When you sleep, the muscles in your upper airways (mouth, nose and throat) relax. If you have obstructive sleep apnoea (OSA), then your airways may narrow or completely collapse, stopping you from breathing for a short time (10 or more seconds). You'll temporarily wake up and might feel like you’re choking, gasping or out of breath. You usually quickly fall asleep again so you may not even remember it in the morning.
This cycle can happen many times (sometimes hundreds of times) during the night, breaking your normal healthy sleep pattern. As a result you may be very sleepy the following day. People with OSA often find that they doze off easily during the day at inappropriate times, such as when talking to people or even when driving.
You can get obstructive sleep apnoea (OSA) at any age, although in the UK it's most common in people aged between 30 and 60. It's also more likely to affect men than women. About four in 100 middle-aged men are thought to be affected in the UK compared to about two in 100 middle-aged women. This number may well be more though, as many people may not even be aware they have OSA.
Certain things may make you more likely to develop OSA. You’re more likely to have sleep apnoea if you:
- are obese
- have a large neck size – (more than 43cm circumference)
- have close relatives with sleep apnoea
- drink alcohol to excess, especially in the evenings
- use sedatives
- sleep on your back
Certain other conditions can also make you more likely to develop OSA. These include an underactive thyroid (hypothyroidism), acromegaly, Down's syndrome and other conditions that affect your jaw, nose, tongue or airway.
Children may be more likely to develop OSA if they are obese, or if they have enlarged adenoids and tonsils.
The main symptoms of obstructive sleep apnoea (OSA) are:
- excessive sleepiness during the day
- frequent pauses in breathing or choking noises when you’re asleep
- getting up at night to urinate more than normal
- feeling unrefreshed when you wake up
- having a headache, or possibly a sore throat or dry mouth when you wake up
You probably won’t be aware that your breathing is being interrupted when you’re sleeping. A partner or someone else in the house may tell you that you’re holding your breath or making choking or gasping noises when you’re asleep.
The disturbed sleep is likely to have other effects on you and your health. You may:
- fall asleep during the day
- find it hard to concentrate
- have mood swings or personality changes
- feel depressed
You may find that you're falling asleep when you don’t mean to, for example, while reading or watching television. This can become dangerous if you're starting to feel sleepy when you’re driving. Never drive if you feel sleepy, and stop immediately if you do. See our FAQ for more information about driving.
Bear in mind, many of these symptoms can be caused by problems other than sleep apnoea. But if you are having any of these symptoms, see your GP for advice.
Your GP will ask about your symptoms and examine you. If someone has noticed problems with your breathing 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 asking you questions from a questionnaire, called the Epworth Sleepiness Scale. This assesses how likely you are to fall asleep in different situations, such as when you’re watching television, reading or in the car.
Seeing a specialist
If your GP thinks you have obstructive sleep apnoea (OSA), they may refer you to a specialist in sleep disorders or a sleep centre for further investigation. You'll need to have various tests while you're asleep, to make a diagnosis of OSA. These generally include tests to measure the amount of oxygen in your blood, your heart rate, airflow, brain activity, eye movements and muscle tone.
You might be able to have some of these tests at home – the specialist will give you the equipment that you need to monitor yourself while you sleep. Or, you may have to stay overnight in a sleep centre, where your doctor can monitor you.
Your doctor will record how many episodes you have where you stop breathing while you're asleep, and work out how many you have on average per hour. The result will determine whether you have sleep apnoea and how severe it is.
Making changes to your lifestyle can help to improve your symptoms. Your GP is likely to give you some advice on this straightaway in addition to any other treatments you may need. Steps you can take include:
- losing excess weight if you’re overweight or obese
- reducing the amount of alcohol you drink, especially in the evening
- stopping smoking
- not using sedative medication in the evenings
- sleeping on your side, rather than your back
A variety of treatments are available for obstructive sleep apnoea (OSA). Your GP or sleep specialist will talk you through all your treatment options. You may need to try a few different options until you find which suits you the best.
If you have mild to moderate OSA, you may be able to try using an oral device at night. You put these in your mouth to help keep your airways open. An example is a mandibular advancement device. These are a bit like gum shields, that you wear over your teeth. They open 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. Sometimes people who have more severe OSA get on with these better than alternative treatments too. 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.
Continuous positive airway pressure (CPAP)
If you have moderate to severe OSA, continuous positive airway pressure (CPAP) is the most effective treatment. 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 does help you get the sleep you need, so try to persevere and speak to your sleep specialist team for advice and support. See our FAQ for more information on CPAP.
Hypoglossal nerve stimulation
This is a newer treatment for people who have moderate to severe OSA. It involves having a device implanted under the skin in your chest, which is connected to a nerve under your tongue. The device sends electrical impulses to this nerve, which makes your tongue contract and stops it falling backwards. This may help to keep your airway open.
