The dangers of sleep apnoea
How likely are you, or your partner, to doze off or fall asleep during the following activities?
Sitting and reading
Watching TV
Sitting inactive in a public place, like the cinema or a meeting
Sitting as a passenger in a car for an hour without a break
Lying down to rest in the afternoon
Sitting talking to someone
Driving in a car while stopped for a few minutes in traffic?
If you have answered ‘‘quite likely’’, ‘‘possibly’’ or ‘‘definitely’’ to any of these, then there is a chance you have obstructive sleep apnoea (OSA). You are not alone – it is estimated that around 4 per cent of adult males and 2 per cent of adult females suffer from this condition, with higher proportions of Ma¯ ori and Pacifica people affected. Children can be affected, too.
Despite being relatively common, OSA often goes undetected until it leads to other health issues, such as heart disease, high blood pressure or accidents resulting from daytime sleepiness.
OSA is a disorder of sleep, characterised by recurrent, partial or complete obstruction of the upper airways.
This airway ‘‘blockage’’ results from relaxation of the muscles in that area during sleep, enabling the tissues around the neck and throat to collapse inwards, obstructing the flow of air.
This obstruction leads to pauses in breathing, typically for between 10 and 30 seconds.
In severe cases, the pauses can last as long as a minute, which is often quite alarming for bed partners. After the breathing pause, there is a typical gasp during which the sufferer sucks in a big breath to replenish their oxygen levels.
This pattern can happen hundreds of times every night, leading to not only very poor quality of sleep, but also long-term hypoxia (lack of oxygen).
This hypoxia is what leads to medical issues such as heart disease.
The biggest risk factor for adults developing OSA is obesity. In fact, more than half of all people who have OSA are classified as obese. Other risk factors include smoking, excess alcohol, an underactive thyroid (known as hypothyroidism) and polycystic ovarian syndrome.
Obviously being excessively sleepy or fatigued is the major sign that you could be suffering from OSA, but other symptoms include: Snoring, choking or restlessness during sleep Having to get up at night to pass urine Vivid dreams Morning headaches Dry mouth Loss of libido Change in mood Poor concentration and reduced mental functioning.
If you think you do have OSA, I would recommend you score yourself on the Epworth Sleepiness scale (available on line at blf.org.uk/page/ Obstructive-sleepapnoea) and then book an appointment with your doctor. They will need to rule out other medical conditions that can cause sleepiness, such as diabetes or thyroid disease.
If they are concerned that OSA could be the cause they will refer you for a sleep study.
This test, known formally as polysomnography, involves monitoring a range of bodily functions overnight, including brain and muscle activity, heart rate and oxygen levels.
The results can conclusively diagnose OSA if it is present.
Treatment for OSA depends on its severity and also the level of risk your sleepiness will bring – for
example, if you are very sleepy but relatively inactive (perhaps living in a nursing home) the implications are less for you than if you were operating heavy machinery or performing brain surgery.
Lifestyle modification is effective and everyone with even mild OSA should be encouraged to stop smoking, minimise alcohol (especially in the evening) and lose weight. Driving should be completely avoided if the sleepiness is at the severe end of the spectrum.
In more serious cases, a machine known as CPAP can be used overnight. It fits over the face via a mask and pushes pressure into the airways,
forcing them to stay open. It is really effective, but unfortunately not everyone can tolerate sleeping with it on.
If a CPAP machine isn’t tolerated, jaw splints (known as mandibular advancement devices) can help. These need to be worn at night, and can be fitted by a dentist if needed.
For people who have enlarged tonsils or adenoids that are contributing to the obstruction, particularly children, surgical removal (known as adenotonsillectomy) can make a huge difference.
Obstructive sleep apnoea often goes undetected until it leads to other health issues, such as heart disease, high blood pressure or accidents resulting from daytime sleepiness.