Sleep apnoea – what it is and what to do about it

Sleep apnoea can be a frustrating condition, which can stop you – and your partner – from enjoying quality sleep. And if it doesn’t get sorted out, it can affect your health as well as your relationship.

So here’s what you need to know about sleep apnoea, including what you can do to help yourself, and when to see a doctor.

What is sleep apnoea?

Sleep apnoea is a problem with your breathing that happens while you’re asleep. There are 2 types, although 1 is much more common than the other:

1. Obstructive sleep apnoea (OSA) is the most common, and this is the type of sleep apnoea discussed in the rest of this article. It happens when the muscles around your throat relax too much during sleep, which causes the walls of your throat to collapse and your airway become narrow or blocked.

As you breathe in, air travelling through your narrowed airway causes vibrations in the tissues in the back of the throat, which causes

. Sometimes, no air is able to get through, and you stop breathing for a short period of time.

2. Central sleep apnoea (CSA) is much rarer. This happens when your body’s way of controlling the rate and depth of your breathing isn’t working normally.

Find useful information on other areas of sleep with our

.

Who gets obstructive sleep apnoea?

According to the BMJ (British Medical Journal), OSA is thought to affect about 2% of women and 4% of men in their mid-50s.

It’s more common as you get older, and some research suggests women may be more likely to get it after the

(when your periods stop). It’s also likely that many people don’t realise they have sleep apnoea.

Sleep apnoea symptoms: what does it feel like?

OSA means you’ll sometimes stop breathing while you’re asleep, because the flow of air is blocked by your relaxed throat muscles. After a few seconds, however, your brain will notice the problem and make your body start breathing again.

This can make you wake up with a deep snoring, choking or gasping sound, or you may not realise you’ve woken up at all. It can happen many times an hour, all through the night, meaning you don’t get enough restful,

.

Some people with OSA also have to get up several times during the night to pee, as well as tossing and turning a lot throughout the night.

How does sleep apnoea affect your daytime health?

Because OSA stops your body from getting the

it needs, you might also get daytime symptoms. These can include:

• sleepiness and tiredness (
  fatigue
  )
• dry mouth and
  headaches
  when you wake up
• problems with concentration and memory
• slow reaction times (such as when driving)
• irritability and
  mood changes
• mental health problems such as
  anxiety
  or
  depression
• reduced sex drive (
  libido
  )
• impotence (
  erectile dysfunction
  )

Common sleep apnoea causes

Several things mean you’re more likely to get OSA. The most common are:

• being
  overweight
  – if you have more body fat, you can have more soft tissue in your neck, which can put pressure on your throat muscles. Women with a neck size of 41cm or more have an increased risk of OSA, while for men it’s 43cm. Too much tummy fat can also cause breathing problems, which can make OSA worse
• being male – it isn’t clear why OSA is more common in men, but it may be related to the different ways men and women carry body fat
• being at least 40 years old – OSA is more common in over 40s (although it can happen at any age)

Other risk factors include:

• taking medication that has a sedative effect, such as sleeping tablets or tranquillisers
• having unusual anatomy – such as a narrow airway, large tonsils or tongue, or small lower jaw
• drinking
  alcohol
  – this can make snoring and OSA worse
• smoking
  – you’re more likely to get OSA if you smoke
• having been though the
  menopause
  – it’s thought that the hormone changes of menopause may increase your risk of OSA
• having a family history of OSA – genes passed on from your parents may make you more likely to get OSA
• having a stuffy nose (nasal congestion) – you’re more likely to get OSA if you have long-term (chronic) nasal congestion, which can be caused by
  allergic rhinitis
  , for example
• sleeping on your back – this can make it more likely for your airway to get blocked, due to gravity’s effect on your throat
• certain medical conditions – including
  type 2 diabetes
  ,
  high blood pressure
  ,
  polycystic ovary syndrome
  ,
  heart failure
  ,
  Parkinson’s disease
  ,
  chronic lung disease
  and
  stroke

The surprising risks of untreated sleep apnoea

If OSA isn’t diagnosed and treated, it can lead to other problems. Your risk of getting these issues is higher if your OSA is severe and you don’t do anything to manage it – such as losing weight or quitting smoking.
Without treatment, OSA can lead to:

• difficulty concentrating at work
• relationship problems
  due to tiredness and the effects of poor-quality sleep
• an increased risk of having an accident (such as a car crash) due to fatigue
• high blood pressure
• depression and mood changes
• an increased risk of stroke

There’s also some evidence that untreated OSA can increase your risk of dying earlier than you otherwise would, though this risk increases with age and weight (

).

