Sleep apnoea

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have sleep apnoea, or who would like information about it.

Sleep apnoea is a condition that causes significant and frequent pauses in breathing during sleep. Sleep apnoea and heavy snoring that interfere with sleep affect many more men (up to one in every four) than it does women (about one in every 10).

About sleep apnoea

When you're awake, the muscles in your nose, mouth and throat keep your airways open. This allows you to breathe freely. When you're asleep, your muscles relax. This means the airways can sometimes close up, preventing air from getting in or out easily. If this happens, and you try to breathe, the soft tissue in your mouth, nose and throat may vibrate, causing you to snore.

Sometimes the airway at the back of your tongue collapses completely, which stops you from breathing (this is called apnoea). This is only temporary (between 10 seconds or longer) as your brain senses that your oxygen levels have dropped, alerting you to wake up.

Usually you will take a few deep breaths and fall asleep again. If you have sleep apnoea, these apnoeas often become a continuous cycle; you may wake up and fall asleep again every minute or so. Sometimes this can happen hundreds of times every night, but you won't usually remember what has happened.

There are three main types of sleep apnoea: obstructive sleep apnoea; central sleep apnoea; and complex sleep apnoea. The three types can be diagnosed by a specialist sleep expert on the basis of their different causes and your specific symptoms. This factsheet will focus on obstructive sleep apnoea as it's the most common type and will be referred to as sleep apnoea throughout.

Symptoms of sleep apnoea

The characteristic symptom of sleep apnoea is snoring and breath-holds during sleep. You may also feel extremely tired and sleepy during the day as a result of the disturbances in your sleep.

At first, you may find you only fall asleep when you're not very active, for example, when reading or watching television. This condition can become dangerous if your sleepiness gets worse, for example, when you're driving on the motorway. If you have sleep apnoea, you shouldn't drive until you're treated. You may even start to fall asleep at any time, even when eating or talking.

When you become very tired, you may:

• be irritable
• not feel refreshed
• struggle to concentrate or make decisions
• start to feel depressed

Although not necessarily a result of sleep apnoea, see your GP if you have these symptoms.

Causes of sleep apnoea

Both physical and lifestyle factors may lead to sleep apnoea.

Physical factors

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

• are male
• are female and going through the menopause
• have enlarged tonsils (a common cause in children)
• have a receding lower jaw that causes an overbite
• have low levels of thyroid hormone (hypothyroidism)
• have a blocked nose, caused by congestion, catarrh, nasal polyps or damage to your nose

Lifestyle factors

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

• are overweight and have excess fat around your neck (particularly with a collar size of 16 inches or more)
• drink alcohol in the evenings
• take sedatives
• smoke cigarettes

Diagnosis of sleep apnoea

Your GP will ask about your symptoms and examine you. If your partner has noticed that your breathing is disturbed while you're asleep, it can be useful for him or her to attend the appointment with you and describe your symptoms.

If your GP thinks you have sleep apnoea, he or she may refer you to a specialist at a sleep clinic. These are centres where you're monitored during your sleep to help diagnose sleeping disorders. You will have tests that measure the amount of oxygen in your blood, your breathing rate and your heart rate. You may be asked to stay overnight and be video-recorded, although many centres can monitor you at home using similar equipment. This will help the specialists diagnose and treat your condition.

Treatment of sleep apnoea

Self-help

If your sleep apnoea isn't severe, there are several changes you can make to your lifestyle that may help. For example, losing excess weight if you're overweight, stopping drinking alcohol in the evenings if you usually drink then, stopping smoking, and keeping your nose as clear as possible can reduce your symptoms. Also, changing your sleeping position may help. For example, if you lie flat on your back, your tongue is more likely to fall back into your throat and block your airway. By lying on your side, or half propped up, you can stop this from happening.

Oral appliance therapy

If you have mild sleep apnoea, but aren't particularly sleepy during the day, you may be able to try an oral appliance therapy such as a mandibular advancement splint (MAS). These are usually a bit like a sports gum shield and will stop you from snoring during the night. MASs open up the back of your throat by positioning your lower jaw and tongue further forward than usual. They are regularly fitted by dentists and sometimes by orthodontic surgeons.

Continuous positive airway pressure

If you have moderate to severe sleep apnoea, the most effective treatment is to use a machine at night that blows pressurised air into your upper airways. The machine connects to a small mask that you wear over your mouth or nose. The continuous positive airway pressure (CPAP) that is created by the machine helps hold your airways open. This makes your airways less likely to collapse.

Although it may be slightly awkward to use at first, CPAP can greatly improve your quality of life if you have sleep apnoea. You will usually have a much better night's sleep and will feel less tired in the daytime. However, if you find it difficult to use CPAP, your GP or sleep specialist may refer you for oral appliance therapy.

CPAP devices don't use oxygen or oxygen cylinders, so there is no fire risk.

Surgery

Having surgery is only an option if your sleep apnoea is caused by something that can't be treated through self-help measures, oral appliance therapy or CPAP. For example, if your sleep apnoea is caused by enlarged tonsils, your doctor may suggest having your tonsils removed. Whether surgery may be an option will depend on the specific cause of your condition. Speak to your GP or sleep specialist for more advice.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.