Sleep Apnoea

What Is Sleep Apnoea?

Sleep apnoea is a common disorder that can be very serious. In sleep apnoea, your breathing stops or gets very shallow while you are sleeping. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour.

The most common type of sleep apnoea is obstructive sleep apnoea. During sleep, enough air cannot flow into your lungs through your mouth and nose even though you try to breathe. When this happens, the amount of oxygen in your blood may drop. Normal breaths then start again with a loud snort or choking sound.

When your sleep is upset throughout the night, you can be very sleepy during the day. With sleep apnoea, your sleep is not restful because:

• These brief episodes of increased airway resistance (and breathing pauses) occur many times.
• You may have many brief drops in the oxygen levels in your blood.
• You move out of deep sleep and into light sleep several times during the night, resulting in poor sleep quality.

People with sleep apnoea often have loud snoring. However, not everyone who snores has sleep apnoea. Some people with sleep apnoea don’t know they snore.

• Sleep apnoea happens more often in people who are overweight, but even thin people can have it.
• Most people don’t know they have sleep apnoea. They don’t know that they are having problems breathing while they are sleeping.
• A family member and/or bed partner may notice the signs of sleep apnoea first.

Untreated sleep apnoea can increase the chance of having high blood pressure and even a heart attack or stroke. Untreated sleep apnoea can also increase the risk of diabetes and the risk for work-related accidents and driving accidents.

What Causes Sleep Apnoea?

Sleep apnoea happens when enough air cannot move into your lungs while you are sleeping. When you are awake, and normally during sleep, your throat muscles keep your throat open and air flows into your lungs. In obstructive sleep apnoea, however, the throat briefly collapses, causing pauses in your breathing. With pauses in breathing, the oxygen level in your blood may drop. This happens if the following conditions occur:

• Your throat muscles and tongue relax more than is normal.
• Your tonsils and adenoids are large.
• You are overweight. The extra soft tissue in your throat makes it harder to keep the throat area open.
• The shape of your head and neck (bony structure) results in somewhat smaller airway size in the mouth and throat area.

With the throat frequently fully or partly blocked during sleep, enough air cannot flow into your lungs, even though your efforts to breathe continue. Your breathing may become hard and noisy and may even stop for short periods of time (apnoeas).

Central apnoea is a rare type of sleep apnoea that happens when the area of your brain that controls your breathing doesn’t send the correct signals to the breathing muscles. Then there is no effort to breathe at all for brief periods. Snoring does not typically occur in central apnoea.

Who Is At Risk for Obstructive Sleep Apnoea?

Anyone can have obstructive sleep apnoea.

It is estimated that more than 12 million Americans have obstructive sleep apnoea. More than half the people who have sleep apnoea are overweight, and most snore heavily.

Sleep apnoea is more common in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnoea that causes them to be very sleepy during the day. Sleep apnoea is more common in African Americans, Hispanics, and Pacific Islanders than in Caucasians. If someone in your family has sleep apnoea, you are more likely to develop it than someone without a family history of the condition.

Adults who are most likely to have sleep apnoea:

• Snore loudly.
• Are overweight.
• Have high blood pressure.
• Have a decreased size of the airways in their nose, throat, or mouth. This can be caused by the shape of these structures or by medical conditions causing congestion in these areas, such as hay fever or other allergies.
• Have a family history of sleep apnoea.

Obstructive sleep apnoea can also occur in children who snore. If your child snores, you should discuss it with your child’s doctor or health care provider.

What Are the Signs and Symptoms of Sleep Apnoea?

The most common signs of sleep apnoea are:

• Loud snoring
• Choking or gasping during sleep
• Fighting sleepiness during the day (even at work or while driving)

Your family members may notice the symptoms before you do. Otherwise, you will likely not be aware that you have problems breathing while you are asleep.

Others signs of sleep apnoea may include:

• Morning headaches
• Memory or learning problems
• Feeling irritable
• Not being able to concentrate on your work
• Mood swings or personality changes; perhaps feeling depressed
• Dry throat when you wake up
• Frequent urination at night

How Is Sleep Apnoea Diagnosed?

Your doctor will do a physical exam and take a medical history that includes asking you and your family questions about how you sleep and how you function during the day. As part of the exam, your doctor will check your mouth, nose, and throat for extra or large tissues; for example, tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat).

