Everything You Need To Know About Sleep Apnoea

At a Glance:

• Sleep apnoea is a condition in which people stop breathing for a period of time during sleep

• Sleep apnoea is a common condition, with an estimated 936 million adults aged between 30 – 69 years having mild to severe obstructive sleep apnoea. (1) 

• There are three different kinds of sleep apnoea that vary due to cause - Obstructive Sleep Apnoea (OSA), Central Sleep Apnoea and Mixed Sleep Apnoea

• Hypopnoea is a condition closely related to sleep apnoea, but rather than stopping breathing, people with hypopnoea experience periods of shallow breathing

• Common treatments for sleep apnoea include lifestyle changes (weight loss, quitting smoking and/or drinking), surgery and the use of a CPAP machine 

What is Sleep Apnoea?

Apnoea is the medical term for a cessation of breathing. Sleep apnoea is a sleep disorder that causes people to frequently stop breathing during sleep. Depending on the severity, people with sleep apnoea may stop breathing a handful of times an hour, or in more severe cases every few minutes. As a result, sleep apnoea can potentially be a very serious condition.

Depending on the cause, sleep apnoea is classified in one of three ways:

• Obstructive Sleep Apnoea (OSA) - the most common form of apnoea is caused by a complete or partial obstruction of the upper airways. These obstructions are typically found in the nose or throat. Common signs of obstructive sleep apnoea include loud snoring and tiredness/fatigue even with a full night’s sleep. 

• Central Sleep Apnoea (CSA) - this form of apnoea is less common than OSA and is caused by your central nervous system and brain failing to tell your lungs to breathe. Unlike OSA, people with central sleep apnoea may not snore (or snore more than usual) so the condition may not have any obvious outward symptoms.

• Mixed Sleep Apnoea - as the name suggests, combines both an airway obstruction and a central nervous system dysfunction.

The severity of sleep apnoea is categorised by the number of times an hour that a person stops breathing.

• Normal Sleep - fewer than five instances an hour

• Mild Sleep Apnoea - between five and 15 instances an hour

• Moderate Sleep Apnoea - between15 and 30 instances an hour

• Severe Sleep Apnoea - over 30 instances an hour 

It may be possible to alleviate mild sleep apnoea through a change of sleep posture, losing weight or other lifestyle changes, more serious cases may require the use of specialised machines referred to as CPAP (Constant Positive Airway Pressure) or APAP (Automatic Positive Airway Pressure) to help maintain regular breathing patterns and achieve a full night’s sleep.

Symptoms of Sleep Apnoea

Sleep apnoea occurs while you are sleeping. Two of the most common symptoms of apnoea are loud snoring or gasping for breath, so unless there is someone around while you sleep these symptoms may go unnoticed. Sleep Apnoea can also be diagnosed through an appropriate test arranged by your Doctor.

People with sleep apnoea may also exhibit a number of other symptoms, including:

• Weight gain - a lack of proper sleep can lead to weight gain through a number of factors. Hormones that manage hunger can become imbalanced due to poor sleep. In addition, sleeplessness may also slow the metabolism, further exacerbating weight gain. 

• High blood pressure - it is believed that sleep helps the body produce and control a number of hormones that help regulate your metabolism and stress levels. A lack of sleep may lead to a fall in hormone production or uneven hormone levels leading to elevated blood pressure.

• Constant tiredness during the day - although a person with sleep apnoea may be in bed for eight hours, they may not be getting any real rest due to their sleep cycle being broken by instances of apnoea. Even if they do not wake fully during these instances it can be enough to significantly impact the quality of sleep.

• Difficulties with concentration - people deprived of sleep exhibit short term cognitive and attention impairment.

• Broken sleep or insomnia - due to instances of apnoea causing the person to wake fully or have difficulty falling asleep due to breathing issues.

• Frequent nighttime urination - during sleep the body produces increased levels of Antidiuretic hormone (ADH), a hormone that helps absorb liquid resulting in concentrated morning urine. In people with poor or broken sleep, this production may be compromised causing the bladder to fill multiple times during the night.

• Mood Swings - . Mood disorders have been recognised in one third of patients who suffer from chronic sleep problems. Conditions that are typified by negative moods, such as depression or anxiety may cause sleeplessness. (2)

• Headaches - A study has shown that 90% of people with sleep apnoea stopped having a morning headache when their sleep apnoea was treated with CPAP. (3)

Am I at risk of Sleep Apnoea?

There are many associated factors to consider that can increase your risk of developing sleep apnoea. Some of these are briefly outlined below:

• Obesity – Sleep Apnoea is highly prevalent in the Obese population (4). Excess weight can contribute to sleep apnoea due to  excess fatty tissue in the neck constricting the airways, or the mass of fat and enlarged organs limiting lung function when lying on your back.  

• Enlarged tonsils or adenoids - if your tonsils and adenoids are large or become inflamed due to tonsillitis or other conditions, they can obstruct your airway leading to instances of sleep apnoea.

• Allergies - allergic reactions to medication, food or environmental factors (hay fever), may cause a blockage in your nasal cavity leading to sleep apnoea.

• Nasal congestion - congestion caused by infection, such as cold, influenza or COVID-19 may lead to a blockage in the nasal cavity, swollen airways or reduced lung function leading to sleep apnoea.

