-Laryngology. 2018;275(6):1557-1567. doi:10.1007/s00405-018-4974-8.

Hamdan AL, Ghanem A. Un-sedated Office-Based Application of Blue Laser in Vocal Fold Lesions. Journal of Voice. 2023;37(5):785-789. doi:10.1016/j.jvoice.2021.03.031.

Dembicka-Maczka D, et al. Effectiveness of the Er:YAG Laser in Snoring Treatment Based on Systematic Review and Meta-Analysis Results. Journal of Clinical Medicine. 2025;14(12):4371. doi:10.3390/jcm14124371.

Picavet VA, et al. Treatment of snoring using a non-invasive Er:YAG laser with SMOOTH mode (NightLase): a randomized controlled trial. European Archives of Oto-Rhino-Laryngology. 2022;280(1):307-312. doi:10.1007/s00405-022-07539-9.

Frelich H, et al. Erbium:Yttrium Aluminum Garnet (Er:YAG) Laser: A Minimally Invasive Treatment Method in Selected Patients with Impaired Breathing During Sleep. Photobiomodulation, Photomedicine, and Laser Surgery. 2023;41(8):415-421. doi:10.1089/photob.2022.0144.

Obstructive sleep apnea (OSA) is usually pictured as a problem of the “man who snores loudly.” That image holds some truth, but it tells only half the story. Apnea also affects women, and it often goes unnoticed precisely because it shows up differently from what people expect. Understanding these differences helps both those who share a bed with a snorer and those who feel tired and sleep poorly without knowing why.

This article about sleep apnea in men and women is educational: it shows how the condition behaves in each sex, why it is underdiagnosed in women, and what changes (and what does not) when it comes to investigating and treating it.

What obstructive sleep apnea is

During sleep, the muscles of the throat relax. In people with a narrower airway or more lax tissues, this relaxation can briefly close off the passage of air, interrupting breathing for a few seconds, several times a night. Each pause makes the brain react with a micro-arousal in order to start breathing again. Sleep becomes fragmented, the body does not truly rest, and blood oxygen fluctuates throughout the night.

This is obstructive sleep apnea. It affects men and women alike, but the way it appears, is noticed, and is even diagnosed changes with sex.

Prevalence and epidemiology: more common in men, but not rare in women

Apnea is, in fact, more frequent in men. One of the landmark population studies, the Wisconsin Sleep Cohort, found sleep-disordered breathing (defined as an apnea-hypopnea index [AHI] of 5 or more per hour of sleep) in about 24% of middle-aged men and 9% of middle-aged women. The classic ratio described is roughly 2 to 3 men for every woman in the general population.

But that figure hides a trap. In clinics and sleep laboratories, for a long time the ratio seemed even higher (it was sometimes described as 8 or 10 men for every woman), not because women are so much less affected, but because they were referred for investigation far less often. In other words, part of the difference between the sexes is not biological, it is diagnostic.

There is also a factor that changes everything over the course of a woman’s life: menopause. Before it, a woman’s risk is lower. Afterward, prevalence rises markedly and approaches that seen in men. Apnea, then, is not a “man’s disease,” but a condition that is distributed differently between the sexes and over time.

Causes: why men tend to have more

The differences begin with anatomy and physiology.

• Fat distribution. Men tend to accumulate fat around the neck and abdomen (the android pattern), which increases pressure on the airway and the effort of breathing while lying down.
• Airway shape and length. The male airway tends to be longer and more prone to collapse during sleep.
• Female hormonal protection. Before menopause, female hormones (especially progesterone and estrogen) help maintain respiratory drive and the tone of the muscles that support the throat. This acts as partial protection. With the hormonal decline of menopause, this protection lessens and risk increases.

In women, other triggers also come into play: weight gain, polycystic ovary syndrome, and pregnancy itself, a period in which hormonal and anatomical changes can favor the onset or worsening of apnea. In both sexes, nasal obstruction (from a deviated septum, enlarged turbinates, or rhinitis) and excess weight often contribute to the problem.

Symptoms: the same condition, two different portraits

Here is perhaps the most important difference of sleep apnea in men and women in practice.

In men, apnea usually presents in the “classic” portrait, the one most people recognize:

• loud, persistent snoring;
• pauses in breathing noticed by the person sleeping beside them;
• excessive daytime sleepiness (dozing off in meetings, in traffic, while reading).

In women, symptoms tend to be less typical and, for that reason, more easily confused with other conditions:

• tiredness and lack of energy (more than “sleepiness” as such);
• insomnia or unrefreshing sleep;
• headache on waking;
• mood changes, such as anxiety and depressive symptoms;
• difficulty with concentration and memory.

Snoring does occur in women, but it is usually reported as milder, and breathing pauses are noticed less often. As a result, the complaint that leads to diagnosis frequently never surfaces.

