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 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 breathing stops during sleep and pauses 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.
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. In the most extreme cases, the breathing rate may decline or stop entirely for up to three minutes. In the general populace, between 10 -60 seconds is the average length of episodes or sleep interruption.
When the above things happen, 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, and most people are unaware of these arousals. They wake up feeling exhausted and like they got no sleep but have no idea their brain woke multiple times during the night even if their body did not physically wake.
This pattern can repeat itself hundreds of times every night, causing you to have a night of fragmented sleep. This can leave you feeling unrefreshed in the morning with fatigue and sleepiness throughout the day. As a result of sleep deprivation, you will be unable to concentrate on simple tasks and follow simple commands.
All areas of your life will be affected and begin to 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?
‘Current Sleep Study Data estimates that around 5% of Australians have sleep apnoea, with around 1 in 4 men over 30 affected. In the over-30 age group, the disorder is about three times more common in men than women.’
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. All those extra kilos of fat compress your chest, lungs, and neck, causing restrictions to the body’s normal operation while sleeping and placing it under stress.
Sleep Apnoea Severity
The severity of sleep apnoea depends on several vectors and the way they influence how often your breathing is interrupted and, more importantly, why your breathing is interrupted. Everyone will snore at some point in their lives or in a certain position. Having colds, flu cases, 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 a sleep study and talk to a professional about your options.
- Severe sleep apnoea – No one with severe sleep apnoea is unaware of their problem. It is likely the neighbours three houses away can hear them snoring and gasping for air when they sleep. If you or they experience more than 30 interruptions per hour, you need to seek immediate medical assessment and treatment. A sleep study will allow the detailed mapping of your brain and oxygen saturation levels as you sleep to determine exactly what is going on and why.
Symptoms Of Sleep Apnoea Include:
- Daytime sleepiness and fatigue that is a daily occurrence
- 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 contributing factors 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.
What Is The Treatment For Sleep Apnoea
Sleep apnoea is a treatable condition in 99 per cent 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 – in people who are overweight or obese, losing weight will improve your sleep apnoea and possibly cure it entirely. Think about it for one minute. If you suddenly went to bed and fell asleep and someone added five kilos to your chest or neck, how well are you going to sleep with the extra weight compressing your chest, lungs and airway? Even half a kilo can be the difference between snoring and not snoring at night in some people. Airway management and breathing is a crucial part of survival for any air-breathing mammal. Could you perform CPR on someone, and how do you know when they need CPR?
- Losing weight also has other health benefits across the spectrum for your vital organs.
- Decreasing or ceasing your alcohol intake.
- CPAP machine or Continuous Positive Airway Pressure device.
CPAP is the most common treatment for sleep apnoea. It is non-invasive and uses a small pump that blows air through tubing into a mask worn on the nose and/or mouth. This positive air pressure is continuous, forcing the back of the throat to remain open after the throat muscles have relaxed during sleep.
The key to CPAP treatment is finding the right mask and machine that match your needs. They are not 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).
Basic First Aid And CPR
Lastly, when was the last time you took a refresher course and brushed up on your CPR and First Aid skills? Like most people, it was probably over a decade ago, and as times change, so does the way medicine is practised. Consider booking yourself onto a FACE First Aid course and gaining national certification. While you are there, check out our FACE Blog Page for a range of interesting topics to motivate and inspire you.