Snoring may not be a laughing matter

What is a sleep apnoea?

Sleep apnoea is a common condition characterised by snoring during sleep, and feeling more tired than expected during the day.  Some patients will have episodes where they are seen to stop breathing during sleep, but sleep apnoea is often present even when this has not been seen.  Sleep apnoea occurs because of narrowing in the upper airway that causes difficulty breathing during sleep.

Around 5% of men and 3% of women have sleep apnoea that is severe enough to have negative effects on their health, causing sleepiness, high blood pressure and increased risk of cardiac disease and diabetes.  Given how common sleep apnoea is, and the negative effects it has on health, sleep apnoea is important to look for and treat if present.

How is sleep apnoea detected?

Sleep apnoea can be diagnosed simply if there are episodes of gasping or choking during sleep. This is typically seen in the setting of variably loud snoring. If a partner has noticed this, then sleep apnoea is present.  The role of further evaluation and treatment is to work out why someone has sleep apnoea, what effect it is having on their health, and what treatments are best suited to them.  These are questions that are addressed by seeing a sleep physician and having a sleep study.

How is sleep apnoea treated?

In treating sleep apnoea, it is important to focus on the goal of treatment, as the aim of treatment will determine choice of treatment.  For those with severe sleep apnoea, the aim of treatment is to improve sleepiness during the day and also to reduce the negative effects of sleep apnoea on blood pressure, heart function and diabetes.  Whereas for those with mild sleep apnoea, the aim of treatment may be to reduce the noise of snoring that is disturbing the bed partner.  Therefore, it is important to know the severity of sleep apnoea and its effects on health to develop and appropriate treatment plan for each individual.

Treatments that are used for sleep apnoea include:

General measures

✦    Reduce weight

✦    Reduce overall cardiovascular risk:  As sleep apnoea increases the risk of cardiovascular disease, patients with sleep apnoea should actively reduce their overall cardiovascular risk with smoking cessation, blood pressure treatment, reducing cholesterol, improved physical fitness and weight reduction

✦    Reduce alcohol: sleep apnoea is worsened by muscular relaxation that occurs during sleep and is worsened by the muscular relaxing effects of alcohol. 

CPAP therapy

✦    Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnoea.  When pressure settings are adequate, and there is little air leak, CPAP completely controls sleep apnoea.  However, whilst CPAP is a very effective treatment, it can be difficult to get used to, so it is important to work closely with your treating team to get the best results when using CPAP. 

Dental appliances

✦    Oral appliances, called mandibular advancement splints are useful in treating OSA, and although not on average as effective as CPAP, are usually well tolerated.  The best candidates for an oral appliance are those who are not obese and have mild or moderate sleep apnoea. 

Provent

✦    Provent is a novel treatment for snoring and sleep apnoea, that involves the application of self-adhesive valves over each nostril prior to bed. These one-way valves make it relatively easy to breathe in but hard to breathe out, creating a back-pressure in the throat, known as EPAP. On average in clinical trials, these have shown similar effectiveness to oral appliances (that is, best for mild-to-moderate sleep apnoea) but are a reasonable treatment option to consider at all severities of OSA, particularly where other treatments have been poorly tolerated.

Surgery

✦    Surgery for sleep apnoea has not been a generally effective long-term treatment unless there were specific upper airway abnormalities such as markedly enlarged tonsils or nasal obstruction. More contemporary surgical approaches, such as palatal advancement, tongue-base reduction (e.g. Coblation™) and jaw surgery offer greater options for surgical success, albeit with more potential side-effects. If surgery is being considered, knowing the severity of sleep apnoea and health effects of sleep apnoea is important prior to surgery.  This information is used to provide a safe anaesthetic as well as plan the most effective surgical treatment possible.

The Future

✦    Experimental treatments currently include medications to treat sleep apnoea and electronic pacemakers to strengthen muscle tone in the throat dilator muscles at night. For the time being, these treatment are only typically used as part of clinical trials.