Mr Oko's Guide to Sleep Apnoea
It is known that 20% of the population snore but only about 4% have sleep apnoea and about 180,000 have severe sleep apnoea in England. The cause of snoring is turbulent airflow in the upper airway ( nose & throat) and this results in the noise generated and this turbulence can also collapse the airway. It is best to think of it as a spectrum of disease with mild snoring at one end and severe obstructive sleep apnoea at the other. The challenge for the clinician is to see where you may be in this wide spectrum of disease and find the appropriate treatment for you.
The common symptoms are:
- Loud snoring
- Breath holding at night (apnoea) / Choking during sleep
- Dry mouth upon waking
- Daytime fatigue
- Short term memory loss
- Mood swings and a short temper
Fatigue throughout the day and low energy, this can result in falling asleep when undertaking mundane activities
- Multiple trips to urinate through the night
- Early morning headaches
- Loss of interest in sex
It is known that if untreated they is a strong association with severe sleep apnoea and
- Heart attacks
- Memory impairment
- Early mortality/Death
- Road traffic accidents
The increased tiredness that sufferers experience can certainly cause problems throughout day to day life, while concentrating or driving for example.
There are various types of Sleep Apnoea:
Obstructive Sleep Apnoea (OSA)
When you sleep your body naturally relaxes all of your muscles, this can sometimes result in an obstruction to the airflow when you sleep, causing your breathing to become disrupted. This form of sleep apnoea is the most common, and can be treated relatively easily. Those most at risk from this form of sleep apnoea are overweight with a low muscle tone around the neck area or those with facial features that are positioned in such a way as to cause problems with breathing obstruction, such as an undershot jaw. It is classified as mild (5-15 episodes per hour), moderate (15-30) or severe (>30). The diagnosis of obstructive sleep apnoea syndrome is a combination of an elevated Epworth score (>10) and evidence on a sleep study of breath holding/desaturations at night.
Central Sleep Apnoea (CSA) or Cheyne-Stokes Respiration
Central Sleep Apnoea is a much rarer form of sleep apnoea that happens when nerve signals from the brain are delayed, resulting in your breathing becoming irregular. This form of sleep apnoea indicates a real problem in the central nervous system, but can be treated using drugs that manipulate the brains need to intake oxygen. Instead of struggling for breathe, an episode of CSA will be a few seconds where there is no effort to breathe whatsoever.
Mixed Sleep Apnoea (MSA)
When there is an overlay of CSA and OSA, the result is that the sleep apnoea can be attributed to both causes, and treatment cannot completely get rid of the problem, although can help to ease it.
What are the Risks of Sleep Apnoea?
There are medical risks associated with sleep apnoea, as well as risks within your everyday life due to the effects it could have upon you. Research is still being carried out to determine the full extent of the health risks of sleep apnoea, however, it has been linked to an increased risk of diabetes, high blood pressure, increased risk of stroke and serious heart problems.
Sleep apnoea sufferers are around 7-12 times more likely to be involved in car accidents and are also likely to find their concentration limited in certain situations throughout the day. This might make accidents more likely to happen and if you treat the condition you can reduce the chance of accidents by over 80%.
How is Obstructive Sleep Apnoea Diagnosed?
There are various tests that can be carried out to diagnose sleep apnoea.
Epworth Sleepiness Scale
If you experience daytime tiredness a questionnaire can be used to measure where you are on the Epworth Sleepiness Scale. This helps to gauge the level of sleepiness that you feel throughout the day. A high score indicates that you may have a sleeping disorder.
Tests to Confirm OSAS
If you have symptoms that suggest sleep apnoea, or a high score on the Epworth Sleepiness Scale, your GP may refer you to our clinic for tests. There are various types of test that can be done whilst you sleep. The tests performed may depend on local policies and availability of equipment. For example:
- The oxygen level in your blood can be monitored by a probe clipped onto your finger.
- Breathing can be monitored and recorded by the use of special belts placed around the chest and abdomen as well as monitoring your pulse rate and oxygen saturation.
- A video of you sleeping may be helpful and might also be taken as well as breathing can be monitored and recorded by the use of special belts placed around the chest and abdomen as well as monitoring your pulse rate and oxygen saturation.
- You may be asked to spend a night in hospital for the tests to be carried out. However, some of the tests may be carried out in your own home, using equipment supplied by our specialists. The information gained from the tests can help us to firmly diagnose or rule out sleep apnoea. We will also check your blood pressure and suggest other tests to exclude other causes of your sleepiness. For example, a blood test can check for an under active thyroid gland.
Stardust 2 is the home test kit that you can use to record your breathing throughout sleep. It is highly portable, and you will be given instruction on how to use the machine at home. Stardust 2 measures your heart rate, blood oxygen level, airway blocks throughout sleep and the effort you use to breathe throughout sleep. This information can be analysed to determine whether you are suffering from sleep apnoea and if so, to what degree.
Apnoeagraph Sleep Study
This is a overnight hospital sleep test used for patients who might be suitable for upper airway surgery, which involves a very small probe being inserted into the nose by a doctor, before you go to sleep. Your data is recorded by a small device usually strapped around your stomach. The data recorded is then analysed to determine the exact level of your snoring/ sleep problem.
Visilab is our in-house/ hospital system used to video record your sleep throughout the night. It takes place in a comfortable room within the sleep clinic, and any disturbances that you experience throughout the night are recorded and then analysed. This is a very in-depth way to assess your sleep problem.