Don’t ignore those snores
Dr Tom Mulholland is an Emergency Department Doctor and GP with over 25 years’ experience in New Zealand. He’s currently a man on a mission, tackling health missions around the world.
Are you tired of being tired? Fatigue is normal after prolonged mental or physical exertion but it is neither safe nor sustainable. Many people understandably selfdiagnose fatigue and self-treat without a proper diagnosis. One of the more common dangerous causes of fatigue is called sleep apnoea. The word apnoea means ‘‘without breath’’. Sleep apnoea is then defined as the cessation of breathing for more than 10 seconds. There are a number of causes but obstructive sleep apnoea (OSA) is the most common.
OSA is more prevalent in overweight middle-aged men and heavy snoring is a common feature with interrupted gasps and pauses. The lack of oxygen makes us wake up to breathe. It not only disrupts our own sleep but the sleep of those close to us, because they fear the apnoea or are wakened by the snoring. As the muscles of the throat and tongue relax the airway becomes blocked, and we essentially suffocate. OSA can range from mild to severe with many apnoeic attacks in one hour. As the brain doesn’t get into deep sleep mode this can have serious complications.
Excessive daytime drowsiness, including falling asleep at the wheel, during conversation or watching TV may be all signs of sleep apnoea. Other symptoms include morning headaches, irritability, memory loss, anxiety, depression, loss of libido and even heart failure.
After speaking at a recent transport conference on fatigue I was offered the chance to see if I suffer from OSA. It is simple procedure: you place your finger in a small oxygen saturation meter and wear a set of nasal prongs. A history is taken and the results analysed. The pulse oximeter can tell if you have significant desaturations while the nasal prongs can pick up the apnoeic episodes.
Fortunately, my results showed no significant desaturations or apnoeic episodes. Given that 4 per cent of males and 2 per cent of females have significant OSA – and I am more at risk, being a middle-aged male who carries a few extra pounds – I can count myself lucky. Unfortunately, there are many others who aren’t so lucky and OSA causes major risks at work and at home for many drivers and operators of heavy machinery. It has been an undiagnosed problem for many years and one, I believe, that’s still being underdiagnosed.
It would be useful to have a robust screening programme and more targeted questioning for sleep apnoea at driver and work medicals. The aim should be to diagnose and treat OSA rather than penalise people for having it. Fortunately, the treatments are getting easier and less invasive. Weight loss and reduction of alcohol may help but not all people with OSA are overweight and drink alcohol.
The mainstay of treatment for OSA is CPAP, continuous positive airway pressure, which keeps the airway open, giving both the patient and their loved one a good and safe night’s sleep.
Given those with OSA have a threefold higher risk of workplace accidents, 40 per cent more risk of depression and are likely to have twice as many traffic accidents, it makes good economic sense to diagnose and treat Obstructive Sleep Apnoea. It may save your marriage, your life or someone else’s. So, what are you waiting for? Take the test.