Sleep Apnoea Treatment

What is sleep apnoea?

When you sleep, your throat muscles and tongue relax, blocking or partially blocking your airway. Sleep apnoea occurs when your breathing is blocked or partially blocked resulting in paused or shallow breathing. Frequently, normal breathing restarts, sometimes with a loud snort or choking sound. As this happens, you will move out of deep sleep into light sleep. This can occur 30 times or more an hour.

Obstructive sleep apnoea is the most common form of sleep apnoea.

When should I see a specialist for sleep apnoea treatment?

You should consider seeing a medical specialist called an Ear, Nose, Throat (ENT) surgeon if you or your partner notices the following symptoms.

Your partner notices that you

• snores loudly and heavily
• toss and turn restlessly in the night
• stop breathing, gasp, or choke during sleep.

You may
• feel sleepy during the day.
• fall asleep at inappropriate times, such as while you are talking or eating.
• have morning or night headaches
• wake up frequently to urinate

Did you know?

Adults should sleep 7 or more hours per night on a regular basis to promote optimal health¹.

What are the complications of sleep apnoea?

When you stop breathing, your oxygen level in your blood reduces and carbon dioxide level increases, making your heart work harder, affecting your heart rate and nervous system. This may lead to problems such as:

• high blood pressure and heart disease.
• increase your risk of having a stroke
• a greater difficulty for people with diabetes to control their blood sugar.

How should I prepare for my appointment?

The ENT surgeon will discuss your personal and family history with you. Your specialist is likely to ask questions regarding your symptoms, if you stop breathing during the night and how often this occurs, how your partner describes the symptoms, and if there was anything you have done that might have made the symptoms worse or better.

The following information should be prepared for the appointment:

• Your symptoms and how long you have had these symptoms

• All medication currently being consumed including dosage, vitamins, and other supplements

The ENT surgeon may order an evaluation which often involves overnight monitoring of your breathing and other body functions during sleep. Home sleep testing may also be an option.

• Nocturnal polysomnography where your blood oxygen levels, breathing patterns, body movements, and activities of heart, lung and brain are monitored while you sleep.

• Home sleep tests where your heart rate, blood oxygen level, airflow and breathing patterns are monitored. It should be noted that portable monitoring devices may not be effective in diagnosing all cases of sleep apnoea. Your specialist may recommend polysomnography even if your initial results are normal.

If you do have sleep apnoea, your test results will show decreases in your oxygen level during apnoea and subsequent rises as you awake.

What can I expect during sleep apnoea treatment?

For mild cases, your ENT surgeon could suggest lifestyle changes such as weight loss or smoking cessation as initial steps.

For moderate to severe cases, the following treatments may be prescribed.

• Continuous positive airway pressure (CPAP) involves the use of a mask-like device that pumps air at a slightly higher pressure than the surrounding air, to keep your upper airway passages open, preventing apnoea and snoring. Variations of such devices include

• Auto-CPAP automatically adjusts the pressure while you’re sleeping

• BiPAP applies more pressure when you inhale and less when you exhale.

• Expiratory positive airway pressure (EPAP) involves a single-use device placed over each nostril before bedtime. Air flows freely in but is exhaled through small holes in the device, keeping the airway open.

• Oral appliances help to keep your throat open by bringing your jaw forward.

• Surgery is an option if other treatments have failed and includes the following:

• Uvulopalatopharyngoplasty is a procedure where your ENT surgeon removes tissue from the rear of your mouth and top of your throat, including tonsils and adenoids to stop throat structures from vibrating and causing snoring.

• Maxillomandibular advancement is done to move your jaw forward, creating more behind the tongue and soft palate, reducing the possibility of an obstruction.

What happens after my sleep apnoea treatment and how do I maintain my health?

Besides treatment, some lifestyle changes such as those below can help you manage your sleep apnoea:

· losing excess weight can help relieve your throat constriction
· exercise can help ease some of the symptoms even if you do not lose weight
· avoid alcohol and sleeping pills as these relax the muscles of your throat, interfering with your breathing
· sleeping on your side or abdomen rather than on your back to prevent your tongue and soft palate from resting against the back of your throat, blocking your airway
· stop smoking as it worsens sleep apnoea.

1. Watson N, Badr M, Belenky G, Bliwise. Recommended Amount of Sleep for a Healthy Adult. J Clin Sleep Med. 2015;1111(66):591-592. doi:10.5664/jcsm.4758.