What is Sleep Apnoea?

The most common sleeping disorder, it is characterised by repeated interruptions of breathing during sleep. It affects 5-10% of the population and up to 1 in 5 of middle aged men & slightly less for females. It is a serious, potentially life-threatening condition but luckily, a treatable one.

It often gets dismissed as just heavy snoring. However, snoring could be a sign of sleep apnoea, where episodes of struggling to breathe can interrupt sleep over and over, usually without the person being aware. As a result, they frequently feel tired during the day but have come to think of their chronic sleepiness as "normal".

COULD I HAVE SLEEP APNOEA?

Take our on-line test to see just what your risk is of having Sleep Apnoea

The typical symptoms are:
  • Loud snoring often signals that something is wrong with breathing during sleep.
  • You (or more than likely your partner) may have noticed that your snoring or breathing is interrupted by pauses and gasps
  • Feeling very sleepy or tired during the day
  • Feeling un-refreshed after awakening
  • Interrupted and restless sleep

Other symptoms include:

  • Poor concentration & forgetfulness
  • Morning headaches
  • Loss of interest in sex/ impotence
  • Mood swings or feeling depressed
  • Frequent urination at night

IF YOU HAVE ANY OF THE TYPICAL SYMPTOMS OR SEVERAL OF THE OTHER SYMPTOMS, YOU SHOULD TALK TO YOUR DOCTOR OR CALL US ON 1300 484 707 REGARDING ORGANISING A SLEEP STUDY. YOU SHOULD ALSO CONSIDER A STUDY TO CHECK FOR SLEEP APNOEA IF YOU SUFFER FROM ANY HIGH RISK DISEASE:
 

Condition Incidence
* Hypertension (High Blood Pressure)
* Heart Failure
* Diabetes 		30%
25-50%
50%
* Atrial Fibrillation 30%
* Ischaemic Heart Disease
  (Angina or history of a heart attack)

* Major obesity 		50-70%


80% (bariatric cases)
* Pulmonary diseases  
- COPD
- Fibrosis		 30-50%
>50%

 

WHAT CAUSES IT?

The muscles used for breathing become very relaxed during sleep particularly those in the back of your throat & nose (the pharynx). In some people, the relaxation is too great causing the soft tissues of the throat to collapse, partially or completely obstructing the airway. This is particularly so if the pharynx is narrow eg. with a big neck, obesity or particular shape of the face.

If someone were to come over and cover your nose and mouth, then quite naturally you would struggle to breathe and wake up. That is almost exactly what happens with sleep apnea, with the choking occurring because of the internal collapse of the airway. Most patients do not realize they are snoring much less snorting and gasping and waking themselves up. The awakenings, called arousals, may only last a few seconds causing the airways to re-open. The individual is usually unaware of these awakenings and this process can be repeated up to several hundred times during the night. Proper, restful sleep becomes impossible resulting in sleepiness and impairment of daytime function.

Just imagine someone ‘nudging’ you in your sleep once every minute or so – you will be pretty tired and sleepy the next day! Not only that, the physiological stress on your body is immense with repeated rise in the blood pressure, heart rate and poor oxygenation amongst others. Long term, this has grave consequences on your body.



There is another form of sleep apnea, called central sleep apnea, which is far less common. Here the regulation of breathing is affected, rather than a mechanical obstruction, preventing breathing. This form of sleep apnea is typically only seen in patients with congestive heart failure or other medical conditions. It too can lead to daytime symptoms and contribute to medical problems.

 

IS IT DANGEROUS?

There are serious consequences to your life:

  • Excessive sleepiness during the day, (frequently "nodding off")
  • Impairment of cognitive function
  • Mood and personality changes
As well as your health*:
  • Work and motor vehicle accidents
  • Heart attack
  • Arrhythmia
  • Blood pressure
  • Strokes
  • Libido & impotence
  • Reflux & heartburn
  • Diabetes

But don’t’ worry! Identifying sleep apnea involves an appropriate medical assessment and simple testing of breathing during sleep. Early detection can prevent the grave consequences of OSA and is easily accomplished with effectively and safely treatments available

* detailed information from the medical literature can be supplied on request.
 

Don't Blame it on Age - It Could be Sleep Apnea

Sleep apnea tends to get worse with age, and can come on very gradually. Often, problems that people attribute to the "aging process," such as poor memory, poor sleep and general fatigue may have nothing to do with aging at all. Instead, they may be the effects of sleep apnea. If you're in your 50s or 60s, you shouldn't assume that you're “just getting older”.

