Sleep apnoea 101: What is it and how to treat it

There are other things apart from a nightmare that can plague your sleep. Sleep apnoea is a serious sleep disorder in which sufferers repeatedly stop breathing while sleeping.

There are fewer things scarier than knowing that you could stop breathing at any moment during your sleep. But that’s precisely what sufferers of sleep apnoea have to contend with every time they catch their forty winks.

Estimated to afflict around 15 per cent of Singapore’s population, sleep apnoea is a serious health condition that can impact your quality of sleep and life if left untreated.

What is sleep apnoea?

Sleep apnoea is a sleep disorder that occurs when your airway collapses partially or fully during your sleep, leading to a decrease in oxygen intake. Such disturbances often lead to fragmented and non-restorative sleep, making it difficult for you to get adequate rest.

Sleep apnoea occurs when there is not enough space in a portion of your upper airway to accommodate for sufficient airflow. As the muscle tone decreases, it leads to repetitive total or partial collapse of your airway.  Each time this happens, it is known as an apneic episode and it can happen many times over the course of a single night.

Risk factors for sleep apnoea

Sleep apnoea happens for all age groups and genders, though it is more commonly found in men. This means that we should all be paying attention to our sleeping patterns and be on the look out for any unusual signs or disturbances as this condition can happen to anyone.

There are however certain risk factors for sleep apnoea that be categorised into congenital risk factors, medical risk factors, and lifestyle factors.

Congenital risk factors for sleep apnoea include:

• Micrognathia, retrognathia, or a lower jaw that is smaller and further behind than where it should be
• Facial elongation
• Mandibular hypoplasia, or undersized lower jaw
• Adenoid (a lymphatic tissue between the back of the nose and throat) and tonsillar hypertrophy, or when your adenoids and tonsils are enlarged
• Down syndrome
• Prader Willi syndrome
• Inferior displacement of the hyoid
• Male gender

Medical risk factors for sleep apnoea include:

• Stroke
• Hypothyroidism
• Metabolic syndrome
• Acromegaly
• Neurological disorders (e.g. myasthenia gravis)

Lifestyle factors for sleep apnoea include:

• Central fat distribution
• Obesity
• Advanced age
• Male gender
• Alcohol use
• Smoking
• Use of sedatives
• Supine sleeping position
• Habitual snoring

What happens when you stop breathing?

During the apneic event, or when your airway is collapsed, you cannot breathe in oxygen or exhale carbon dioxide. This causes low levels of oxygen and heightened levels of carbon dioxide in your blood, which then alerts the brain to resume breathing and causes you to partially wake up from your sleep.

Each time this happens, a signal is sent from your brain to your upper airway muscles to open the airway for breathing to resume. Often this happens with a loud snort or gasp. These frequent arousals from sleep, though necessary for breathing to continue, interrupt your sleep and prevent you from getting proper rest.

ALSO READ: Sleep apnoea severity linked to Covid-19 outcomes

What causes sleep apnoea?

There are two primary forms of sleep apnoea: Central sleep apnea and obstructive sleep apnea.

Central sleep apnoea happens when your brain does not send the right signals to your muscles for breathing to start. It is the less common of the two.

Obstructive sleep apnoea happens when air cannot flow into or out of your mouth and nose, although you are still attempting to breathe while sleeping.

As such, sleep apnoea can be caused by the following mechanical or structural issues in your body:

• When your throat muscles and tongue relax during sleep and partially block the opening of the airway.
• When the muscles of the soft palate at the base of your  tongue and the uvula relax and sag, blocking your airway and  making breathing laboured and noisy and even stopping it altogether.
• When an excess amount of tissue in the airway causes it to be narrowed in obese individuals.
• With a narrowed airway, you attempt to continue breathing, but air cannot easily flow into or out of your nose or mouth.

What are the symptoms of sleep apnoea?

Some common symptoms of sleep apnoea include:

• Loud, disruptive snoring
• Gasping for air during sleep
• Waking up with a dry mouth
• Excessive daytime sleepiness
• Difficulty paying attention during waking hours
• Changes in heart rate
• Drops in oxygen levels

This is important as the disease is associated with very high morbidity and mortality that includes:

• Hypertension
• Coronary artery disease
• Depression, insulin-resistant diabetes
• Sleep-related accidents

If you find yourself experiencing any of these symptoms, you should consult a doctor at your earliest convenience.

Diagnosing sleep apnoea

Diagnosing sleep apnoea is not a simple or easy task as there can be many different causes for the disease. Primary healthcare providers, pulmonologists, neurologists, or other healthcare providers with specialty training in sleep disorders may be needed to make a diagnosis and start treatment for sleep apnoea.

Healthcare professionals that you consult may recommend the following tests to diagnose sleep apnoea:

Polysomnography

This test records a variety of bodily functions as you sleep, such as the electrical activity of your brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. Naturally if you are experiencing sleep apnoea, any unusual activity observed will be signs of apneic events taking place.

Multiple Sleep Latency Test (MSLT)

This test measures the speed of falling asleep. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. People who fall asleep in less than 5 minutes are likely to need some type of treatment for sleep disorders. While this test is less specific, it is a good start to check if you are indeed suffering from a sleep disorder.

These tests may be done at a sleep centre, but they could also be administered at home depending on the available technology.

Effects of sleep apnoea

The constant lack of oxygen during your sleep can lead to headaches in the morning and the lack of adequate rest can lead to persistent sleepiness during the daytime. These effects not only lower your quality of life but can also significantly impact other areas of your life such as your work productivity or academic studies.

Treatments for sleep apnea

Depending on your age, health, medical history, the severity of the disease, and your preferences, your healthcare provider may recommend various kinds of treatment options.

There is no medication available for the treatment of sleep apnoea and most treatment options are either surgical, mechanical, or behavioural.

Behavioural treatment options are recommended for mild sleep apnoea and can include:

• Avoid alcohol.
• Avoid tobacco.
• Avoid sleeping pills.
• Lose weight if obese (even a 10 per cent weight loss can reduce the number of apneic events for most people).
• Use pillows and other devices to help sleep in a side position.

Mechanical treatment options for sleep apnoea include:

Nasal Continuous Positive Airway Pressure (CPAP)

This is a device that is used nightly in which you wear a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages.

Dental appliances

These devices reposition your lower jaw and tongue, helping you to breathe while you sleep. They are suitable for those with mild sleep apnoea.

Surgical treatment options for serious sleep apnoea include:

Removal of adenoids and tonsils, and nasal polyps

Sleep apnoea caused by growths or physical obstructions in the airway can be corrected by surgical intervention which can also help correct other deformities that can contribute to sleep apnoea.

Uvulopalatopharyngoplasty (UPPP)

This is a procedure used to remove excess tissue at the back of the throat such as your tonsils, uvula, and part of your soft palate, which helps to alleviate severe sleep apnoea.

Surgical reconstruction of lower jaw

The correction of deformities in the lower jaw may benefit some people with sleep apnoea.

Surgical procedures to reduce obesity

Since obesity can be a strong contributing factor to sleep apnoea, those who are morbidly obese may consider surgical procedures to help them lose weight to treat their sleep apnoea if weight loss is a challenge for them.

Key takeaways

As usual you should consult your doctor before deciding on any treatment option to find out what is the most suitable treatment option for your individual situation.

After reading through this guide, we hope that you’ve learnt more about sleep apnoea and are better empowered to take charge of your health.

This article was first published in Homage.