Are you snoring?                                                                                                        Do you know it may be serious ?                                                                                  Do you know it may even reduce your life span ?                                                          You know you may have obstructive sleep apnoea …………………….                                Sleep apnoea is a common and potentially serious condition in which a person stops breathing during sleep. Typical symptoms include snoring, not feeling refreshed on waking, day-time sleepiness, altered mood and morning headaches.

There are two types of sleep apnoea: obstructive sleep apnoea which is the more common and central sleep apnoea . OSA can occur at any age (including infancy) but is most common in middle-aged males.

In snoring what is basically happening i the tongue and soft palate within our mouths relaxing during sleep. This relaxation can cause tongue to fall back and partly block the airway.

Then, the vibration of the soft tissues in the upper airway happens with the air going in and out of the lungs. This is what causes the snoring.

This eventually leads to semi-wakening and breathing resumes, usually accompanied by a loud snort or gasp.

The person affected by OSA is often unaware that they have woken and immediately returns to sleep. Once asleep the muscles relax again and the whole cycle recurs. This cycle can occur hundreds of times during sleep. You do not get quality sleep. You do not get enough oxygen to the body. Your heart finds difficulty to pump blood out due to increased intrathoracic pressure.

Obesity , alcohol , sedative drugs , nasal obstruction, enlarged tonsils can also be a cause for OSA.

There are a number of signs and symptoms that may indicate that OSA is occurring. Often, the first indication is reports from others in the household about noisy snoring while asleep. OSA can lead to:

  • Waking up feeling as if you haven’t had enough sleep
  • Early morning headache
  • Dry or sore throat
  • Feeling sleepy throughout the day
  • Difficulty concentrating
  • Loss of interest in sex and impotence in males
  • Memory loss
  • Personality change
  • Grumpiness and bad temper.

Associated health problems

In addition to its possible impact on quality of life, some studies have shown that people with OSA are at greater risk of developing the following health conditions:

  • Hypertension (high blood pressure)
  • Heart disease
  • Stroke
  • Type 2 diabetes
  • Depression
  • Irregular heart beat (arrhythmia).

Due to feeling sleepy throughout the day there can be a propensity to fall asleep while driving, which is obviously very dangerous.

Diagnosis

As there can be many reasons for disturbed sleep or daytime sleepiness (including rare conditions such narcolepsy ) so diagnosing OSA can be difficult.

Tests may be used to confirm the diagnosis. Polysomnography is the most comprehensive medical test undertaken to confirm OSA. Before going to sleep for the night the person is attached to a number of leads or wires to monitor what happens during sleep. Blood oxygen levels, brain activity, eye movement and other indicators are assessed.

Treatment

OSA needs to be managed firstly through lifestyle changes, often in combination with other treatments.

Lifestyle and behavioural changes

In cases of mild OSA, lifestyle changes may lead to improvement in the condition.  Changes include:

  • Loosing weight
  • Minimise alcohol
  • Taking measures to assist sleeping on one’s side rather than on one’s back, as OSA can often be worse when sleeping on the back
  • Quit smoking
  • Regular exercise.

Positive airways pressure therapy

Continuous positive airways pressure (CPAP) is the most common treatment for obstructive sleep apnoea. It involves the use of a pump which delivers low pressure air into the airways via tubing and a mask fitted to the nose. It is worn during sleep and delivers enough pressure to keep the airway open during sleep. The amount of pressure required to maintain an open airway varies with each individual.  If the results of the sleep study clearly indicate OSA, a CPAP machine is often applied and adjusted to the appropriate settings while the study is in progress. It may be necessary to return to the sleep clinic after the study to receive training on how to properly use the CPAP machine at home. Many people find they feel much better within a few days of commencing CPAP as they get the benefit of deep restorative sleep that they previously lacked.

Variations of positive airways pressure therapy devices are auto-titrating CPAP, in which the levels of pressure are adjusted if the device senses increased airway resistance, and Bilevel positive airway pressure (BiPAP) which delivers a pore-set level of pressure when you breathe in and a different level of pressure when you breathe out.

Dental appliances

There are a number of dental appliances or devices available that can help to hold the jaw and tongue in a particular position in order to help maintain an open airway. These need to be fitted by a dentist or orthodontist and can have side effects such as damage to teeth and soft tissues. They are most effective in cases of mild OSA.

Surgery

Surgery may be an option to address specific abnormalities that contribute to the obstruction of airways, including procedures to remove the tonsils and adenoids, correct abnormalities in the nasal passages, and remove excess tissue from the back of the throat or tongue.  Surgery can also improve tolerance of nasal CPAP and improve effectiveness of dental devices.  Pubudu Jayaweera ( reference American Family physician )

 

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