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Sleep Apnoea

Obstructive Sleep Apnoea (OSA) is a common condition affecting up to 7 in 25 people. It results from temporary blocking of the airways during sleep.

When we go to sleep, the whole body normally relaxes, becoming a little more floppy. This relaxation includes the tissue of the throat. In some people, relaxation at the back of the throat is of no consequence; in others it leads to snoring: and in a small proportion of people, the relaxation can cause complete blockage of the upper airway. This last group of people have OSA.

When a person with OSA sleeps, breathing IN causes the tongue and soft palate to be sucked against the back of the throat, completely blocking the airway. This causes apnoea (temporary stopping of breathing). The body is therefore, starved of oxygen, leading to suffocation. This eventually wakes the person and breathing begins again.

A patient suffering from OSA will often not wake completely, but instead return to a lighter level of sleep. Patients are therefore usually unaware of the apnoeic events taking place during their sleep. Episodes of obstruction may occur hundreds of times throughout the night.

In some cases, episodes of obstruction may occur while lying on the back only, called Positional Sleep Apnoea, or only during dreaming-sleep when the body relaxes even more. Being overweight, drinking alcohol or taking sedatives make episodes of obstruction worse.

Symptoms of Obstructive Sleep Apnoea:

Loud snoring and grunting Restless sleep
Choking sensation at night Morning headaches
Severe daytime sleepiness Intellectual deterioration
Memory Lapses Morning confusion
Personality changes Irritability
Sexual dysfunction  

Effects of Obstructive Sleep Apnoea

The consequences of OSA are two-fold. First, it results in a very disrupted sleep pattern, so that the sufferer becomes chronically deprived of the deeper stages of sleep and develops excessive daytime sleepiness. Sleep then ceases to be refreshing or of good quality.

Patients with OSA may not be aware that their sleep is of very poor quality. Since the awakening caused by an apnoea is very brief, he/she probably will not remember waking, even if it happens hundreds of times during the night. Thus, the main symptom of OSA, apart from snoring, is excessive daytime sleepiness. This may range from nodding off in front of the television to falling asleep at work or at the wheel of a car.

If you suffer from OSA, or you are suspected of having OSA, it is important that you do not drive, particularly long distances, nor should you operate dangerous machinery, as your risk of having an accident is greatly increased.

The second consequence of OSA is the effect of repeated suffocation during the night, which can result in morning headaches, irritability and forgetfulness. In more severe cases, it can result in damage to the heart and the brain. This can be life threatening.

Other complications of OSA include:

Treatment

CPAP Therapy

Nasal CPAP (continuous positive airway pressure) is the Gold Standard for treating OSA and involves the patient wearing a mask that fits over the nose during sleep. A blower gently pushes air into the mask and into the airway, thus acting as a pneumatic splint, keeping the tongue and tissue of the soft palate supported. This keeps the airway open and allows uninterrupted breathing. In the sleep laboratory, the critical pressure of CPAP required is determined by trained staff.

For patients who are unable to tolerate CPAP therapy, oral appliances or positional therapy devices, or a combination of both depending upon the severity of OSA, may be used as an alternative.

Oral appliances

The best and most effective oral appliances are designed to be moulded and fitted over your teeth to bring you jaw forward during sleep. Bringing the lower jaw forward creates more space for air to move into your airway. However, sometimes people may experience pain in the joint of the jaw called TMJ or suffer from a dry mouth. It is important to have the oral appliance fitted properly by an experienced sleep dentist to minimise these side effects.

Positional Therapy

Mild to moderate sleep apnoea may be treated by a positional therapy device if the apnoeas occur mainly when sleeping on your back. Approximately 20% of people with OSA have position-related OSA which can be treated inexpensively by wearing a simple device that encourages side sleeping.

EPAP

These are small sticky pads that contain valves which attach to the opening of the nose. They work on the principal of allowing more air in than they let out during each breath which prevents the upper area of the soft palate and tongue from collapsing and blocking the airway. A chin strap is sometimes required to keep the mouth closed to ensure that the trapped air doesn’t escape. EPAP (expiratory positive airway pressure) therapy may be an effective alternative to CPAP therapy.

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