Sleep apnoea is also known as obstructive sleep apnoea or OSA. Sleep Apnoea occurs when the throat muscles relax during sleep, the tongue falls backwards and blocks the airway. Snoring is often an indicator of sleep apnoea, and the more chronic the snoring, the more chronic the sleep apnoea.
A rarer form of sleep apnoea is called central sleep apnoea – where the person’s breathing stops entirely while they sleep, and there is a pause before breathing begins again. It is caused by a disruption to the mechanisms in the central brain that control the rate and depth of breathing.
How does sleep apnoea work?
Sometimes the throat can collapse so much that not enough air can get into the lungs, called hypopnea, or it blocks the airway completely, and no air gets into the lungs, called apnoea.
Suffers of apnoea may have partial, complete or combination obstructions. The rate of breathing may decline or stop entirely for a period of up to three minutes in the most extreme cases. In the general populace, around 10 – 60 seconds is the average length of an episode or sleep interruption.
When this happens, the blood chemistry changes and the brain receives the message that something is wrong. The brain will arouse itself from sleep for a few seconds to correct the problem, allowing normal breathing to resume. Most people are not even aware of these arousals, as they never fully wake. This pattern can repeat hundreds of times every night, causing you to have a fragmented sleep.
How can sleep apnoea affect you?
When waking in the morning, the person often feels exhausted and underslept, but has no idea their brain woke multiple times during the night as their body did not physically rouse. This can leave you feeling unrefreshed in the morning and fatigued throughout the day. As a result of the sleep deprivation, a sufferer may be unable to concentrate on simple tasks and follow simple commands.
All areas of your life can be affected by this, and it can show in your work performance and general demeanour. You may find people refer to you as grumpy or irritable and not your usual self.
Who is at risk of developing sleep apnoea?
Anyone and everyone can develop sleep apnoea at any time throughout their life. Would you know what to do if your loved one suddenly stopped breathing?
It’s estimated that around one in twenty Australians suffer from sleep apnoea. In the over thirty age bracket, the condition is three times as common in men, with up to a quarter of men over thirty affected by the condition.
People with narrow throats or fat tongues are more likely to have sleep apnoea and snore during sleep when their throat muscles relax. Back sleepers and people who drink alcohol also increase the chances of developing sleep apnoea. By far, the most common cause is being overweight or obese – extra body fat can compress your chest, lungs, and neck, causing restrictions to the body’s normal operation while sleeping and place it under stress.
Sleep apnoea severity
The severity of sleep apnoea depends on several factors which influence how often your breathing is interrupted and, more importantly, why it is interrupted. Most people snore at some point in their lives or in certain sleeping position. Having colds, flus, medications and alcohol in your system will all cause snoring for different reasons. For the sake of having a rough guide so you can assess yourself, your partner, or your child is as follows:
- Normal sleep – none to fewer than five interruptions per hour is deemed a healthy normal sleep zone.
- Mild sleep apnoea – When the person has between 5 and 15 interruptions per hour you will have developed a mild sleep apnoea that might be short-term in duration to illness or the presence of alcohol.
- Moderate sleep apnoea – Now we are getting serious. If the person is experiencing between 15 and 30 sleep interruptions per hour and there is no illness or alcohol to exacerbate the situation, you need to seek out a sleep study and talk to a professional about your options.
- Severe sleep apnoea – People with severe sleep apnoea are likely to already be aware of their problem – it’s likely that everyone in the house can hear when they snore,and thus when they suddenly stop snoring. If you or they experience more than 30 interruptions per hour, you need to seek medical assessment and treatment. A sleep study will allow the detailed of your brain and oxygen saturation levels during sleep, to determine exactly what is going on and why.
