Obstructive Sleep Apnoea
what are the causes and the effects?
Could you be suffering from Obstructive Sleep Apnoea?
Do any of these symptoms plague you?
- Does your partner complain about your snoring?
- Do you wake in the morning with a headache?
- Do you often feel very sleepy during the day?
- Are you more irritable that you should be?
- How is your memory? - especially short term.
- Do you experience breathlessness during the day, or at night?
- Are you a restless sleeper?
- Do you suffer from heartburn at night?
- Do you need to frequently get up to the toilet at night?
- Do you experience personality changes or often feel depressed?
- Do you wake in the night feeling that you are choking?
If you can answer 'yes' to some of these questions, it could be that you are suffering from 'Obstructive Sleep Apnoea' (more commonly spelt apnea). See your GP to discuss the problem and a diagnostic sleep study may be ordered.
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Now to get back to the Obstructive Sleep Apnoea
I have a friend who is a Clinical Nurse who works as a CPAP (Continuous Positive Airway Pressure) Consultant in a Sleep Laboratory. I was amazed when she told me just how common this disorder, obstructive sleep apnoea, is, and I was interested to learn that there are ways to relieve the situation.
I asked her to explain just what is 'Obstructive Sleep Apnoea' and what can be done about it. So, after picking her brains and doing some more research, here are a few nuts and bolts about the subject - just in case you are like me and haven't had a lot to do with this condition.
Basically, snoring is caused by repetitive pauses in breathing during sleep, due to obstruction or a mild narrowing of the upper airway (throat). This is usually accompanied by reduction in blood-oxygen saturation, and followed by an awakening to breathe. A more severe narrowing of the throat occurs when muscles become too relaxed and completely block the airway thus preventing breathing. This will lead to 'obstructive sleep apnoea', which is the most common form of sleep apnoea.
There are several different causes and factors that can lead to the narrowing of the throat during sleep, including:
- Obesity or weight gain: obesity, particularly around the neck, may cause a narrowing of the upper airways - it's true that we tend to gain weight on the inside as well as on the outside.
- Alcohol: drinking alcohol causes greater muscle relaxation during sleep than would normally occur, which can result in an abnormally collapsible upper airway. Excessive alcohol intake may also damage nerve cells in the brain which can decrease arousal responses.
- Nose or throat problems:
- any abnormal lumps such as nasal polyps, tonsil and adenoid enlargement, thyroid gland swellings or a large tongue can narrow the upper airway. Hayfever and smoking may lead to narrowed nasal passages which can aggravate snoring and lead to sleep apnoea.
- some people, just because of simple variations in the shape of the jaw, throat, face or nose, have a smaller than usual upper airway. These types of problems tend to run in families, so that if you are a snorer or have sleep apnoea, you may well have relations with the same problem.
- Medications: sleeping tablets or other medications may cause increased throat muscle relaxation.
- Being Male:(now there's a problem!) It is far more common for snoring to occur in men than in women. Women in their reproductive years seem to be protected from sleep apnoea, due, it is thought, to sex hormone differences and their effect on muscle strength and fat distribution (men tend to gain weight around their abdomen and neck, and women around their hips). The higher alcohol consumption by men could also be a factor.
Obstructive Sleep Apnoea and ‘simple’ snoring can occur in all age groups, including children and the elderly. A common cause for children is enlarged adenoids or tonsils. However, most people who have a problem with snoring are in the middle age group and by far the majority of these are men.
Some effects of Obstructive Sleep Apnoea:
It takes only a few minutes after breathing stops for our body’s oxygen stores to be used up and for damage to occur to the brain, heart, kidneys and other vital organs, so, as we breathe, if the flow of fresh air into the lungs is reduced or absent for more than a few seconds, the body's defense mechanisms are alerted and the brain is stimulated to wake up.
This allows a return of strength to the muscles of the pharaynx which opens the throat and allows air to flow again, and breathing to resume. Sleep takes over again and so starts another cycle of airway narrowing and the pattern repeats itself. In severe cases this cycle of breathing, apnoea, breathing, apnoea, etc, is repeated every 1-2-minutes.
When these apnoeas and arousals occur frequently (sometimes up to 400 per night), the night's sleep can be very disrupted. Rarely do these arousals lead to complete wakefulness so there is usually no recollection of the events the next day. Sometimes the person is fully aroused and wakes with a start & a choking feeling in the throat.
Is it any wonder that people suffering from these apnoeas feel tired and lethargic in the morning, often feeling as if they are suffering from a "hangover"? People who have had such an eventful night often remain sleepy throughout the day and tend to fall asleep ‘at the drop of a hat’ – often at inappropriate times, such as during meetings, watching TV or even driving their car! This can, of course, have dire consequences.
Any wonder, too, that this can be a cause of great concern to the partner who lies awake fearful that breathing might not start again. Repeated arousals in sleep apnoea and the associated oxygen deprivation disrupt the quality of sleep to such an extent that it can lead to slow mental functioning, poor memory, depression and loss of libido, as well as daytime sleepiness.
What tests are available to investigate snoring?
You need to discuss your snoring or sleep problem with your doctor. If you have a sleep partner, include them in the discussion as they will usually know more about what is happening to you during your sleep and will be able to fill in a few gaps.
Following a thorough history and examination by your doctor, you may be referred to a sleep disorder specialist. A detailed examination of the chest, heart, blood pressure, nose and throat and nervous system should be performed. It is recommended by those working in this field, that a diagnostic sleep study or polysomnogram should be performed before a diagnosis is made. Your doctor can refer you for a diagnostic sleep study and if the result is positive, then you will need to see a sleep physician who will probably then refer you for a second sleep study using CPAP (Continuous Positive Airway Pressure) equipment.
These studies are performed in a sleep unit or laboratory usually consisting of a number of private, quiet rooms with simple non-invasive equipment being used to monitor brain, heart, lung and other organ activity during sleep. Staff attach monitoring leads to the patient, prior to sleep, then work in an adjacent room to observe recordings.
What can be done to help those with Obstructive Sleep Apnoea?
The sleep study will diagnose and determine the severity of your sleep apnoea and available treatments will be discussed.
If you are told that you suffer from 'mild' obstructive sleep apnoea, some of the suggestions could be:
- weight reduction
- reduced alcohol intake
- keeping nose clear with medically prescribed nasal sprays
- avoiding sleep medication
- improving respiratory function – no smoking
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If the condition is more 'severe' then the “gold standard” treatment for obstructive sleep apnoea is to use a nasal CPAP mask and pump.
The mask fits over the nose, or over the nose and mouth, and delivers filtered room air at a pressure determined by a second sleep study. This aid acts as an 'air splint' to keep the upper airway open during sleep.
This CPAP machine is a relatively new invention by Professor Colin Sullivan of Sydney University and is proving to be a great help to sufferers of Obstructive Sleep Apnoea.
Other treatments could include an individually designed mouth splint and the recommendation that you sleep on your side, not your back. It is sometimes difficult to prevent people from rolling over on to their back during sleep, but, certainly by sleeping on the side there is less tendency for the tongue to fall back against the back wall of the throat.
My thanks to Sue Greta who has over 7 years experience in this specialist area, for her valuable input and to the article about Obstructive Sleep Apnoea which appeared on the Monash University web site.
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