Sleep Disorders Uncovered: Sleep Apnea

Our resident sleep expert, Christabel Majendie, explores the fascinating and little known subject of Sleep Apnea.

Most people are aware of insomnia but public knowledge of other sleep disorders is fairly limited. Sleep apnea is a relatively common sleep disorder affecting roughly 4% of men and 2% of women. It is characterised by an interruption of normal breathing during sleep which can lead to chronic sleep deprivation and result in people feeling exhausted during the day, affecting quality of life and leading to potential serious health complications.

Besides daytime sleepiness, sleep apnea can lead to reduced productivity, problems concentrating, forgetfulness, moodiness, irritability, insomnia and depression. It can increase your risk of having a road traffic accident by 12 times. It also puts you are risk of developing physical health conditions like type 2 diabetes, stroke or heart disease, high blood pressure and obesity.

There are three types of sleep apnea: obstructive sleep apnea is due to the airway passage collapsing during periods of sleep; central sleep apnea is caused by the brain failing to activate breathing muscles during sleep; the third type is a mix of central and obstructive sleep apnea.

Central sleep apnea

Central sleep apnea is less common than obstructive sleep apnea. This disorder can occur in premature or full-term infants or in adults with heart disease, neurological diseases or congenital diseases. In infants, an apnea monitor is often needed which sets off an alarm if an apnea is detected and this wakes the baby or the parent. For many infants, the central apnea episodes reduce or stop altogether with development.

For adults with central sleep apnea, the underlying medical condition is treated to prevent apneas occurring.

Obstructive sleep apnea (OSA)

Often it is a sleeping partner who first notices the signs of OSA in an individual. These indicators include loud snoring, laboured breathing or repeated pauses in breathing followed by gasping or snorting when the airway collapses during deep sleep. The resulting lack of oxygen then triggers the brain to come out of deep sleep into a light sleep or wakefulness, pulling the person out of their natural sleep rhythm. This causes the airway to reopen again leading to normal breathing. This process can occur hundreds of times in one night in severe cases. The individual may have no memory of these sleep interruptions but they can lead to excessive sleepiness during the day.

Other signs of OSA are excessive night sweats and waking up frequently to go to the bathroom, waking up with a sore throat or dry mouth, morning headaches or impotence.

While everyone’s muscles and soft tissues in the throat relax to some degree during sleep, with OSA the airway has become narrower due to a number of reasons, and this causes breathing problems during sleep when the throat muscles relax. You are at higher risk of having OSA if the following factors apply to you:

 Being overweight

 Male

 Being over 50 years of age

 Afro-Americans

 Having a large neck

 Taking sedatives such as sleep tablets or tranquilisers  Drinking alcohol

 Smoking

 Going through the menopause

 Having a family history of OSA

 Having a deviated septum where the tissue dividing the nostrils is bent to one side

 Nasal polyps (soft growths inside the nose)

 Enlarged tonsils, adenoids or tongue or small lower jaw

Diagnosis and treatment

If you or your partner suspects you have OSA, speak to your GP about your symptoms and for a possible referral to a sleep specialist. Formal diagnosis involves an overnight stay in a sleep clinic or your sleep being monitored at home with some specialised equipment.

OSA is treatable with several options available, depending on severity:

The simplest treatment is making some lifestyle changes such as losing weight, reducing alcohol or quitting smoking, avoiding sedatives or changing your sleeping position to sleep on your side.

Another treatment option is to wear an anti-snoring mouth device (called a mandibular advancement device). This fits around your teeth to bring your tongue and jaw forward to increase your airway during sleep.

A common treatment for OSA is to wear a continuous positive airway pressure device (CPAP) during sleep. This stops your airway constricting during sleep by providing a continuous supply of air under high pressure through a mask.

Finally, surgery may be necessary if the OSA is due to a physical problem such as enlarged tonsils or adenoids and other methods of treatment have not been effective.

When is it just snoring and when is it sleep apnea?

Although heavy snoring is a common sign of OSA, some people are just snorers. Equally not everyone with OSA snores. Normal snoring has less of an effect on the quality of your sleep and how you feel the next day (although it can cause severe problems for bed partners!) If the snoring is accompanied by excessive sleepiness during the day, it may be worth you speaking to your doctor for a referral to a sleep clinic.

You could record your sleep or ask your partner to observe your snoring and breathing during sleep. Things to look out for are pauses in breathing, gasping, choking or other abnormal sounds.

Advice for snoring

Changing your sleep position can be an effective way to reduce snoring. Try sleeping on your side rather than on your back. Some people suggest tying or sewing a sock to the back of your nightwear and putting a tennis ball inside to prevent you rolling onto your back. With time, sleeping on your side will become a habit.

Raise your head a few inches with a pillow to encourage breathing by moving your tongue and jaw forward. Or you could invest in a special pillow to reduce snoring: these aim to ensure neck muscles are not squashed.

Another suggestion is an anti-snoring mouth device (see above) which can help to widen your airway during sleep. Lifestyle changes such as exercise, weight loss, quitting smoking or avoiding alcohol and sedatives can also help to reduce snoring.

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