Your doctor may order a sleep recording of what happens with your breathing while you sleep. A sleep recording is a test that is often done in a sleep center or sleep laboratory, which may be part of a hospital. You may stay overnight in the sleep center, although sleep studies are sometimes done in the home. The most common sleep recording used to find out if you have sleep apnoea is called a polysomnogram (poly-SOM-no-gram), or PSG. This test records:

• Brain activity
• Eye movement
• Muscle activity
• Breathing and heart rate
• How much air moves in and out of your lungs while you are sleeping
• The percentage of oxygen in your blood

A PSG is painless. You will go to sleep as usual. The staff at the sleep center will monitor your sleep throughout the night. The results of your PSG will be analyzed by a sleep medicine specialist to see if you have sleep apnoea, how severe it is, and what treatment may be recommended.

In certain circumstances, the PSG can be done at home. A home monitor can be used to record your heart rate, how air moves in and out of your lungs, the amount of oxygen in your blood, and your breathing effort. For this test, a technician will come to your home and help you apply the monitor that you will wear overnight. You will go to sleep as usual, and the technician will come back the next morning to get the monitor and send the results to your doctor.

Once all your tests are completed, the sleep medicine specialist will review the results and work with you and your family to develop a treatment plan. In some cases, you may also need to see another physician for evaluation of:

• Lung problems (treated by a pulmonologist)
• Problems with the brain or nerves (treated by a neurologist)
• Heart or blood pressure problems (treated by a cardiologist)
• Ear, nose, or throat problems (treated by an ENT specialist)
• Mental health, such as anxiety or depression (treated by a psychologist or psychiatrist)

How Is Sleep Apnoea Treated?

Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness. Treatment will also help associated medical problems, such as high blood pressure, and reduce the risk for heart attack and stroke.

Changes in Activities or Habits

If you have mild sleep apnoea, some changes in daily activities or habits may be all that are needed:

• Avoid alcohol, smoking, and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
• Lose weight if you are overweight. Even a little weight loss can improve your symptoms.
• Sleep on your side instead of your back. Sleeping on your side may help keep your throat open.

People with moderate or severe sleep apnoea will need to make these changes as well. They also will need other treatments, such as the following.

Continuous Positive Airway Pressure

Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnoea. For this treatment, you wear a mask over your nose during sleep. The mask blows air into your throat at a pressure level that is right for you. The increased airway pressure keeps the throat open while you sleep. The air pressure is adjusted so that it is just enough to stop the airways from briefly getting too small during sleep.

Treating sleep apnoea may help you stop snoring. Stopping snoring does not mean that you no longer have sleep apnoea or that you can stop using CPAP.

Sleep apnoea will return if CPAP is stopped or if it is not used correctly. Usually, a technician comes to your home to bring the CPAP equipment. The technician will set up the CPAP machine and make adjustments based on your doctor’s orders.

CPAP treatment may cause side effects in some people. Some side effects are:

• Dry or stuffy nose
• Irritation of the skin on your face
• Bloating of your stomach
• Sore eyes
• Headaches

If you are having trouble with CPAP side effects, work with your sleep medicine specialist and technician. Together you can do things to reduce these side effects, such as:

• Use a nasal spray to relieve a dry, stuffy, or runny nose.
• Adjust the CPAP settings.
• Adjust the size/fit of the mask.
• Add moisture to the air as it flows through the mask.
• Use a CPAP machine that can automatically adjust the amount of air pressure to the level that is required to keep the airway open.
• Use a CPAP machine that will start with a low air pressure and slowly increase the air pressure as you fall asleep.

People with severe sleep apnoea symptoms generally feel much better once they begin treatment with CPAP. When using CPAP, it is very important that you follow up with your doctor. If you are having side effects, talk to your doctor.

Mouthpiece

A mouthpiece (oral appliance) may be helpful in some people with mild sleep apnoea. Some doctors may also recommend this if you snore loudly but do not have sleep apnoea.

A custom-fit plastic mouthpiece will be made by a dentist or orthodontist. An orthodontist is a specialist in correcting teeth or jaw problems. The mouthpiece will adjust your lower jaw and your tongue to help keep the airway in your throat open while you are sleeping. Air can then flow easily into your lungs because there is less resistance to breathing.

