Almost all of us snore. Some of our bedrooms are accompanied by a soundtrack of a gentle rhythmic hum, while others are filled with a loud rumble. For most, snoring can be considered entirely normal, but for some people, it is a marker that not all is well – it may be an indication of a condition known as sleep apnoea.
Sleep apnoea refers to pauses in breathing during sleep. Rarely, this may be due to the brain not signalling for us to breathe – something known as central sleep apnoea. But a far more common is obstructive sleep apnoea (OSA). This occurs when there is a mechanical obstruction in the airway that prevents air from entering the lungs when we breathe in during sleep.
OSA is very common. It affects about 13 per cent of men and 6 per cent of women and is more prevalent in older people but can also affect children.
undefined
So how does it arise? The upper airway that links the mouth to the windpipe is essentially a floppy tube, held open in part by many small muscles. As we drift off to sleep, these muscles lose tension, which increases the tendency of the airway to collapse when we breathe in.
Anything that makes our airway narrower can increase the risk of it being blocked off during sleep. Having large tonsils or even a small lower jaw can all contribute. Sleeping on our backs and sleeping with our mouths open can also have an impact.
However, obesity is the single strongest risk factor for OSA, mainly due to fat deposits gathering in and around the airway. Being male also increases the risk by about two or three times, most likely due to hormonal effects on breathing control.
Each time the airway is obstructed we partially awaken (something that we may or may not be aware of), until breathing returns to normal. Sometimes this can lead to disruption of sleep several times a night, but in the most extreme cases, it can occur more than a hundred times an hour.
People with OSA will often be very sleepy during the day as a result of very poor and broken sleep overnight, and they will occasionally experience a sensation of choking or gasping overnight. The reverberation of the soft tissues at the back of the throat may cause inflammation or irritation, causing people to wake with a sore throat or dry mouth.
Some effects of OSA are less obvious. Due to hormonal changes related to the effects of these obstructions and sleep disruption, people with OSA may get up frequently at night to pee and may gain weight due to increased appetite. Occasionally OSA may even feel like you are not sleeping and can be mistaken for insomnia.
Read more:
- Tired all the time? Here’s how to kick sleep deprivation for good
- Why do we sleep?
- Keeping your eyes open can help you to fall asleep faster. Here's why
OSA can be bad for your health in a number of ways. This comes as a result of recurrent drops in oxygen in the bloodstream, changes to the nervous system and how they influence the blood vessels, and increased inflammation.
Sleep apnea has been linked to a range of conditions like high blood pressure, type 2 diabetes, cardiovascular disease and stroke. OSA has also been associated with various aspects of brain health, including cognitive abnormalities, mood and anxiety levels and even dementia.
However, the jury remains out on whether OSA directly causes these problems; while evidence grows that OSA contributes to these conditions, definitive proof that treating it reduces risk remains scant.
When it comes to treatment, one of the big problems is recognising that you have OSA in the first place. The symptoms often creep up on people, and so often go unnoticed for many years.
An additional issue is the lack of knowledge about the condition until recent years, and the lack of clinical services in the UK to treat it. For these reasons, it is estimated that about 80 per cent of people with OSA in the UK are undiagnosed and untreated.
There are however several treatment options. If you’re carrying extra weight, weight loss can help and can even cure it entirely. If your sleep apnoea only occurs when you‘re sleeping on your back, a range of devices known as positional sleep trainers can be used to promote sleeping on your side.
Dental retainers, called mandibular advancement devices, that hold the lower jaw in place, pushing it forward a little and expanding the airway can also provide relief.
For more severe OSA, the best treatment is called automated positive airway pressure (APAP). This involves wearing a mask strapped to the face, which may cover the nose, the mouth or both. The mask is attached to a small machine that generates positive air pressure, essentially preventing the airway from collapsing.
The sensation is a little like breathing into a strong wind. While not tolerated by everyone, APAP can transform the sleep of people with OSA and can change their lives. In the last year or two, for highly selected individuals, a medical device similar to a pacemaker can even be surgically inserted. This stimulates the muscles of the tongue and throat in sleep, keeping the airway open.
It’s important to remember that anyone can have OSA – any age, any gender, any weight. But if you are snoring, are waking with a sensation of choking or gasping, or have been noted to stop breathing in your sleep, your first port of call should be your doctor.
They can provide you with a simple home-based test to monitor your oxygen levels and breathing patterns and then determine the appropriate treatment. This can make the difference between feeling like a train wreck throughout the day or waking up fresh as a daisy. There’s no need to suffer in (relative) silence.
Read more: