What Is Sleep Apnoea (Is Snoring a Problem?)

About 12% of chronic snorers have a potentially serious medical disorder called obstructive sleep apnoea.

Many obstructive sleep apnoea sufferers are not aware they have a problem. It affects 4% of the adult population. Sleep apnoea leads to excessive daytime sleepiness, lack of concentration and poor memory. Over time, it may cause serious damage to the heart and brain.

During sleep all of your muscles relax, including those surrounding the airway. In simple snoring, the narrowed airway vibrates but does not block off. Obstructive sleep apnoea is caused by the tounge and other soft tissues in the back of the throat falling backwards and blocking the airway. Some people are particularly at risk of this, because the airway is narrow from obesity or it is made worse by extra muscle relaxation with alcohol or sedatives. Some are affected because the lower jaw is relatively small.

Obstructive sleep apnea can appear at all ages, but most frequently in men between the ages of 30 to 60 and in women after the menopause.

Symptoms

Sufferers often snore loudly and stop breathing repeatedly. The bed partner may notice frequent pauses, grunts and gasps. The partner often worries breathing will not start again. Often there is a deep gasp or snort after a pause with a partial awakening as the person struggles to breathe. Sufferers are mostly not aware of this as they are still half asleep. Occasionally, people wake with a startle as if they have been choking.Sleep quality is poor because of these frequent partial wakings. Next morning, they may feel washed out, like a hangover. The sufferer often struggles to stay awake the next day -- often a problem watching TV or in meetings. In more severe cases, unwanted sleep occurs while driving, during group conversations, at the meal table or at work.

Other symptoms which are seen with untreated obstructive sleep apnoea include personality changes, depression, weak sex drive, poor short term memory and difficulty with concentration.

Social Consequences

Snoring can be extremely irritating and often leads to sleep disturbance for bed partner. Such problems tend to aggravate marital problems and contribute to family stress. This is made worse by the sufferer's chronic unexplained sleepiness and lack of interest in life.

Medical Consequences

Medical research has demonstrated links between sleep apnoea and high blood pressure and heart disease and stroke. In severe cases, sleep apnoea leads to premature death; sometimes, sudden death during sleep. Motor vehicle accidents are up to seven times more common in this group. There is a similar risk of work place accidents.

Diagnosis

While the story may suggest sleep apnoea is present, a formal diagnostic sleep study is very useful to show how severe the problem is.

Measurements typically include computerised monitoring of sleep quality, airflow through the nose and mouth, blood oxygen levels, heart rate and muscle activity. We test for repeated jerking movements of the legs during sleep, known as periodic leg movements syndrome as well as for apnea. Special tests are used for rarer problems such as Narcolepsy.

Testing is painless and non-invasive. Patients are usually at the clinic between 7:30 p.m. and 7 a.m. Breakfast and a shower are available.

It is relatively simple to go to the toilet, if needed.

What is the Treatment

Mild cases can be helped by weight loss, limiting the use of alcohol, avoiding the use of sleeping tablets and treating a blocked nose. If one puts the way back on, then the problem will also return.

Collapse of the upper airway can be prevented by the use of CPAP [continuous positive airways pressure]. The applied pressure of air acts as a splint to keep the airway open. You wear a small comfortable nose mask while you sleep, which is connected by tubing to an air pump. Most people find this easy-to-use. A few people have problems with CPAP - mainly from nose irritation. Often patients sleep better and so are more alert - functioning better the next day. Snoring is well controlled. Current machines are quiet and usually do not disturb partners.

If snoring is the dominant problem without significant apnea, then ENT surgery or a Mandibular Advancement Splint may help. Surgery is not useful to treat moderate or severe sleep apnea.