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Sleep apnoea and snoring

Guide to respiratory problems and treatment

Sleep apnoea, sometimes written as sleep apnea, is a common condition in people who are overweight or obese but it can also occur due to a brain problem. People who experience sleep apnoea have their nightly sleep disturbed by an irregular breathing pattern. Every few minutes they stop breathing, and then are woken up with a jolt when they start to breathe again. This lack of ‘proper’ sleep leaves people with sleep apnoea tired and irritable during the day.

 

Snoring is a common condition that affects most people to a greater or lesser extent. Causes include allergies such as hay fever and viral infections such as the common cold.  Some people always snore because they have naturally narrow airways, in which case nasal strips may help the problem as they hold the nostrils open.

 

The noise of snoring is due to vibration of the soft tissue at the back of the nose and throat and is usually more of a problem for a partner, rather than the snorer. However, severe, loud snoring is more of a cause for concern as it is often accompanied by periods of sleep apnoea.

 

What happens in someone who has sleep apnoea?

Apnoea means ‘no breathing’ and refers to brief pauses in the normal breathing pattern that can happen when someone is asleep.The problem is usually noticed by a partner, as the person with the sleep apnoea does not attain full consciousness, even though their sleep is disrupted and of poor quality. It can be very alarming to lie alongside someone who appears to have stopped breathing.

 

As someone who is prone to sleep apnoea falls into a deep sleep, the muscles of their neck relax and their airway becomes narrowed and eventually closes completely. When breathing stops, carbon dioxide builds up and forces them to wake up, often with a loud gasp or snort.  The individual then falls asleep again, only for the pattern to repeat itself, often hundreds of times a night.

 

What is the impact of sleep apnoea?

The regular bouts of loud snoring punctuated by gaps in breathing and followed by sudden, loud snorts or gasps as breathing restarts is more than an annoyance. The lack of sleep that accompanies sleep apnoea can cause:

 

  • Extreme daytime sleepiness. People with sleep apnoea frequently fall asleep while relaxing, typically when watching TV. As the problem gets more severe, people can fall asleep at work or even when driving
  • Irritability, which can lead to angry outbursts
  • Inability to concentrate
  • Headaches, especially in the morning
  • Clumsiness, which can be dangerous when operating machinery
  • Forgetfulness
  • Changes in temperament, or unusual behaviour
  • Lowered sex drive
  • Anxiety or depression
  • Long-term damage to the lungs and heart.

 

The symptoms of sleep apnoea result from a lack of deep sleep, known as non-REM and REM sleep. The exact reasons why we need deep sleep are complex but it is thought that it is necessary to ‘reset’ the brain and nervous system, allowing chemical receptors to rest and regain their normal levels of sensitivity. This leads to an elevated mood and improved ability to concentrate and learn. Studies on sleep-deprived animals have revealed raised levels of stress hormones, which could explain the changes in mood and temperament often observed in people with sleep apnoea.

 

What are the underlying causes of sleep apnoea?

Sleep apnoea has three possible causes:

 

  • Obstructive sleep apnoea (OSA) where the muscles of the throat and neck relax and close the airway. This is by far the most common cause

  • Central sleep apnoea (CSA) where the brain doesn’t send regular signals to maintain regular breathing

  • Complex or mixed sleep apnoea, which is a mixture of obstructive sleep apnoea and central sleep apnoea.

 

Who is at risk from sleep apnoea?

Men are more likely to get sleep apnoea than women, especially the over 50s. Generally people are more at risk if they:

 

  • Smoke

  • Take sedatives

  • Have blocked airways due to nasal congestion, or allergies.

  • Are overweight, especially if they have a neck circumference of over 40 cm (16 inches)

  • Drink alcohol before going to bed

  • Have a weak/receding chin, leading to an overbite.

 

How is sleep apnoea diagnosed?

Sleep apnoea is defined as experiencing pauses in breathing of longer than ten seconds, more than ten times an hour when asleep. A partner could carry out an informal measurement and many GPs will diagnose sleep apnoea on this basis.

 

Sometimes diagnosis is less clear, in which case you may need to be referred to a sleep clinic. During a detailed assessment you will have tests that record breathing patterns, blood oxygen levels and pulse rate throughout the night. Alternatively, you might be provided with sensors that will record your sleeping pattern at home.

 

The ultimate investigation is polysomnography, which includes a thorough battery of tests:

 

  • Brain wave monitoring via EEG (electroencephalography)
  • Electromyography (EMG): muscle tone monitoring
  • Measuring mouth and nose airflow
  • Recording chest and abdominal movements
  • Measuring heart rate and blood oxygen saturation
  • Heart monitoring via electrocardiography (ECG)
  • Sound and video recording of you while you sleep.

 

Lifestyle changes that help snoring and sleep apnoea

Changes to lifestyle can go a long way towards minimising sleep apnoea or completely eliminating snoring, but they take effort and commitment. They include:

 

  • Losing weight so that your BMI falls to below 25

  • Removing any allergens such as animals and house dust that might be causing inflamed airways

  • Stopping smoking

  • Reducing alcohol intake, especially in the evenings.

 

Sleeping position may be important. One simple tactic to reduce snoring and sleep apnoea is to sleep on your side and avoid sleeping face up. You can stop yourself rolling over by placing pillows behind your back, or by sewing a tennis ball into your pyjama top.

 

Mechanical devices used to treat sleep apnoea

Mechanical devices are used in people whose sleep apnoea is severe and frequent. Sleeping using the following devices can help, but they take time to get used to:

 

  • Continuous positive airway pressure (CPAP) machines keep the airways open by gently forcing air into the lungs through a face mask. These can be very effective but uncomfortable

  • Mandibular advancement devices (MADs) are dental devices that resemble gum shields. They hold the lower jaw and tongue forward, which opens up the airways. These need to be fitted by a dentist or orthodontist.There may be a few side-effects including soreness, saliva build-up, nausea, and a permanent change in position of the teeth and jawbone.

 

 


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