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Sleep apnoea

Sleep apnoea is a condition that causes frequent pauses in breathing when you sleep, leaving you tired. This page is about the most common type of sleep apnoea: obstructive sleep apnoea syndrome (referred to simply as sleep apnoea from now on).

Simon Boote, Senior Respiratory Physiologist, Bupa Cromwell Hospital: “Sleep apnoea can really disturb your sleep, leaving you feeling tired, grouchy and not alert. Lifestyle changes and devices to keep your airways open at night can help you get a much better night’s sleep.”


Sleep apnoea happens when the muscles in your upper airways (mouth, nose and throat) relax too much when you sleep. This narrows your airways and stops you from breathing properly for 10 or more seconds, causing you to wake up momentarily. You might wake up feeling like you’re choking, gasping or out of breath. You won’t usually remember what has happened because you quickly fall asleep again. For some people, this cycle can happen many times during the night.

In the UK, sleep apnoea is most common in people aged between 30 and 60, but it can happen to anyone of any age. It affects more men (about four in 100 middle-aged men) than women (about two in 100 middle-aged women).

 

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Details

  • Symptoms Symptoms of sleep apnoea

    The tell-tale signs of sleep apnoea are:

    • snoring
    • frequent pauses in breathing when you’re asleep
    • extreme tiredness during the day

    You probably won’t be aware that your breathing is being interrupted when you’re sleeping. Someone may tell you that you’re holding your breath or making choking or gasping noises when you’re asleep. You may also find that you get up in the night to urinate more often than usual. All this disturbance to your sleep can leave you feeling extremely tired and sleepy during the day.

    Lack of sleep can cause you to:

    • fall asleep during the day
    • find it hard to concentrate
    • have mood swings or personality changes
    • feel depressed

    You may fall asleep when you don’t mean to, for example, while reading or watching television. More importantly, this problem can be dangerous. For example, you may feel sleepy when you’re driving. You should never drive if you feel sleepy. Stop immediately if you do. If you’re diagnosed with sleep apnoea, don’t drive until you are being treated successfully for it. See our frequently asked questions for more information about driving.

    Bear in mind, these symptoms can be caused by problems other than sleep apnoea. If you have any of these symptoms, see your GP for advice.

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  • Diagnosis Diagnosis of sleep apnoea

    Your GP will ask about your symptoms and examine you. If someone has noticed that your breathing is disturbed while you’re asleep, it can be useful for them to come to your appointment too. If possible, ask your partner to record or video your snoring or disturbed breathing. This will help your GP with the diagnosis.

    Your GP may assess how tired you are by using the Epworth Sleepiness Scale. Your GP will ask you whether you ever fall asleep in different situations, such as when you’re watching television, reading or in the car.

    If your GP thinks you have sleep apnoea, they may refer you to a specialist at a sleep clinic. These are centres where you are monitored while you’re asleep to help diagnose sleeping disorders. You’ll have tests that record your breathing and sleep patterns while you sleep. You might be able to have these tests at home, or you may have to stay overnight in a hospital for them. Your doctor will then be able to examine the results from these tests and make a diagnosis.

  • Treatment Treatment of sleep apnoea

    A variety of treatments are available for sleep apnoea. The treatment that’s best for you will depend on how severe your symptoms are, your preferences and personal considerations, such as your job. Your GP or sleep specialist will talk you through all your treatment options and help you decide which is the best one for you.

    Self-help

    If your sleep apnoea isn’t severe, simple changes to your lifestyle may improve it and help you get a better night’s sleep. These include:

    Also, changing your sleeping position may help. Some people only get episodes of sleep apnoea when they’re lying on their back. By lying on your side, or propped up, your sleep apnoea might not be as bad. To stop yourself lying flat on your back you could try using pillows, or a tennis ball sewn to the back of your night wear.

    Oral devices

    If you have mild or moderate sleep apnoea, you may be able to try using an oral device at night. These are put into your mouth to help keep your airways open. An example is a mandibular advancement device, which is a bit like a sports gum shield. This opens up the back of your throat by causing your lower jaw and tongue to sit further forward than usual. You can have these fitted by a dentist or orthodontic surgeon (a dentist who specialises in straightening or moving teeth).

    Oral devices can improve your breathing during the night and allow you to get a better night’s sleep. However, they can have some side-effects. They may feel uncomfortable or increase the amount of saliva you produce, causing you to dribble while you sleep. Some people also find that they can fall out during the night.

    Continuous positive airway pressure (CPAP)

    If you have moderate to severe sleep apnoea, the most effective treatment is continuous positive airway pressure (CPAP). You might try CPAP after trying oral devices, or at the same time as using one. CPAP involves using a machine at night that blows pressurised air into your upper airways.

    The machine connects to a mask that you wear over your mouth or nose. The air pressure that’s created by the machine helps to hold your airways open.

    CPAP is a long-term treatment, so you’ll need to keep using it every night. Using the machine may take some getting used to. But it can help you get the rest you need, so try to persevere and speak to your sleep specialist for advice and support. See our frequently asked questions for more information on CPAP.

    Surgery

    Surgery is a last resort. It’s only an option if your sleep apnoea is caused by something that can’t be treated through lifestyle changes, oral devices or CPAP. For example, if your sleep apnoea is caused by enlarged tonsils, your doctor may suggest having your tonsils removed.

    If you’re obese, and your doctor thinks this is causing your sleep apnoea, you might be offered surgery on your stomach. This will help you to lose weight. However, whether surgery may be an option for you depends on the cause of your sleep apnoea and if you’ve tried all other options. It’s important to remember that surgery comes with risks and complications.

