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Sleep apnoea

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Sleep apnoea is a condition that causes significant and frequent pauses in breathing when you're asleep.

About sleep apnoea
Types of sleep apnoea
Symptoms of sleep apnoea
Complications of sleep apnoea
Causes of sleep apnoea
Diagnosis of sleep apnoea
Treatment of sleep apnoea

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 your airways can sometimes close up a little, 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 can last for 10 seconds or more, but is only temporary because 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 because you quickly fall asleep again. Your breathing won't stop altogether, but you might wake up feeling like you're choking, gasping or out of breath.

Types of sleep apnoea

There are three main types of sleep apnoea, which are described below.

  • Obstructive sleep apnoea is caused by your muscles in your throat relaxing too much and closing up when you're asleep.
  • Central sleep apnoea is caused by your brain not giving the signal to breathe at times when you're asleep.
  • Complex sleep apnoea is caused by a mixture of obstructive and central apnoea; however, this is rare.

The three types can be diagnosed by a specialist sleep expert on the basis of their different causes and your specific symptoms.

The following information will focus on obstructive sleep apnoea because it's the most common type; it will be referred to as sleep apnoea throughout.

Symptoms of sleep apnoea

The main symptoms of sleep apnoea are snoring and breath-holds when you're asleep. You may also feel extremely tired and sleepy during the day because 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 problem can become severe if your sleepiness becomes worse, for example, you may fall asleep even when you're eating or talking. Falling asleep can become dangerous, for instance, when you're driving. If you have sleep apnoea, you shouldn't drive until you're treated.

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 a doctor if you have these symptoms.

Complications of sleep apnoea

Sleep apnoea can increase your risk of heart conditions, including:

  • coronary heart disease
  • heart failure
  • arrhythmia
  • stroke
  • hypertension (high blood pressure)

Also, the excessive sleepiness you may feel in the daytime can lead to accidents at work, at home or when driving.

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), although people who aren't overweight can still get sleep apnoea
  • drink alcohol in the evenings
  • take sedatives
  • smoke cigarettes

Diagnosis of sleep apnoea

Your doctor 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.

Your doctor may assess your level of sleepiness can be assessed using a test such as the Epworth Sleepiness Scale. If your doctor 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. There isn't a proven benefit of having the tests in a hospital compared to having them done at home. However, you may have more measurements taken if you have the overnight test in hospital. These tests will help your specialists diagnose and treat your condition.

Please note that availability and use of specific tests may vary from country to country.

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, such as:

  • losing excess weight if you're overweight
  • not drinking alcohol in the evenings if you usually drink
  • stopping smoking
  • keeping your nose as clear as possible

Also, changing your sleeping position may help. If you usually lie 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 using an oral appliance therapy at night, such as a mandibular repositioning appliance (MRA) or a mandibular advancement splint (MAS). These are a bit like a sports gum shield and will stop you from snoring during the night. An MRA or MAS opens up the back of your throat by positioning your lower jaw and tongue further forward than usual. You can have these fitted by a dentist or sometimes by an orthodontic surgeon (this is a dentist who specialises in straightening or moving teeth, to improve the appearance of the teeth and how they work).

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 doctor may refer you for oral appliance therapy instead.

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 doctor or sleep specialist for more advice.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

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This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

Can I drive if I have been diagnosed with sleep apnoea?
Will I be able to sleep using CPAP?
If I have sleep apnoea and I stop breathing when I sleep, is there a risk that I won't start again?
Can sleep apnoea run in families?
I have heard that playing the didgeridoo can help with my sleep apnoea, is this true?

Can I drive if I have been diagnosed with sleep apnoea?

This will depend on how severe your condition is and whether you’re having treatment to improve your symptoms. As a general rule, you should never drive when you feel sleepy.

Explanation

People who are less alert and sleepy at the wheel of a vehicle are more likely to cause road traffic accidents. Therefore, if you tend to fall asleep easily during the day and generally feel tired, you shouldn’t drive.

According to the Road Traffic Act (1988) all drivers have a duty of care to be fit to drive. So as soon as you have been diagnosed with sleep apnoea, you should inform the Driver and Vehicle Licensing Agency (DVLA) about your condition. The DVLA will get in contact with your GP or sleep specialist and advise you about driving. Your symptoms and progress with therapy will be monitored. If your symptoms don’t improve, or you haven’t been using your therapy, there is a chance your licence may be taken away, but this is uncommon. 

If you’re a commercial driver (for example of a lorry, bus or coach), you will need to go through a detailed assessment of your condition and treatment plan with the DVLA.

Further information

Driver and Vehicle Licensing Agency (DVLA)
0300 790 6806
The Sleep Apnoea Trust
0845 60 60 685
www.sleep-apnoea-trust.org

 

Sources

 

  • Personal communication, Dr Dev Banerjee, Consultant sleep and respiratory physician, Spire Parkway Hospital, Solihull, 19 July 2010
  • Sleep apnoea information. Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 21 June 2010
  • Road Traffic Act (1988). Office of Public Sector Information. www.opsi.gov.uk, published 15 November 1988

 
 Will I be able to sleep using CPAP?

 
It may take a few nights to adjust to sleeping with CPAP; however, once you have become used to it, you can expect a great improvement in you your quality of life.
 

