Obstructive sleep apnoea (OSA)

Obstructive sleep apnoea is when your breathing frequently stops and starts when you’re asleep. This interrupts your sleep and can make you feel extremely sleepy the next day. There are things you can do to improve your symptoms, and several treatment options can help.

About obstructive sleep apnoea

When you’re asleep, the muscles in your mouth, nose, and throat (upper airways) relax. This can cause your airways to narrow or completely close if you have obstructive sleep apnoea. This stops you from breathing for a short time (10 or more seconds). You may temporarily wake up, and might feel like you’re choking or gasping for breath. Usually, you’ll fall asleep again very quickly, so you may not even remember it in the morning.

This cycle can happen many times (sometimes hundreds of times) during the night. As a result, you may be very sleepy the next day. People with obstructive sleep apnoea often find that they doze off during the day at inappropriate times. This might be when talking to people, or even when driving.

You may see the ‘OSA’ medical abbreviation, short for obstructive sleep apnoea. There is no ‘o’ in the American spelling (‘apnea’).

Causes of obstructive sleep apnoea

Obstructive sleep apnoea happens if your airways become too narrow while you’re asleep. There are several things that can make this more likely to happen. These include if you:

• have obesity – this is a strong risk factor for obstructive sleep apnoea
• have a large neck (collar size) – more than 41cm (16 inches) circumference
• are middle-aged or older – you can get it at any age, but it’s more common as you get older
• are male (women do get obstructive sleep apnoea, but the risk is greater for men)
• have a family history of sleep apnoea
• smoke
• drink too much alcohol, especially before you go to bed
• take drugs that have a sedative effect
• sleep on your back

Certain conditions that affect your jaw, nose, tongue, or airway can also make you more likely to get obstructive sleep apnoea. These include:

• an underactive thyroid (hypothyroidism)
• acromegaly (where the body produces too much growth hormone, causing body tissues and bones to grow more quickly)
• Down’s syndrome

Children may get obstructive sleep apnoea if they have enlarged adenoids and tonsils.

Symptoms of obstructive sleep apnoea

Obstructive sleep apnoea symptoms include:

• excessive sleepiness or tiredness during the day
• snoring
• frequent pauses in breathing, or choking noises when you’re asleep – it may be that a partner or someone else in the house notices
• getting up at night to pee (more than normal)
• feeling unrefreshed by sleep when you get up in the morning
• having a headache, or possibly a sore throat, or dry mouth when you wake up

Your disturbed sleep is likely to affect your day-to-day life in different ways. You may find it hard to concentrate, and might notice changes in your personality or feel depressed. It might have an impact on your relationships or your performance at work. You may find that you’re falling asleep when you don’t mean to – for example, while reading or watching television. Never drive if you feel sleepy, and stop driving immediately if you do.

Many of these symptoms can be caused by problems other than sleep apnoea. If you’re having these symptoms, see a GP for advice.

Diagnosis of obstructive sleep apnoea

A GP will ask about your symptoms and examine you. They’ll ask you some questions to check if there’s anything else that could be making you feel sleepy, or other reasons for your symptoms. They’ll want to know how your symptoms are affecting your daily life – including your work, ability to drive, and relationships. If a partner has noticed problems with your breathing while you’re asleep, it can be useful for them to come to your appointment.

A GP may ask you to complete a questionnaire, called the Epworth Sleepiness Scale, to assess how severe your symptoms are. This questionnaire asks how likely you are to fall asleep in different situations, such as when you’re watching television, reading, or in the car. It gives an obstructive sleep apnoea score. A GP may also arrange for you to have blood tests. These check for any possible underlying causes such as an underactive thyroid.

Seeing a specialist

If a GP thinks you might have obstructive sleep apnoea, they’ll refer you to a specialist in sleep disorders, or a sleep centre. You’ll have a sleep study, where they’ll monitor your sleep to make a diagnosis of obstructive sleep apnoea, and how severe it is. This will involve taking various measurements, such as the amount of oxygen in your blood, your heart rate, airflow, brain activity, eye movements, and muscle tone. Often, you’ll be given equipment to monitor yourself while you’re asleep at home. But sometimes, you may need to stay overnight in a sleep centre, where a doctor can monitor you.

Self-help for obstructive sleep apnoea

There may be lifestyle changes you can make to improve your symptoms. Your GP can discuss these with you. Here are just some of the steps you can take:

• lose weight if you’re overweight or obese
• drink less alcohol, especially in the evening
• stop smoking
• don’t use sedative medicines in the evenings
• sleep on your side rather than on your back

It’s important to follow a good sleep routine too.

Treatment of obstructive sleep apnoea

A variety of treatments can help with obstructive sleep apnoea, outlined below. A sleep specialist will talk you through your options. You may need to try a few different obstructive sleep apnoea treatments until you find the one that suits you the best.

Continuous positive airway pressure

Continuous positive airway pressure (CPAP) is usually the treatment that works best for obstructive sleep apnoea. CPAP involves using a machine at night that blows pressurised air into your mouth, nose, and throat (upper airways) through a mask over your nose or face.

CPAP is a long-term treatment. You’ll usually need to use it every night, sometimes for the rest of your life. It can take some time to get used to the machine. But it will help you get the sleep you need, so try to stick with it, and speak to your sleep specialist team for advice and support. For more information, see our FAQ on CPAP equipment.

Oral devices

If your symptoms are very mild or you can’t use CPAP, you may be able to try an oral device at night. You put this in your mouth to help keep your airways open. An example is a mandibular advancement splint – you wear this over your teeth, a bit like a gum shield.

A doctor will refer you to a specialist and the device will be made to fit you. These devices can have some side-effects; for instance, they may increase the amount of saliva you produce. And they can cause problems with your jaw joint. But they can help to improve the quality of your sleep.

Surgery

Obstructive sleep apnoea surgery is usually only an option if other treatment options have completely failed or there’s a clear reason for surgery – for example, to remove enlarged tonsils. Other types of surgery aim to remove any excess tissue in your throat that might be causing your sleep apnoea.

Hypoglossal nerve stimulation

This is a treatment for people who have moderate to severe obstructive sleep apnoea. It involves having a device implanted under the skin in your chest. The device sends electrical impulses to a nerve under your tongue to make your tongue contract and stop it falling backwards. This may help to keep your airway open.

There's not enough good evidence yet to say how safe or effective this procedure is, so it’s not currently available in routine practice. It is only available in some settings as part of a research trial where you’ll be closely monitored. Your doctor will let you know if this is an option for you.