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  • Causes Causes of sleep apnoea

    Obstructive sleep apnoea happens when your upper airway muscles relax and your airways collapse, stopping you from breathing momentarily.

    Sleep apnoea can also be caused by your brain not signalling for you to breathe. This is a different type of sleep apnoea called central sleep apnoea, which is not covered by this page.

    Both physical and lifestyle factors may lead to obstructive sleep apnoea.

    Physical factors

    You’re more likely to have sleep apnoea if you:

    • are overweight or have a wide neck – (more than 43 cm circumference)
    • are male
    • have close relatives with sleep apnoea
    • are female and have been through the menopause
    • have an underactive thyroid (hypothyroidism)
    • have a congenital condition, such as Down’s syndrome
    • have an abnormally shaped jaw, nose, tongue or airway
    • have acromegaly (excessive growth due to growth hormones)

    Lifestyle factors

    You’re more likely to have sleep apnoea if you:

    • drink alcohol in the evenings
    • take sedatives
    • smoke
  • Complications Complications of sleep apnoea

    There is a connection between sleep apnoea and conditions that affect your heart, such as:

    Not getting enough sleep can also cause depression. Also, feeling very tired during the day, or when you’re awake, could lead at accidents at home, work or even when you’re driving.

  • Can I drive if I have sleep apnoea? Can I drive if I have sleep apnoea?

    Answer

    This will depend on how severe your sleep apnoea is and whether you’re having treatment to control your symptoms. You should never drive when you feel sleepy – if you have an accident then tiredness is not an excuse that can be used by law.

    More information

    People who are less alert and sleepy at the wheel of a vehicle are more likely to cause road traffic accidents. Therefore, if you tend to fall asleep easily during the day and generally feel tired, don’t drive.

    If you’re receiving treatment for sleep apnoea, you should tell the Driver and Vehicle Licensing Agency (DVLA).

    When you tell the DVLA, you’ll need to fill in a questionairre. With your permission, the DVLA may contact your GP or sleep specialist to ask about your condition. You won’t be able to drive until your symptoms are well controlled, so you’re not sleepy at the wheel.

    If you’re a commercial driver (for example, you drive a lorry, bus or coach), you must stop driving until your symptoms are well controlled. Your GP or sleep specialist will need to confirm that you’re following your treatment plan. You’ll also have to renew your license regularly (usually every year).

    Keep in mind, if you don’t follow medical advice about driving, this could affect your motor insurance.

  • Can sleep apnoea run in families? Can sleep apnoea run in families?

    Answer

    Having a relative who has sleep apnoea may increase your risk of having the condition too.

    More information

    There’s some evidence that sleep apnoea is more common in some families. However, more research is needed before we can be sure that genes play a role. Some physical factors that make it more likely that you could develop sleep apnoea – such as the shape of your head – can be inherited. Obesity is another risk factor for sleep apnoea, which can be more common in some families.

    If you’re worried about your (or a family member’s) risk or think you may have sleep apnoea, talk to your GP.

  • I’m having problems with my CPAP equipment I’m having problems with my CPAP equipment. What can I do?

    Answer

    If you’re finding it hard to use your continuous positive airway pressure (CPAP) equipment, ask your sleep clinic to help. Simple adjustments can be made to the set up to make it more comfortable and work better.

    More information

    You may find it reassuring to know that about two out of every three people manage to use CPAP long-term. The air pressure of your CPAP machine needs to be just right for it to help stop your sleep apnoea. If it doesn’t seem to be helping, the pressure may need adjusting. Many machines now have an automatic adjuster for this.

    Other problems that some people have with CPAP machines – especially when they first start using them – include:

    • the mask not fitting properly
    • your nose getting inflamed (rhinitis)
    • the bridge of your nose getting sore
    • getting a dry nose
    • feeling claustrophobic
    If you’re having problems, your sleep clinic may adjust your mask or suggest trying a different type. If you’re getting a dry nose, a humidifier to make the air warmer and damper may help with this. If you’re finding that the mask makes you feel claustrophobic, ask your specialist for advice and support. You may be able to have a course of cognitive behavioural therapy to help with your claustrophobia.
  • Other helpful websites Other helpful websites

    Sources

    • Obstructive sleep apnoea syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2015
    • Obstructive sleep apnoea in adults. BMJ Best Practice. www.bestpractice.bmj.com, published December 2014
    • Map of Medicine. Obstructive sleep apnoea/hypopnoea (OSAHS). International View. London: Map of Medicine; 2014 (Issue 3)
    • Always sleepy? The British Thoracic Society and Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 9 July 2015
    • Obstructive sleep apnoea. Medscape. www.emedicine.medscape.com, published August 2014
    • Treatment of sleep apnoea. Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 9 July 2015
    • Central sleep apnea. The Merck Manuals. www.merckmanuals.com, published May 2015
    • Tiredness can kill – advice for drivers including drivers with obstructive sleep apnoea syndrome (OSAS). Driver and Vehicle Licensing Agency (DVLA). www.gov.uk, published July 2013
    • For medical practitioners. At a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency (DVLA). www.gov.uk, published November 2014
    • Lam JC, Sharma SK, Lam B. Obstructive sleep apnoea: definitions, epidemiology and natural history. Indian J Med Res 2010; 131:165–70
    • Varvarigou V, Dahabreh I, Malhotra A, et al. A review of genetic association studies of obstructive sleep apnea: field synopsis and meta-analysis. Sleep 2011; 34(11):1461–68. doi:10.5665/sleep.1376
    • Sleep apnea and heart disease. National Sleep Foundation. www.sleepfoundation.org, accessed 10 September 2015
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