Possible side effects of the mouthpiece include damage to your:

• Teeth
• Gums
• Jaw

Follow up with your dentist or orthodontist to check for any side effects and to be sure that your mouthpiece fits.

Surgery

Some people with sleep apnoea may benefit from surgery. The type of surgery depends on the cause of the sleep apnoea.

• Surgery may be done to remove the tonsils and adenoids if they are blocking the airway. This surgery is especially helpful for children.
• Uvulopalatopharyngoplasty (U-vu-lo-PAL-a-to-fa-RIN-go-plas-te) (UPPP) is a surgery that removes the tonsils, uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and part of your soft palate (the roof of your mouth in the back of your throat). This surgery is only effective for some people with sleep apnoea.
• Laser-assisted uvulopalatoplasty (U-vu-lo-PAL-a-to-plas-te) (LAUP) is a surgery that can stop snoring but is probably not helpful in treating sleep apnoea. A laser device is used to remove the uvula and part of the soft palate. Because this surgery stops the main symptom of sleep apnoea (snoring), it is important to have a sleep study first.
• Tracheostomy (TRA-ke-OS-to-me) is a surgery used in severe sleep apnoea. A small hole is made in the windpipe and a tube is inserted. Air will flow through the tube and into the lungs. This surgery is very successful but is needed only in patients not responding to all other possible treatments.

Other possible surgeries for some people with sleep apnoea include:

• Rebuilding the lower jaw
• Surgery on the nose
• Surgery to treat obesity

Currently, there are no medicines for the treatment of sleep apnoea.

Living With Sleep Apnoea

Getting treatment for sleep apnoea and following your doctor’s advice can help you and your family members.

• Getting treatment for sleep apnoea can help snoring and can improve your sleep.
• Treating sleep apnoea helps you feel rested during the day.
• Many people will benefit by making healthy changes, such as stopping smoking and losing weight.
• Some people will need to wear a mask at night to help keep the throat open and improve breathing.
• A few people will need to have surgery to remove tonsils and adenoids, part of the uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and/or the soft palate (the roof of your mouth in the back of your throat) that may block the airway.
• Regular and ongoing followup is needed; your sleep medicine specialist will check whether your treatment is working and whether you are having any side effects.

What Can Family Do To Help?

Often, people with sleep apnoea do not know they have it. They are not aware that their breathing stops and starts many times while they are sleeping. Family members or bed partners are usually the first ones to notice that the person snores and stops breathing while sleeping.

There are many things family members can do to help a loved one who has sleep apnoea, including:

• Letting the person know if he or she snores loudly during sleep or has breathing stops and starts
• Encouraging the person to get medical help
• Helping the person follow the doctor’s treatment plan, including continuous positive airway pressure (CPAP)
• Making sure the person puts on the CPAP mask before falling asleep
• Providing emotional support
• Helping with insurance paperwork

Sleep apnoea can be very serious. People with sleep apnoea are at higher risk for car crashes, work-related accidents, and other medical problems due to their sleepiness. It is important that people with sleep apnoea see their doctor to treat and control this disorder.

Treatment may improve a person’s overall health and happiness as well as the quality of sleep for both the person and the entire family.

Key Points

• Sleep apnoea is a common breathing disorder that can be very serious.
• In sleep apnoea, your breathing stops or becomes very shallow for periods of 10 to 20 seconds or longer many times during the night.
• The most common type of sleep apnoea is obstructive sleep apnoea.
• It is estimated that more than 12 million Americans have sleep apnoea.
• The most common signs of sleep apnoea are loud snoring and choking or gasping during sleep and being sleepy during the day.
• Having a physical exam and providing your doctor with information about your sleep will help to diagnose sleep apnoea. Your doctor may also want you to have special sleep tests.
• Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as loud snoring and daytime sleepiness. Treatment will also help associated medical problems, such as high blood pressure, and reduce the risk for heart attack and stroke.
• Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnoea.
• Some people with sleep apnoea may benefit from surgery.
• Family members can help a person who snores loudly or stops breathing while sleeping by encouraging him or her to get medical help.
• Treatment for sleep apnoea may improve a person’s overall health and happiness as well as the quality of sleep for both the person and the entire family.