Parent specialty: Cardio Respiratory Unit (CRU)
Sleep
Sleep is driven by natural brain activity. You need to have a certain amount of deep sleep for your body and mind to be fully refreshed. Having only limited episodes of deep sleep will leave you feeling very tired the next day.
In order to function properly, most adults need seven to eight hours of sleep. Around 15-25% of that time should be spent in the deepest phase of sleep, known as slow wave sleep.
What happens during OSA?
During the night, people with OSA may experience repeated episodes of apnoea and hypopnoea.
During an episode, lack of oxygen causes the person to come out of deep sleep and into a lighter state of sleep, or a brief period of wakefulness, in order to restore normal breathing. However, after falling back into deep sleep, further episodes of apnoea and hypopnoea can occur. Such events may occur more than once a minute throughout the night.
Most people with OSA snore loudly. Their breathing may be noisy and laboured and it is often interrupted by gasping and snorting with each episode of apnoea.
The repeated interruptions to sleep caused by OSA can make the person feel very tired during the day. A person with OSA will usually have no memory of breathlessness, so they are often unaware that they are not getting a proper night's sleep.
Symptoms of sleep apnoea
Episodes of interrupted breathing are often visible in someone with obstructive sleep apnoea (OSA) who is asleep. OSA can also cause other symptoms, often due to tiredness resulting from lack of deep sleep.
Most people with OSA snore loudly. Their breathing may be noisy and laboured, and it is often interrupted by gasping and snorting with each episode of apnoea.
If you have OSA, you may have no memory of your interrupted breathing during the night. However, when you wake up you are likely to feel as though you have not had a good night's sleep.
Other symptoms of OSA include:
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feeling very sleepy during the day
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waking up with a sore or dry throat
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poor memory and concentration
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headaches (particularly in the morning)
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anxiety
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depression
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lack of interest in sex
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in men, impotence (inability to get or maintain an erection)
Some people with OSA may also wake up frequently during the night to urinate.
How common is OSA?
OSA is a relatively common condition that affects more men than women. In the UK, it is estimated that around 4% of middle-aged men and 2% of middle-aged women have OSA.
The onset of OSA is most common in people aged 35 to 54 years old, although it can affect people of all ages, including children. The condition often goes undiagnosed. It is estimated that up to 5% of adults have undiagnosed OSA.
Studies have also shown that 60% of people over 65 years old have OSA.
Treatment
OSA is a treatable condition and there are a variety of treatment options to reduce the symptoms.
Lifestyle changes, such as losing excess weight, can often help mild cases of sleep apnoea to resolve. In more severe cases, the use of breathing apparatus while sleeping may be necessary.
Common treatments for obstructive sleep apnoea (OSA) include advice on lifestyle changes, and use of breathing apparatus (CPAP) while you are asleep.
Lifestyle changes
Mild cases of obstructive sleep apnoea (OSA) can usually be treated by making lifestyle changes, such as:
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losing weight (if you are overweight or obese)
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stopping smoking (if you smoke)
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limiting your alcohol consumption
Men should not regularly drink more than 3 to 4 units of alcohol a day. Women should not regularly drink more than 2 to 3 units of alcohol a day. If you've had a heavy drinking session, avoid alcohol for 48 hours.
'Regularly' means drinking these amounts every day or most days of the week.
One unit of alcohol is equal to half a pint of normal-strength beer, a small glass of wine or a pub measure (25ml) of spirits.
Stopping smoking can also help sleep apnoea to resolve. Sleeping on your side, rather than on your back, may also help to relieve the symptoms of OSA, although it will not prevent the condition.
Continuous positive airway pressure (CPAP)
Moderate to severe cases of sleep apnoea may need to be treated using a type of treatment called continuous positive airway pressure (CPAP). This involves using breathing apparatus to assist with your breathing while you are asleep.
CPAP is used when you are asleep. A mask is placed over your nose, which delivers a continuous supply of compressed air. The compressed air prevents the airway in your throat from closing.
Earlier versions of CPAP often caused nasal dryness, nosebleeds and a sore throat. However, the latest version includes a humidifier (a device that increases moisture), which helps to reduce these side effects.
If CPAP causes you discomfort, inform your treatment staff because the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep.
As CPAP can feel peculiar to start with, you may be tempted to abandon the treatment. However, people who persevere with it quickly get used to wearing the mask, and their symptoms improve significantly.
CPAP is available on the NHS and it is the most effective therapy for treating severe cases of OSA. It reduces blood pressure and the risk of stroke by 40%, and lowers the risk of heart complications by 20%.
Possible side effects of CPAP include:
If you have any of these side effects, discuss them with your sleep specialist who may be able to recommend an alternative treatment.
Left untreated, OSA can increase the risk of:
Untreated OSA also increases a person’s risk of developing heart failure and irregular heartbeats, and it can lead to poor performance at work and at school.
Driving
As someone with OSA can suffer a lack of refreshing sleep, they run an increased risk of being involved in a life-threatening accident, such as a car crash. Their risk of having a work-related accident also increases.
Research has shown that someone who has been deprived of sleep due to OSA has the same impaired judgement and reaction time as someone who is over the drink-drive limit.
If you have OSA, it could affect your ability to drive. It is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. The GOV.UK website has advice about how to tell the DVLA about a medical condition.
Your GP can refer you to the Respiratory Consultants at the George Eliot Hospital for a simple Overnight Oximetry test that will tell us if you have mild / moderate or severe OSA (or just a snorer).