Explanation

 
CPAP pumps are small and very quiet, so they should not disturb your sleep with noise. Wearing the mask may be awkward at first, but you’re likely to gradually get used to it. You will then be able to sleep much better and won’t feel as tired in the day anymore.
 
Most people manage to use their CPAP device long term. However, if you find you have problems, you should contact the sleep clinic where you got your machine from. You may be able to try a different mask, sometimes a different machine, or even humidifier equipment if you have a dry mouth.

Further information

The Sleep Apnoea Trust
0845 60 60 685
www.sleep-apnoea-trust.org

Sources

  • Personal communication, Dr Dev Banerjee, Consultant sleep and respiratory physician, Spire Parkway Hospital. Solihull, 19 July 2010
  • Sleep apnoea information. Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 21 June 2010

If I have sleep apnoea and I stop breathing when I sleep, is there a risk that I won't start again?

No, this isn't a danger.

Explanation

When sleep apnoea stops you breathing, your brain senses the drop in your oxygen levels and causes you to wake up. Usually you aren't aware of this and will fall asleep again. This may become a regular cycle. However, you may sometimes be aware of waking up with a feeling of being out of breath.

Further information

The Sleep Apnoea Trust
0845 60 60 685
www.sleep-apnoea-trust.org

Sources

 

 

Can sleep apnoea run in families?

 
This isn’t certain. Sleep apnoea can have many causes, and it’s possible some of these may run in families.
 

Explanation
 

Physical factors such as tonsil size, a large uvula or overbite could potentially run in a family and therefore increase your risk of developing sleep apnoea.
 
Bring obese or overweight make snoring and sleep apnoea more likely. While obesity is known to be related to your diet and how much exercise you do, it’s also possible that some people inherit genes that predispose them to obesity. This could also make snoring more likely in some families.

Further information

Source

  • Frayling TM, Timpson NJ, Weedon MN. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science, 2007; 316(5826):889–94

 I have heard that playing the didgeridoo can help with my sleep apnoea, is this true?

There is some evidence to suggest that learning and practising the didgeridoo can improve sleep apnoea, but the research is very limited and the studies have been small.

Explanation

Some people have found that learning to play the didgeridoo over the course of a few months can help improve sleep during the night and reduce daytime sleepiness. This could be because playing the didgeridoo may be able to help strengthen the muscles in your upper airways through the technique you use to blow into it. If the muscles in your airways become stronger, they will be less likely to collapse when you sleep.
However, playing the didgeridoo is not an alternative treatment for severe sleep apnoea. More studies on alternative therapies need to be carried out before being accepted as treatment options. You should try to help yourself by making lifestyle changes such as losing excess weight or stopping smoking. Your GP or sleep specialist may recommend continuous positive airway pressure treatment or an oral appliance to help with your symptoms.

Further information

The Sleep Apnoea Trust
0845 60 60 685
www.sleep-apnoea-trust.org

Sources

  • Puhan MA, Suarez A, Cascio CL, et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial BMJ, 2005(332):266–70. doi:10.1136/bmj.38705.470590.55

Related topic

Adenoid and tonsil removal

Further information

The Sleep Apnoea Trust
0845 60 60 685
www.sleep-apnoea-trust.org

 
British Lung Foundation
0845 850 50 20
www.lunguk.org

Sources

  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:346–47
  • Obstructive sleep apnea. eMedicine. www.emedicine.medscape.com, published 27 June 2012
  • Obstructive sleep apnoea. British Lung Foundation. www.blf.org.uk, accessed 20 August 2012
  • Central sleep apnea clinical presentation. eMedicine. www.emedicine.medscape.com, published 30 May 2012
  • Obstructive sleep apnoea in adults. BMJ Best Practice. www.bestpractice.bmj.com, published 6 July 2011
  • Obstructive sleep apnoea syndrome. Prodigy. www.prodigy.clarity.co.uk, published January 2009
  • Management of obstructive sleep apnoea/hypopnoea syndrome in adults. Scottish Intercollegiate Guidelines Network. www.sign.ac.uk, published June 2003
  • Who gets sleep apnoea? The Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 20 August 2012
  • Living with OSA. British Lung Foundation. www.blf.org.uk, accessed 21 August 2012
  • Tiredness can kill – advice for drivers. Driver and Vehicle Licensing Agency (DVLA). www.dvla.gov.uk, accessed 21 August 2012
  • At a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency (DVLA). www.dft.gov.uk, published May 2012
  • Personal communication, Dr Dev Banerjee MB ChB BSc Hons MD FRCDr FRCP, Consultant Sleep Physician BMI Priory Edgbaston, Birmingham and Spire Parkway Hospital, Solihull, 10 October 2012
  • Who is at risk for sleep apnea? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 10 July 2012
  • Varvarigou V, Dahabreh I, Malhotra A, et al. A review of genetic association studies of obstructive sleep apnea: field synopsis and meta-analysis. Sleep 2011; 34(11):1461–68. doi:10.5665/sleep.1376
  • Ho M, Brass S. Obstructive sleep apnea. Neurol Int 2011; 3(3):e15. doi:10.4081/ni.2011.e1
  • Puhan M, Suarez A, Cascio CL, et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 2006; 332:266. doi:10.1136/bmj.38705.470590.55

This information was published by Bupa’s Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice form a qualified health professional.
 
 

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