Managing sleep apnoea and snoring so you can get a good night's rest

A sleep apnoea is a disruption of breathing that occurs during sleep. It’s most notably characterised by snoring, and it can be potentially dangerous due to the lack of oxygen flow to the brain. In this article, a consultant ENT surgeon explains the effects of sleep apnoea and associated snoring, and how they may be managed.

Apnoea comes from the Greek word for ‘breathless’. It can affect anyone, but it is most common in older people, specifically women. People who are overweight or obese are likely to have sleep apnoea and snore as a result of it.

Sleep apnoea does not only disrupt breathing, but the sleep cycle as well. Patients with sleep apnoea may suddenly jerk awake after a period of not breathing, as their brain sends out a survival reflex to restart the breathing. For patients with sleep apnoea, they may experience between 5 (mild) to 30 (severe) apnoea-related interruptions in an hour. The lack of consistent, deep sleep can have further detrimental effects on health. There are three main types of sleep apnoea:

1. Obstructive sleep apnoea (OSA), which is the most common and occurs due the muscles in the back of the throat relaxing, pressing on the windpipe which narrows the airways and disrupts respiration.
2. Central sleep apnoea (CSA), which is when the brain fails to transmit the correct signals to the muscles that facilitate breathing. This can happen due to things such as¡ high altitude-caused hypoxia, nerve damage or diseases, or heart failure.
3. Complex apnoea, which is a mix of both OSA and CSA.

What are the symptoms of sleep apnoea?

The signs of sleep apnoea include:

• Snoring, which is the most common symptom but is not necessarily present in all cases
• Daytime fatigue and feeling tired upon waking up due to interrupted sleep
• Mood changes and irritability
• Brain fog, like memory issues and inability to focus
• Waking up repeatedly in the night, though patients may not be able to remember these events
• Pauses in breathing while sleeping, which may be noted by friends, families, or partners, or recorded with sleep trackers

Snorers and people with sleep apnoea may experience a higher blood pressure, depression, and chest pain at night. Snores can even be loud enough to disrupt others’ sleep.

To lower the chances of developing sleep apnoea and starting to snore, it is recommended to maintain a healthy weight and exercise regularly, to avoid smoking tobacco and alcohol overconsumption, and cease using sleep medicines unless advised by a doctor.

How is sleep apnoea diagnosed?

Sleep apnoea is typically diagnosed beginning with a review of the symptoms and medical history. If doctors suspect apnoea, they may want to conduct an overnight sleep study (nocturnal polysomnography), which will monitor the activity of the lungs, brain, heart, limbs, breathing patterns, and blood oxygen while the patient sleeps in the medical facility. If that is not possible, then a sleep study can be conducted in the patient’s own home, and is very similar but they will not be able to monitor the brain activity, so it is ineffective for those with CSA.

How can sleep apnoea and snoring be treated?

Sleep apnoea can be treated in a variety of different ways. There is no definitive cure, but there are methods to manage and reduce apnoea events in frequency or severity, and thus minimise snoring.

Conservative, at-home management techniques for mild sleep apnoea include weight loss for those who are overweight, sleeping in different positions and having sleep aids like supportive pillows that patients sleep on their side, or nasal sprays and adhesive strips to encourage nasal breathing.

One of the best-known treatments for sleep apnoea is the continuous positive airway pressure (CPAP) machine, which is a special mask that is worn during sleep and attached to a machine that increases the air pressure of the air in the airways and lungs during inhales, so that the tissues surrounding those areas don’t shut.

A new treatment for OSA that is an alternative to a CPAP machine is hypoglossal nerve stimulation implant. It involves devices implanted in the neck and chest to stimulate a nerve under the tongue, preventing the tongue from blocking the airway during sleep. It includes a breathing monitor, which is implanted in the chest, a pulse generator, which is implanted below the collarbone and is signalled by the breathing monitor to release an electrical pulse, and a cuff electrode, which wraps around a portion of the nerves under the tongue and stimulates the nerves with the electrical pulse to make the tongue stick out, clearing up the airway and ceasing snoring. The patient will be given a remote to turn on the implant before going to sleep so that it doesn’t interfere with their lives while awake.

To implant the devices, small incisions are made under the jaw for the electrode, and by the ribs to insert the breathing sensor and pulse generator. The devices are connected by a created tunnel under the skin, and they are secured with sutures.

To be considered for the hypoglossal nerve stimulation implant, patients must undergo a drug-induced sleep endoscopy. This is a non-invasive examination carried out while the patient is sedated, where an endoscope, which is a thin, flexible tube with a camera and light at the end, is inserted into the nose and through it, a doctor can see the condition of the airways and assess if the patient is suitable for hypoglossal nerve stimulation.

For very extreme OSA, surgery may be considered, such as tonsillectomy, adenoidectomy, or uvulopalatopharyngoplasty to remove auxiliary structures (the tonsils/adenoids/uvula) and widen the space at the top of the throat, making it easier for air to pass through, jaw surgery to change the position of the jaw so that the relaxed tissues don’t constrict the airway, or nasal surgery to straighten the nasal passages.

If you believe you are suffering from sleep apnoea or snoring, you can consult with a specialist on Top Doctors today