• Face shape and facial bones - the shape of a person’s face and the size and shape of their facial bones may increase the risk of developing sleep apnoea. The size and dimensions of the jaw may cause the tongue to bunch leading to the airways being blocked. 

• Excess alcohol consumption - alcohol consumption may lead to excess relaxation and impaired brain function leading to impaired or irregular breathing. Excess alcohol consumption over time may also erode the lining of the larynx leading to scarring, swelling or collapsing.

• Being male - men are around three times more likely to suffer from sleep apnoea than women. Sleep apnoea becomes more prevalent in women as they age, especially after menopause. (5)

• Smoking - smoking can cause irritation and damage to the airways and may increase the likelihood of fluid retention in the upper airways. As a result, smokers are around three times more likely to develop obstructive sleep apnoea than non-smokers. (5)

• Medical conditions - a number of medical conditions, including type 2 diabetes, congestive heart failure, hypertension, Parkinson’s disease, thyroid dysfunction, goitres, polycystic ovary syndrome and lung diseases can all increase the risk of developing OSA. (5)

• Age - sleep apnoea is far more common in older people than young people.

• Genetics - you are more likely to develop sleep apnoea if you have a direct relative with sleep apnoea. 

• Being overtired - being overtired may lead to your body relaxing more than usual when you finally do sleep, potentially causing instances of sleep apnoea due to reduced lung function, or your tongue relaxing and obstructing your airways.. As such, undiagnosed sleep apnoea may be exacerbated by the sleeplessness caused by sleep apnoea.

Risk factors of Central Sleep Apnea include:

• Heart conditions - having congestive heart failure increases the risk of central sleep apnoea.

• Impaired breathing reflex - people with long-term obstructive sleep apnoea may develop central sleep apnoea as their nerves become “trained” or accustomed to the impaired function.  

• Opioids - opioid based pain medications, especially long lasting ones such as methadone may reduce the urge to breathe leading to central sleep apnoea.

• Neuromuscular disorders - a number of conditions that affect the brain controls the movement of muscles, such as the various forms of muscular dystrophy, multiple sclerosis and motor neurone disease may result in a weakening of lung muscles or an impaired breathing reflex.

• Stroke or other brain impairment - having a stroke may increase your risk of developing central sleep apnoea as damage to the brain may affect its ability to control breathing. 

• Being male - much like obstructive sleep apnoea, men are more likely than women to develop central sleep apnoea.

• Age - the risk of developing central sleep apnoea becomes more pronounced with age. 

Treatments For Sleep Apnoea

As excess weight, alcohol consumption and smoking are amongst the most common causes of obstructive sleep apnoea, lifestyle change is typically a frontline treatment. Losing weight, cutting down on alcohol and cigarettes can all significantly reduce instances of sleep apnoea. That said, it is recommended in most cases that lifestyle change goes hand in hand with mechanical treatment with a CPAP machine, as combined lifestyle change and mechanical treatment appears to be a more effective treatment than either treatment in isolation.

If instances of OSA occur when sleeping on your back, what is known as positional therapy may be required. This refers to training your body to sleep in a different position, such as on your side, which aim to stop you from rolling onto your back. A number of gadgets designed to stop rolling are commercially available. 

In some cases, surgical measures may be taken to help alleviate obstructive sleep apnoea. Surgery may be in the form of gastric sleeving to help with weight loss or may be used to reduce tissue in problem areas. Removal of the tonsil and adenoids may be recommended if they are blocking airways. Likewise, sinus surgery or surgery to remove tissue from the soft palate or uvula may be recommended if the obstruction is caused by or located in those areas. This can be discussed with your Medical Practitioner.

If you are experiencing broken sleep or worry that you may have sleep apnoea, you should book an appointment with a doctor to arrange a sleep apnoea test. The fastest and easiest way to search for and book healthcare appointments online is through MyHealth1st.

If you would like to speak to a CPAP Therapist about your concerns and if you do or don’t require a test, book an appointment with a sleep health consultant on MyHealth1st .

You can take a free online sleep apnoea assessment today to show your risk of sleep apnoea. The online assessment is a good indicator of your risk of suffering from Sleep Apnoea, this is not a replacement for a proper medical diagnosis.

STUDIES:

1. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-698. doi: 10.1016/S2213-2600(19)30198-5. Epub 2019 Jul 9. PMID: 31300334; PMCID: PMC7007763.
2. Ruth M. Benca, Masako Okawa, Makoto Uchiyama, Shigeru Ozaki, Toru Nakajima, Kayo Shibui, William H. Obermeyer. Sleep and mood disorders, Sleep Medicine Reviews, Volume 1, Issue 1, 1997, Pages 45-56, ISSN 1087-0792, https://doi.org/10.1016/S1087-0792(97)90005-8.
3. Goksan B, Gunduz A, Karadeniz D, Ağan K, Tascilar FN, Tan F, Purisa S, Kaynak H. Morning headache in sleep apnoea: clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure. Cephalalgia. 2009 Jun;29(6):635-41. doi: 10.1111/j.1468-2982.2008.01781.x. Epub 2009 Feb 2. PMID: 19187338.
4. Valencia-Flores M, Orea A, Castano VA, Resendiz M, Rosales M, Rebollar V, Santiago V, Gallegos J, Campos RM, Gonzalez J, Oseguera J, Garcia-Ramos G, Bliwise DL. Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obesity Research 2000;8(3):262-9.
5. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631