The way symptoms are expressed also differs

It is not only the body that behaves differently: so does the way people describe what they feel. Many women do not report snoring spontaneously, whether because they sleep alone and no one observes them, or because of a social embarrassment still attached to snoring in women. And when they describe feeling unwell, they tend to use words like “tiredness,” “exhaustion,” or “stress,” rather than “daytime sleepiness.”

Men, on the other hand, often come to the office prompted by the complaint of whoever shares their bed: it is the loud snoring and the breathing pauses that trigger the search for help. This difference in how symptoms are reported means that apnea in men is “seen” more easily, while apnea in women stays silent for longer.

Effects on life and health

Untreated apnea goes well beyond poor sleep. In both sexes, it is associated with a higher risk of hypertension, arrhythmias, cardiovascular disease, metabolic changes, and worse quality of life.

In women, some aspects deserve special attention. Mood and fatigue symptoms tend to weigh heavily on daily life and on the sense of well-being. And during pregnancy, apnea is associated with a higher risk of complications such as gestational hypertension, preeclampsia, and gestational diabetes, which reinforces the importance of investigating sleep during this period as well.

In men, earlier diagnosis is an advantage, but daytime sleepiness carries concrete risks, such as traffic and workplace accidents, along with an impact on performance and relationships.

How each sex tends to cope with the condition

Because they are referred less and later, many women spend years with symptoms attributed to depression, hypothyroidism, anemia, fibromyalgia, or “menopause things” before apnea is even considered. This delay in diagnosis is one of the most important points to correct.

In men, the path to diagnosis tends to be shorter, especially when a partner notices the snoring and the pauses. Once diagnosed, men and women may face different strengths and difficulties in sticking with treatment, which is why close follow-up, adjusting whatever is needed, makes a difference to the outcome.

The practical message is simple: chronic tiredness, unrefreshing sleep, morning headache, and mood changes warrant a sleep evaluation, even without the thunderous snoring of the classic portrait.

Diagnosis: the same test, with a close eye on the differences

Diagnosis does not use a different test according to sex, but it does require attention so that apnea in women is not missed. The evaluation usually includes:

• a detailed conversation about sleep, symptoms, and habits;
• examination of the airway, often with nasal endoscopy, to check whether a nasal component is contributing;
• when indicated, polysomnography (the “sleep study”), which confirms the diagnosis and grades its severity.

One extra caution is worth noting: in women, apnea tends to concentrate in certain sleep stages (such as REM sleep) and in certain positions, and the index of events per hour may be lower even when symptoms are significant. For that reason, the number from the test alone must always be interpreted together with the person’s clinical picture.

Treatment of sleep apnea in men and women: the same principles, individually tailored

Treatment options are, on the whole, the same for men and women, and the choice depends on severity, anatomy, and each person’s lifestyle:

• CPAP (continuous positive airway pressure) remains the most established treatment for moderate to severe apnea in both sexes.
• Oral appliance (mandibular advancement device, MAD) and positional therapy: useful in selected cases, especially when apnea is milder, positional, or concentrated in REM sleep, a pattern common in women.
• Treating the nose: when nasal obstruction is part of the problem, septoplasty and turbinoplasty can improve breathing and even help with CPAP adherence.
• Laser: for snoring and mild to moderate apnea, the Fotona laser (NightLase protocol) can be a non-surgical alternative. It involves 3 to 4 in-office sessions, with good results in selected cases.
• Surgery: in some cases, surgery, such as septoplasty, robotic pharyngoplasty, or barbed reposition pharyngoplasty (BRP), can be a treatment option in patients with favorable anatomical features.
• Lifestyle changes: weight control and attention to alcohol at night and to sleep are also part of treatment, whatever the sex.

In women, it is also worth considering the stage of life (menopause and pregnancy, for example) when deciding on the best strategy. In every case, the goal is the same: to treat the cause of the obstruction, not merely to silence the snoring.

Frequently asked questions

It’s worth discussing your case

If you (or someone close to you) has tiredness that won’t go away, unrefreshing sleep, snoring, or breathing pauses, the first step is an evaluation that gets to the origin of the problem. Sleep apnea is treatable, and recognizing that sleep apnea in men and women shows up differently is part of reaching the right diagnosis.

Dr. José Eduardo Marcondes is a PHYSICIAN and otolaryngologist (ENT) (CRM-SP 107.711 | RQE 43.840), working in nasal surgery and in the treatment of snoring and sleep apnea, seeing patients in Morumbi and Itaim (São Paulo) and in Alphaville (Barueri). If it makes sense for you, book a consultation so we can discuss your case.

References

1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine. 1993;328(17):1230-1235. doi:10.1056/NEJM199304293281704.
2. Bonsignore MR, Saaresranta T, Riha RL. Sex differences in obstructive sleep apnoea. European Respiratory Review. 2019;28(154):190030. doi:10.1183/16000617.0030-2019.
3. Lin CM, Davidson TM, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Medicine Reviews. 2008;12(6):481-496. doi:10.1016/j.smrv.2007.11.003.

This content is informational, does not replace a medical consultation, and does not supersede the plan of care defined by your own physician.