Sleep Apnea

Sleep is essential for your physical health and emotional wellbeing. Everyone experiences occasional sleep problems, but if you experience sleep problems repeatedly, it could indicate an underlying health problem. Sleep disorders are problems associated with sleeping, including difficulty falling or staying asleep through the night, feeling sleepy during the day, or waking up feeling exhausted. Because of lack of sleep you may find it difficult to concentrate and perform activities of daily living. This lack of sleep can lead to depression, mood swings, or other health problems.

Sleep apnoea is a common sleep disorder in which breathing stops or gets very shallow during sleep. These breathing pauses last between 10 to 20 seconds or more. Apnoea causes sleep disruption because of reduced oxygen level in the blood.

Types

The types of sleep apnoea include:

• Central sleep apnoea: This type of apnoea is the least common and occurs when brain signals aren’t sent properly to the muscles involved in breathing.
• Obstructive sleep apnoea is the most common type of sleep apnoea and occurs because of airway obstruction preventing sufficient flow of air. In this condition, the brain signals are not interrupted however the muscular efforts to breathe will be unsuccessful.
• Mixed sleep apnoea is a combination of both central sleep apnoea and obstructive sleep apnoea.

Risk factors

Sleep apnoea can develop in anyone at any age, even in children. However, you are at higher risk for sleep apnoea if you are:

Male, overweight, and over the age of 40,

Physical traits that can raise your risk include:

• Having a large neck
• Nasal obstruction
• Large tonsils
• Large tongue
• Small jaw bone.

Other risk factors include a family history of sleep apnoea, or Gastroesophageal reflux or GERD.

Symptoms

The common symptoms of sleep apnoea include daytime sleepiness, weakness, repeated naps, headaches, irritation, sleeplessness (insomnia), waking up with a sore or dry throat, poor memory and concentration, and snoring.

Most people with obstructive sleep apnoea (OSA) often snore loudly. Immediate or abrupt awakening that may be accompanied by shortness of breath could be an indication of central sleep apnoea.

Complications of Sleep Apnoea

If left untreated Sleep apnoea can lead to complications such as hypertension, heart failure, heart rhythm disturbances, diabetes, depression, heart attacks, and stroke. 

People with sleep apnoea also have an increased risk of motor vehicle accidents from driving and poor performance at work or school. Children with untreated sleep apnoea can exhibit problems in attention and hyperactivity.

Diagnosis

Your doctor will diagnose sleep apnoea based on your signs and symptoms, your medical and family histories, a physical examination, and test results from sleep studies. Your doctor will make an evaluation and may refer you to a sleep specialist for testing and further evaluation.

Sleep studies are tests that monitors what happens to your breathing while you sleep. The most common sleep studies are:

Polysomnogram (PSG): A PSG is the most commonly used test in the diagnosis of sleep apnoea. This test records brain activity, eye movement, oxygen and carbon dioxide blood levels, heart rate and rhythm, breathing rate and rhythm, the flow of air through your mouth and nose, and body muscle movements.

Home-Based Portable Monitor: Your doctor may provide you a home based portable monitor to diagnose sleep apnoea. These tests usually involve measurement of airflow and breathing patterns. Your doctor may use these results to find out whether you require a full PSG study in a sleep centre.

Treatment

Sleep apnoea may be treated by:

Behaviour Modification - This therapy includes losing weight if overweight; avoiding alcohol or sedative medications, stopping smoking, and changing sleeping positions.

Dental devices: These are devices that hold the jaw forward and may be used for mild snoring and in people who have not responded to behavioural changes.

Medications: Nasal steroid sprays may be used to decrease inflammation in the nasal passages. Decongestant nasal sprays and drops are prescribed to relieve the stuffy nose. These medicines shrink the swollen blood vessels in the lining of the nose and help to improve snoring resulting from nasal congestion. Medications may also be used to increase daytime wakefulness in people with sleep apnoea.

Nasal continuous positive airway pressure: Nasal continuous positive airway pressure (CPAP) is a face mask device worn during sleep that prevents narrowing of the airway during inspiration and expiration by providing persistent increased air pressure. Another similar option is a “bi-level positive airway pressure (BiPAP)” in which the face mask allows for two different alternating pressures: one with inhalation and one with exhalation.

Surgical Treatment

Surgery may be considered to correct sleep apnoea if you have a deviated nasal septum, enlarged tonsils, or a small lower jaw. 

Nasal surgery: Nasal surgery is done to remove any nasal polyps present or to straighten a deviated nasal septum.

Uvulopalatopharyngoplasty (UPPP): Uvulopalatopharyngoplasty is the surgical removal of excess tissue from the back of the throat and palate to widen your airway. The procedure removes the tonsils, the uvula, and trims the palate of excess tissue.

Maxillomandibular advancement: Maxillomandibular advancement is a procedure which moves your upper (maxilla) and lower (mandible) jaws forward. This enlarges the space behind the tongue and soft palate and opens the airway.