Nothing to snore about: all about sleep apnoea

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 how it can 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.

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 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. A lack of quality sleep and oxygen to the brain can lead to high blood pressure, strokes, and depression.

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

To lower the risk factors of sleep apnoea, 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 is sleep apnoea 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.

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 machine (CPAP), which consists of a special mask that is worn during sleep 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.

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, you can consult with a specialist on Top Doctors today.