This is a relatively common condition that interrupts breathing during sleep. It affects around 4% of middle-aged men and 2% of middle-aged women in the UK, rising to 60% of people over 65 years old. The onset of OSA is usually between 35 to 54 years old, and it is believed that up to 5% of adults have undiagnosed OSA.
Apnoea occurs when the soft tissues and muscles in the throat relax and collapse, blocking the airway for 10 seconds or more. Hypopnoea is partial collapse that reduces airflow by more than 50%. There are also some rare forms of sleep apnoea, such as when the brain forgets to breathe during sleep.
Apnoea and hypopnoea can keep occurring, more frequently than 60 times an hour throughout the night. During each incident, lack of oxygen draws the person from deep to light sleep or even brief wakefulness in order to restore normal breathing
Most people with OSA snore loudly, snorting and gasping as every bout of sleep apnoea or hypopnoea reduces the air intake, making their breathing noisy and difficult and their sleep shallow. To a bed partner, OSA may be obvious; however, many people with OSA are unaware of it, so may wonder why they are always tired during the day.
Other symptoms of OSA include a frequent need to urinate during the night; waking up with a sore or dry throat; headaches in the morning, and in men, an inability to get or maintain an erection. Meanwhile constant sleep disruption can mean a lack of concentration; poor memory; anxiety or depression; a loss of libido (interest in sex); irritability and a short temper.
Sleep apnoea is associated with being overweight; excessive soft tissue in the neck can place a strain on the throat muscles (for a man, a collar size of more than 45cm/18 inches is a danger signal), whilst excess stomach fat can impact on breathing, which can make OSA worse.
OSA is three times more common in people with diabetes, and occurs twice as often in people with nasal congestion, probably due to the airways being narrowed.
Apnoea may be in your genes, as a family history of OSA would suggest, and you could have an unusual inner-neck or mouth structure; e.g. an unusually narrow airway, large tonsils or tongue, excess folds in the inner lining of the mouth, or a small lower jaw that pushes the tongue backwards.
Other causes can be the menopause, when changes in hormone levels may cause a woman’s throat muscles to relax, or taking sedatives (sleeping tablets or tranquillisers).
OSA is largely diagnosed by observation of the way you sleep. However, you will first be asked questions about your symptoms, such as whether you regularly find yourself falling asleep during the day, and you will need a physical examination and some tests, including a blood test, to rule out other conditions that could explain your tiredness, such as an underactive thyroid gland.
You may be asked to spend a night at the sleep laboratory or you may be given a monitoring device to wear at night while you sleep at home, returning the monitor to the clinic by post the following day so that the recorded information can be downloaded. This is known as polysomnography, and will enable us to decide the best treatment for you. Once the tests have been completed, we should have a good idea about whether or not you have OSA. If you do, we can recommend treatment.
Mild cases of OSA respond to lifestyle changes, such as losing weight, giving up smoking, and cutting down on alcohol consumption, particularly during the evening. Avoid the use of sleeping tablets and tranquillisers, and try not to sleep on your back which can make snoring worse. Improve overall sleep quality by reducing light and noise in your bedroom and by relaxing before going to bed. This can be helped by taking your mind off work-related activities, keeping your computer out of the bedroom, not checking emails late at night and not reading or watching television in bed. Spending enough time in bed is also useful.
More severe cases may require the use of a continuous positive airway pressure (CPAP) breathing apparatus while sleeping; a mask over your nose delivers a continuous supply of compressed air, which prevents the airway in your throat from closing. The CPAP breathing apparatus reduces blood pressure and the risk of stroke by 40%, and lowers the risk of cardiac complications by 20%.
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