Symptoms of sleep apnoea
The symptoms of sleep apnoea include:
- Daytime sleepiness and fatigue (on a daily basis)
- Dry mouth and dehydration headache upon waking
- Poor concentration, poor memory, slow reaction times and an inability to focus attention
- Irritability, mood changes and short temper
- Poor sleep quality – with regular periods of depressed, reduced or absent breathing accompanied by loud snoring and/or gasping for air. This will often be a cycle. Snoring, no breathing, then a sudden gasp or gulping for air, back to sleep, snoring, no breathing and so on repeatedly for the entire time their body is considered to be sleeping.
- Impotence and possible erectile dysfunction in men and decrease in libido in general.
People with significant sleep apnoea have an increased risk of motor vehicle accidents due to inattention and the inability to focus for more than a few seconds before their minds are distracted. There is also the risk of chronic sleep deficit seeing the person engage in microbursts of sleep or outright fall asleep behind the wheel with fatal consequences.
Contributing factors of sleep apnoea
- Being overweight or obese – excess fat on the neck surrounds the windpipe, and the weight constricts the throat making it narrower.
- Age – as people get older, their general muscle integrity decreases and the throat muscles are no exception.
- Alcohol relaxes the throat muscles during sleep leading to sleep apnoea and snoring.
- Certain illnesses include colds, flu and sinus congestion from allergies and hay fever.
- Large tonsils and swollen adenoids may be a contributing factor for sleep apnoea in children. The surgical removal of both can fix the problem but is not guaranteed to do so.
- Certain medications with muscle relaxant properties like sleeping tablets, sedatives, and depression medications.
- Nasal congestion and obstruction via broken noses and a deviated septum.
- Facial jaw shape, things like jaw deformity in the form of underbites and overbites that affect where the relaxed tongue is positioned in the mouth during the sleep stages.
How is sleep apnoea diagnosed?
If you recognise the signs and symptoms of sleep apnoea, see your GP. If your GP suspects you may have sleep apnoea, you will be referred to a sleep specialist for a sleep study. Most sleep studies can now be conducted in your own home, but some are still undertaken in specialised sleep clinics.
Treatment for sleep apnoea
Sleep apnoea is a treatable condition in 99% of the population. Treatment may range from simple and easy to apply lifestyle changes and move to more serious changes like surgery. There are also external breathing devices like CPAP machines.
Lifestyle changes include:
- Weight loss – for people who are overweight, losing some of that weight will improve your sleep apnoea and possibly cure it entirely.It’s easy to underestimate the significance of an extra 5-10kgs compressing the chest and neck. Even half a kilo can be the difference between snoring and not snoring at night in some people.
- Decreasing or ceasing your alcohol intake.
- CPAP machine or Continuous Positive Airway Pressure device.
The key to CPAP treatment is finding the right mask and machine that match your needs. They are not always comfortable to sleep with, and the constant pressure can, in some people, create more problems than the apnoea, so they opt to discontinue use, and the cycle starts once more.
A mandibular advancement splint or MAS might be considered if you have mild to moderate sleep apnoea. They need to be fitted by a dentist and worn whenever sleeping. They are also used as a treatment for snoring. Some chemists stock a cheaper version in the mouth guard section you could trial for effectiveness before undertaking the expense of having a personalised MAS created and fitted.
Upper airway surgery
Upper airway surgery aims to create more room in the throat by removing tissue from the throat. However, there is a limit to how much tissue can be removed, and it does not prevent the throat from collapsing during sleep, so it may not be effective over the long term.
If you recognise any of the signs and symptoms in this article, you or the person who has them should talk to your GP. Don’t run the risk of putting your health, your life, or others at risk from the side effects of sleep deprivation. Ensure you get the right information from a doctor, and you will be back to sleeping the entire night soundly through (parents with infants excluded).
Would you know what to do if someone stopped breathing?
One thing which can help your piece of mind is to learn what to do if someone really does stop breathing. Taking a CPR course can teach you how to assess a person who’s not breathing normally, when to call for help, and how to apply CPR to provide oxygen to their brain until help arrives.