Getting treatment for sleep apnea, often brings a dramatic improvement in one’s quality of life. Sufferers of sleep apnea will get up to urinate after they've been awakened by their snoring or struggle to breath but because they are unaware of the apnea, they assume the awakening was due to the need to urinate. Once the apnea is corrected their frequent urination often disappears. Another common sleep complaint is insomnia (difficulty sleeping or staying asleep) which sometimes is due to sleep apnea. The difficulty breathing and restless sleep leads to difficulty sleeping. Thinking that insomnia is the main problem, patients or their physicians may reach for medication. However, taking sleeping pills may make the situation worse, since the pauses in breathing occur more frequently and last longer when the drugs make the muscles more relaxed and collapsible.



HOW CAN I BE TESTED TO SEE IF I HAVE SLEEP APNOEA?

The first step is to discuss your snoring or sleep problem with your own doctor. It is a good idea to take your sleeping partner to the doctor with you, to fill in the gaps regarding what happens to you when you are asleep.

We have an on-line referral form which you can print & give to your local doctor (GP) or dentist in order to refer you to get a sleep study, if appropriate. Alternatively, you can call us on 1300 484 707 and we can help co-ordinate everything for you.

The most accurate way to diagnose sleep apnoea is through an overnight sleep study called a polysomnogram (PSG). This is described more thoroughly in our Clinical Services section, simply involves the placement of special sensors on the skin to monitor the many physical processes as you sleep. These studies can be conducted in a sleep clinic with a sleep technologist in attendance to ensure the best possible recording. They can also, in most circumstances, be done in a patient’s home.



WHAT CAN BE DONE ABOUT IT?

There are several options for treating sleep apnoea, depending on the severity. At SleepMed, we tailor an approach to suit you depending on your needs and preferences, in a multidisciplinary approach.

  • Lifestyle changes
     

    • Weight loss: whilst a significant weight loss can lead to marked improvement in the severity of sleep apnoea, it rarely lead to a ‘cure’ in those other than with mild disease. We work closely with local bariatric (gastric banding) surgeons to assist those patients suffering with severe obesity.
       

    • Postural strategies to sleep: some patients have most of their apnoea event when lying on their back. They may benefit from strategies to avoid this position. However, there is very little data on long term outcomes and success.
       

    • Other measures may help such as avoiding alcohol and sedatives before sleep and quitting smoking. Except for the mildest of cases, these measures rarely lead to any significant improvements on sleep apnoea on their own.

       

  • Continuous Positive Airway Pressure (CPAP)

    This is the standard and most effective treatment for most cases of Sleep Apnoea. The CPAP machine adds gentle pressure to the air as it is breathed in through a mask over your nose or mouth while you sleep. This prevents the airway from collapsing and prevents obstructions during sleep, allowing you to breathe and sleep without disruptions. It is completely safe and extremely effective in eliminating sleep apnoea and snoring. Effects can be seen very quickly.

    SleepMed does not sell or supply CPAP machines, following the Australian Sleep Association’s recommendations. We work closely with local CPAP therapists and run Therapy Clinics with medical guidance though the entire process, to ensure you receive the best possible treatment.

    CPAP may take some getting used to, but with the help of our dedicated team a person’s comfort with the equipment can be improved. Some patients wonder what their spouses will think of the equipment, but most spouses are pleased with the change from snoring and restlessness to a quiet night of sleep.

  • Oral appliances

    Specially fitted dental appliances are also of proven effect. Mandibular Advancement Splints (MAS) are most commonly used. These are like sports mouth guards and are very well tolerated. They are designed to bring the jaw slightly forward as you sleep, keeping the airways open. They should be custom made by someone trained in sleep dental medicine. Oral devices are best for mild or moderate cases and not as effective for severe sleep apnoea.

     

  • Surgical treatment

    These approaches aim to change the inside anatomy of the nose, mouth, or throat. They may be effective for patients who have a clear, isolated area of obstruction causing their sleep apnea. There are a host of procedures such as Laser-Assisted Uvuloplasty, Uvulopalatopharyngoplasty, Maxillomandibular Advancement and Rhinoplasties. Some of these procedures have limited long term data to support efficacy and sometimes, repeated procedures are required. The overall success rate for such surgeries is only modest, especially when considered over a longer period of 5-10 years.
     

Talk to your Sleep Specialist about the risks, benefits, effectiveness and costs when considering all the available options. At SleepMed, our focus is on getting results and we tailor a strategy to best suit your needs.