Sleep Apnoea: What is it? What causes it? How is it treated? These are some of the burning questions people have on the little-known topic. That’s why we asked Kath Hope, founder of the charity Hope2Sleep, to be our guest blogger this month. Kath, who was a victim of undiagnosed sleep apnoea herself, shares with us her knowledge on the subject, the myth that sleep apnoea only affects overweight people and how help is out there for sufferers.

What is sleep apnoea?
For many years snoring has been the subject of much leg-pulling and jokes, but we now realise it’s no laughing matter! Apart from the annoyance to the bed partner, or even people sleeping in other bedrooms, the sound of snoring is often a warning that something more serious is going on. Snoring can be an important ‘wake up’ alarm that alerts a person to investigate whether the snoring is a sign of sleep apnoea – though not all people with sleep apnoea do snore, and this is why these non-snorers are often the least to be diagnosed.

The Greek word ‘apnoea’ means ‘without breath’ which is where the name of the disorder, sleep apnoea is derived from – stopping breathing whilst sleeping. People with sleep apnoea stop breathing regularly during sleep, and most sufferers are unaware of this. People are still under the impression that you have to be overweight to suffer from sleep apnoea, which is far from the truth, and in fact untreated sleep apnoea can actually cause weight gain.

Sleep apnoea is a disorder which is far more common than people realise and is not unique to adults either. It’s thought around 1 in 30 children suffer from this – many who are misdiagnosed with other conditions like ADHD for instance. If untreated it can cause, or exacerbate, physical, mental and emotional problems such as:

• Heart attacks and other cardiovascular disorders
• Strokes
• High Blood Pressure
• Type 2 Diabetes
• Driving Accidents
• Obesity
• Anxiety and depression
• Hypothyroidism
• ADHD
• Brain confusion and memory problems
• Fibromyalgia
• Chronic Fatigue Syndrome (CFS)
• Dementia, particularly Alzheimer’s
• Floppy Eyelid Syndrome (FES)
• Glaucoma
• Asthma
• Erectile Dysfunction Syndrome
• Parkinson’s
• Heartburn and Gastrointestinal Reflux
• Vitamin D and/or B12 Deficiency
• (New research is being undertaken constantly and many more links to other medical conditions are possible)

Symptoms of Sleep Apnoea
(Not all of the following symptoms will apply to everyone with untreated sleep apnoea)
• Daytime tiredness
• Snoring or noisy breathing
• Sudden awakenings from sleep (although many people are unaware of having interrupted sleep)
• Night time bathroom trips, which normally stop when on good therapy
• Lack of concentration, poor work or school performance and possibly memory problems or confusion
• Depression, anxiety, irritability or short tempered
• Morning headaches
• Dry mouth and/or sore throat on waking
• Decreased sex drive
• They may already be a diabetic, have heart problems, have had a stroke/TIA or have hypothyroidism
• They may already be on medication for high blood pressure
• Many other symptoms can be present due to sleep deprivation

Types of Sleep Apnoea
There are three types of sleep apnoea:

Obstructive Sleep Apnoea (OSA) which is when there are physical obstructions causing the airways to block, such as large tonsils and/or adenoids, a large tongue, floppy soft palate, large uvula, nasal congestion/obstructions, large neck, receding jaw etc. Additionally, drinking alcohol within 3-4 hours of bedtime or taking certain medications which have sedative effects can also cause or make worse obstructive sleep apnoea. In most cases, a person will be a snorer or a noisy breather, but it’s the sound of silence in between the noise that is the danger area, as this is when the person has stopped breathing.

Central Sleep Apnoea (CSA) is not as common as OSA and most often not linked to snoring. Put simply, it is when the brain ‘forgets’ to or is slow to send signals to breathe, and has different causes, such as congestive heart failure, neurological diseases like Parkinson’s and Alzheimer’s, damage to the brainstem caused by encephalitis, stroke, injury or other factors and strong painkillers (narcotics/opioids).

Complex/Mixed Sleep Apnoea is rarer still and means a person has both OSA and CSA.

People with any form of sleep apnoea are often unaware of stopping breathing. The apnoeas (stopping breathing) or hypopnoeas (partially stopping breathing or struggling to breathe) will happen whilst sleeping. Usually the oxygen levels will drop, carbon dioxide levels will increase, and the heart will have to work hard to jolt the person to start breathing again – hence why untreated sleep apnoea is detrimental to our health! Unfortunately, this cycle will repeat itself throughout the night (particularly during deep REM sleep) and the sufferer will often wake up feeling unrefreshed. They will not put this down to lack of sleep, as they are often under the impression they have slept well, due to most people being unaware of what has been happening through the night. Some people do wake up gasping or choking though, but not all. It is normally the bed partner who may notice what is going on, and many have reported of hearing their bed partner snoring, followed by a silent pause when they suspect their partner has stopped breathing (which they have!). The sufferer will then usually make a snorting, choking or gasping noise, and they will start breathing again, but the cycle will continue throughout the night.

Treatment
Once sleep apnoea is diagnosed and successfully treated people almost always achieve benefits to their physical, mental and emotional health, and will also have more energy during the day. Just as important they will be protecting themselves from further damage to their bodies and minds.

The gold standard treatment for sleep apnoea is a CPAP (Continuous Positive Airway Pressure) machine which blows air through a tube and mask to keep the airways open. In milder cases of sleep apnoea and depending on the cause, a mandibular advancement device (MAD) can be fitted by a dentist trained in sleep. Sometimes surgery by an ENT consultant can help too.

What is encouraging is that none of the treatments involve having to take permanent prescription drugs which is a rarity in a serious medical condition.

What to do if you suspect sleep apnoea…
The first thing to do is to see your GP and it’s a good idea to take along your bed partner or someone who has witnessed the sleep problems, as very often the sufferers themselves are unaware of what is happening during their sleep. You may be asked to fill in the Epworth Sleepiness Scale, which you can find here. This isn’t always a true indication so a GP who is well educated about sleep apnoea will still refer a person to their local sleep clinic for a sleep study. Nobody can guess whether a person has sleep disordered breathing without seeing the evidence from a sleep study. Some sleep clinics have facilities for in-hospital sleep studies here in the UK, but many clinics will send people home to sleep in their own beds with the equipment.

Whilst getting a diagnosis can be quite a shock, I can honestly say (and on behalf of most diagnosed sufferers our charity supports), the diagnosis is usually a blessing in disguise. It is often the missing piece in the jigsaw for people who have been seeking answers to their problems for a long time. Therefore, if you do suspect sleep apnoea in yourself, a friend or family, investigate further, and contact us at the Hope2Sleep Charity for help and support in your journey.

Hope2Sleep Charity, founded by Kath Hope, supports people with sleep disordered breathing, of which the most common condition is sleep apnoea. http://www.hope2sleep.co.uk/

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