Sleep apnoea treatment: what can you do at home?

If your OSA is mild, making some changes to your lifestyle can improve your symptoms and make a big difference to your quality of life.
Self-care tips for OSA include:

• losing weight
  if you’re overweight or
  obese
• limiting
  how much alcohol you drink
  , and avoiding alcohol in the evenings
• quitting smoking
  if you smoke
• avoiding taking sleeping tablets or tranquillisers
• not sleeping on your back – you can try taping a tennis ball to the back of your nightclothes so you can’t roll onto your back, or buy a special pillow or bed wedge to help keep you on your side

If your OSA is also disrupting your partner’s sleep, you may want to consider sleeping in a different room.

How can a pharmacist help with sleep apnoea?

If you think OSA is being caused by nasal congestion or allergic rhinitis, your pharmacist may be able to offer you

or to help you breathe more easily.

When to see a doctor

You should see your doctor if you have any of the main symptoms of OSA, such as if your breathing stops and starts or you make gasping, snorting or choking noises while you sleep, or if you always feel very tired during the day.

If your partner or someone else has seen you having OSA symptoms, it can be helpful for them to come to your appointment too, so they can describe your symptoms. If you sleep alone, you could try using your phone to record you sleeping.

If you’re not sure whether you need to see a doctor, try our

to help you work out what your next step should be.

How is sleep apnoea diagnosed?

Your doctor will review your symptoms and ask you about your medical and family history, before arranging some tests to confirm a diagnosis.

It can be helpful to keep a diary of your symptoms and bring this to your appointment, as well as bringing your partner (if relevant).

Your doctor may ask you to fill in a questionnaire, such as the Epworth Sleepiness Scale or the Stop-Bang questionnaire, so you might want to look at 1 of these online and fill it in before your appointment.

Your doctor may also refer you to a specialist sleep clinic, where you may be asked to wear some devices while you sleep to check for signs of OSA. You can sometimes do these tests at home, but you may need to stay in the clinic overnight.

Most sleep studies check your:

• heart rate
• breathing and snoring
• blood oxygen levels
• sleep position and limb movements

Some more complex sleep studies, such as polysomnography, can also measure your brain signals and muscle movements.

These tests can find out if you have OSA and how severe it is, based on how often your breathing stops while you sleep. You may be given what’s known as an AHI score: a score of 5 to 14 is mild OSA, while 15 to 30 is moderate and over 30 is severe.

Medical treatment for sleep apnoea

If self-care tips don’t help and your OSA is more severe, continuous positive airway pressure (CPAP) is the most common medical treatment.

Here’s what you need to know about CPAP:

• you wear a face mask at night, which is attached to a machine – this constantly pushes air into your airways while you’re asleep
• it stops your throat from collapsing – which prevents breathing pauses and improves the quality of your sleep
• it can take time to get used to and may feel uncomfortable at first – it’s important to find a mask that fits well and a machine that suits you, so speak to your doctor if you’re finding it hard to use

Things you can try to help make CPAP easier to use:

• wear the mask while you’re awake to get used to it – such as while you’re reading or watching TV
• use it every time you sleep – this will help you get used to it more quickly
• try to relax before bed and practise good sleep hygiene – try these tips for the
  best bedtime routine
• wear ear plugs if you find the machine noisy

Less common treatments for OSA may not work as well as CPAP. But other options include:

• mandibular repositioning appliances (MRAs) – these are gum shield-like devices that you wear in your mouth to hold your airways open. They need to be fitted by a dentist and worn whenever you sleep, and work best for mild to moderate OSA
• surgery to help your breathing – such as removing very large tonsils, which may block your throat during sleep. Although surgery may help some people, it isn’t usually recommended because it doesn’t always stop OSA coming back

Your health questions answered

If I have OSA do I need to let my car insurers know?

Answered by:

“Driving authorities such as the DVLA recognise certain sleep disorders that can affect your ability to drive, such as sleep apnoea. You should tell the DVLA if you have a diagnosis of moderate or severe OSA with excessive sleepiness. You must not drive until you’re free from excessive sleepiness, or your symptoms are under control and you’re following any treatment you need.”