Snoring and Sleep Apnoea

Introduction

Most people have trouble sleeping at some point in their lives. This can be due to a variety of reasons including stress, too much caffeine, some types of food etc. There are many people in our communities who have a particular problem with loud snoring. Although these people are vulnerable to being made fun of, loud snoring is not a joking matter. For many, it may signal a breathing problem during sleep. Some snores stop breathing for brief periods throughout the night and may develop a condition called "sleep apnoea". Early recognition and treatment of sleep apnoea is important because it may be associated with numerous medical problems.

What is sleep apnoea?

Sleep apnoea is a serious, potentially life-threatening condition that is far more common than is generally recognised. It is a breathing disorder characterised by brief interruptions of breathing during sleep. Despite the person's continuous efforts to breathe, they are unable to pass air into or out of the nose or mouth due to the relaxation of muscles that control the tongue and soft palate to an extent wherein complete blockage of the breathing passage may occur. This also called "Obstructive Sleep Apnoea" or OSA. After a period of time which may range from ten seconds to two minutes, the brain realises that there is a lack of oxygen and alerts the body to wake up. This cycle may happen several hundred times during the night, severely disrupting sleep. Many times, the sufferer is not even aware of it.

The breathing pauses or apnoeic events are almost always accompanied by snoring between the episodes, although it is important to note that not every one who snores has this condition. Sleep apnoea can also be characterised by choking sensations. One can often tell if someone has OSA by listening to the person whilst they sleep. What you may hear is loud snoring followed by a period of silence. There may then be a loud snort or a gasp as they start breathing again. The frequent interruptions of deep sleep often lead to early morning headaches and excessive daytime sleepiness.

Who gets sleep apnoea?

Sleep apnoea affects all ages and both sexes and it affects about 10% of the population. It appears to be more common in males. Approximately 20 million people in North America may have sleep apnoea. 4% of middle aged men and 2% of middle aged women have sleep apnoea along with excessive daytime sleepiness. There are many risk factors for developing sleep apnoea:

¿ Loud snoring
¿ Obesity and being overweight
¿  High Blood Pressure
¿  Physical abnormality in the nose, throat, or other part of the breathing passage
¿   There is a possible genetic basis.

Can sleep apnoea be hazardous to your health?

As the breathing passage is narrowed, air is unable to flow into or out of the nose or mouth. This leads to heavy and loud snoring, periods of no breathing, and frequent arousals which causes abrupt changes from deep sleep to light sleep. Because of the serious disturbances in sleep patterns, sleep apnoea can cause people to feel very sleepy and drowsy during the day and affect the person's day time performance and concentration. Sleep apnoea can cause very grave consequences to a person's health. This includes:

¿     Depression.
¿     Irritability - this can have a huge impact on an individual's working and family life and social functioning.
¿      Sexual Dysfunction.
¿     Memory and learning difficulties.
¿     Daytime sleepiness - often these people will fall asleep at work especially in the afternoon or fall asleep whilst driving or talking. This can be especially dangerous and even life threatening. In order to keep awake, the individual often resorts to the ingestion of stimulants such as caffeine and nicotine (smoking).
¿      High Blood Pressure - up to 50 % of sleep apnoea patients have high blood pressure and sleep apnoea appears to contribute to it.
¿     Heart Attack and Stroke - The risk of heart attack and stroke increases in those with sleep apnoea.
¿    Morning headaches - this is a common symptom in those with sleep apnoea and can be quite debilitating for certain people.

Do I have sleep apnoea?

For many sleep apnoea people, their spouses are the first ones to suspect that there is a problem, usually from their loud snoring, pauses of no breathing and then a gasp or snort resulting from the apparent struggle to breathe. Co-workers or friends may notice the person falling asleep during the day at inappropriate times such as during work, whilst driving a car, talking etc. Sometimes, sleep apnoea is associated with restlessness and leg movements during the night whilst asleep. Often, sleep apnoea is accompanied by a morning headache.

As mentioned above, the individual with sleep apnoea can be quite irritable, depressed, have problems with sexual function, high blood pressure and other medical illnesses. Sleep apnoea can affect the person's medical, social and spiritual well being. The person often is unaware that there is a problem and may not believe it when told. It is important that the person see a doctor for evaluation of the sleep problem. Most likely, the doctor will refer the individual suspected of having sleep apnoea to a sleep laboratory for a "sleep study". This will diagnose the sleep problem so that treatment can be instituted.

Is there treatment available for sleep apnoea?

The specific treatment of sleep apnoea is tailored to the individual and depends on the results of the sleep study:

Behavioural changes - certain life style changes are important in reducing the apnoeic events. The individual should avoid the use of tobacco and sleeping pills which makes the sleep apnoea worse. Overweight persons should make efforts to reduce weight as even a 10% reduction in weight will have a significant reduction in decreasing apnoeic events. In some patients with mild sleep apnoea, breathing pauses occur when they sleep on their backs and therefore using special pillows and other devices that assist them to sleep on their sides is often helpful.

Medical treatment - The most effective treatment for sleep apnoea is Nasal Continuous Positive Airway Pressure (CPAP). This involves the wearing of a nasal mask during sleep which blows air under a certain pressure through the nasal passages. The pressure is constant and continuous. Nasal CPAP therefore prevents airway closure and prevents the apnoeic periods.

In mild cases, dental appliances that reposition the lower jaw and tongue have been helpful and have been effective in also reducing the snoring. A dentist or orthodontist is often required to fit the device for the person.

Surgery - Some patients with sleep apnoea need surgery to treat the illness. There are many surgical procedures that can be used to expand the size of the airway although most are not completely successful and have many risks associated with them. Many times, more than one procedure may need to be tried for effective results.

Conclusion

Snoring and sleep apnoea is common and can have very serious consequences to the health of an individual. It is important that this illness is recognised and appropriate evaluation is sought from a doctor with referral for a formal sleep study. There are many treatments available for sleep apnoea. Life style changes are a critical part of the treatment regimen and nasal CPAP still remains the most effective treatment.

For further details, please contact Medical Advisory Board Secretariat.