There's not enough good evidence yet to say how effective this procedure is or how safe it is. If your doctor thinks it could work for you and you decide to give it a try, you'll be monitored closely. Your doctor may even see if you'd like to join a clinical trial for this treatment. This is when you're given the treatment, as part of a study, to test how well it works. Speak to your doctor for more information.
Surgery is usually 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, or if these treatment options aren't working for you. You may be able to have surgery to remove any excess tissue in your throat, for example, or to remove your tonsils, if they are causing your sleep apnoea.
Other procedures use laser or radiofrequency ablation (heat from radio waves) to reduce the amount of tissue around your soft palate or uvula.
Obstructive sleep apnoea (OSA) is associated with an increased risk of a number of conditions that affect your heart and circulation. These include:
- coronary heart disease
- heart failure
- an abnormal heart beat (arrhythmia)
- high blood pressure (hypertension)
Not getting enough sleep can also lead to depression. Also, feeling sleepy during the day, or when you’re awake, could make you more likely to have accidents at home or work. OSA is strongly associated with an increase risk of driving accidents. See our FAQ below for more information about driving if you have OSA.
You won't die from stopping breathing in your sleep. Your brain recognises that you've stopped breathing, and wakes you up. However, obstructive sleep apnoea (OSA) does put you at risk of certain serious diseases.
If you have OSA, your airway completely closes when you're asleep, causing you to temporarily stop breathing. Although it may sound scary, your brain senses this pause in breathing and automatically wakes you up. You might make snorting or choking noises as you wake and start breathing again.
Although you won't die from stopping breathing in your sleep, OSA has been linked to various conditions that affect your heart and circulation. These include coronary heart disease, stroke and high blood pressure. Your risk of dying from one of these diseases is higher if you have OSA.
You're also at greater risk of having a car accident if you have OSA.
Making sure you seek help for your symptoms and get the treatment you need will help. Treatment for OSA has been shown to reduce your risk of dying from cardiovascular disease.
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.
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 automatic adjustment for this.
Other problems that some people have with CPAP machines – especially when they first start using them – include:
- the mask not fitting properly
- a runny or irritated nose
- getting a dry nose or bleeding from your nose
- having an irritated throat
- feeling claustrophobic
If you’re having problems, your sleep clinic may adjust your mask or suggest trying a different type. You may be able to have a corticosteroid nasal spray to help prevent irritation to your nose. 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.
CPAP is usually very effective for OSA, so it's worth sticking with it if you can.
This will depend on how severe your sleep apnoea is, whether it's making you feel sleepy, 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.
People who are less alert and sleepy at the wheel of a vehicle are more likely to cause road traffic accidents. So, if you tend to fall asleep easily during the day and generally feel tired, don’t drive.
New rules were brought in at the end of 2017 to make it clearer when you need to stop driving and contact the Driver and Vehicle Licensing Agency (DVLA) if you have obstructive sleep apnoea (OSA). The new rules are as follows (the same rules apply to car, motorcycle, bus and lorry drivers).
- If you've been feeling sleepy during the day and it's having a negative effect on your driving, you must stop driving.
- You don't need to inform the DVLA while you're waiting for a diagnosis, or if it's confirmed that your OSA is mild. You'll be able to start driving again as soon as your symptoms are under control. If your symptoms aren't under control within three months though, you will need to inform the DVLA.
- If you have a diagnosis of moderate or severe OSA, you'll need to stop driving and inform the DVLA straightaway. The DVLA will need confirmation from your doctor that your condition is under control and your sleepiness has improved in order for you to continue driving.
- If you have OSA, but it's not causing you symptoms that affect your driving, you can carry on driving and don't need to inform the DVLA.
If you’re a commercial driver (for example, you drive a lorry, bus or coach), it's worth mentioning this to your GP. Your GP may be able to request that you receive treatment urgently, so that you can get back to work as soon as possible. Keep in mind, if you don’t follow medical advice about driving, this could affect your motor insurance.
There’s some evidence that genetic factors may play some role in the development of obstructive sleep apnoea (OSA). The condition seems to be more common in some families. There may be certain genes that have a direct effect on your chance of developing OSA, but more research is needed in this area. In addition, some physical factors that make it more likely that you could develop sleep apnoea – such as the shape of your face and jaw – can be inherited. Obesity is another risk factor for sleep apnoea, which can be more common in some families.
There are many lifestyle factors that are known to be risk factors for OSA. These include being obese, drinking alcohol to excess and smoking. While there may be certain things that you can't control, it's important to look at those things that you can.
If you think you may have symptoms of OSA, talk to your GP.
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Reviewed by Pippa Coulter, Freelance Health Editor, March 2018
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