What is Sleep Apnoea?

Sleep apnoea is a common condition where breathing stops and starts during sleep. This occurs when the upper airways (including the throat, voice box, nose, etc.) become too relaxed. When this happens, the airflow towards the lungs can become blocked, affecting sleep and limiting the oxygen supply through the body. Episodes of sleep apnoea can occur hundreds of times throughout the night [1].

According to the Australian Institute of Health and Welfare, around 42-58% of Australian women and men experience sleep apnoea [2]. Additionally, about 1 in 10 Australians suffer from undiagnosed sleep apnoea. Like most sleep disorders, the risk of apnoea increases with age and in men [2].

Sleep apnoea can severely affect long-term health and sleep quality. Additionally, those diagnosed with this condition can increase the risk of workplace and motor vehicle accidents [2]. Those with a suspected sleeping disorder or apnoea need to talk to their doctor about receiving the necessary medical management.

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Sleep Apnoea Symptoms

There are several common symptoms of sleep apnoea, including [1]:

• Constantly getting unrefreshing sleep
• Fatigue
• Being constantly tired
• Difficulty concentrating and focussing
• Being irritable

Additionally, the sleeping partner may notice certain signs and symptoms, which could provide information about a potential sleep apnoea diagnosis. Some relevant signs and symptoms include excessive snoring, periods where the partner is not breathing and the partner waking to be unrefreshed.

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Sleep Apnoea Causes

The collapse of the upper airways causes sleep apnoea. The upper airway is made up of several structures (e.g. nose, throat, voice box, etc.) that are responsible for talking, swallowing food and breathing. This area is made of muscles and soft tissue that can relax and narrow during sleep [3]. Narrowing of the airways restricts the amount of oxygen being delivered to the body, which can increase effort or even stop breathing.

There are risk factors that can increase the likelihood of developing sleep apnoea, which includes [2]:

• Being overweight or obese
• Smoking
• Being physically inactive
• Drinking heavily
• Being diagnosed with type 2 diabetes
• High blood pressure (hypertension)

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Tests and Diagnosis

Talk to your doctor if you or your sleep partner suspect that you may have sleep apnoea. They will ask you relevant medical questions to determine the likelihood of this condition and whether follow-up tests are required. There are several specific questionnaires that doctors can use for sleep apnoea.

The most common and accurate way of determining sleep apnoea is by undergoing a sleep study [4]. A sleep study tests for any disturbances during your sleep. You may be required to undergo testing while sleeping in a laboratory. Sleep professionals will be present to assess your quality of sleep. They will measure a range of conditions, including:

• Brain activity
• Heart rate
• Oxygen levels in the blood
• Eye and leg movements
• Breathing patterns

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Sleep Apnoea Treatment

Treatment for sleep apnoea may vary depending on the individual’s circumstances and underlying causes. In most cases, sleep apnoea can be treatable. However, there may be underlying causes of sleep apnoea that may need to be addressed first.

Lifestyle Changes

Lifestyle habits can contribute to sleep apnoea. Your doctor may recommend changes in your daily routine to help improve symptoms. Referrals to other health professionals, such as therapists and nutrition, can help with these changes [5]. Examples include:

• Managing your weight, especially if you’re obese or overweight.
• Reducing your smoking habits
• Limiting alcohol intake
• Developing more optimal sleep hygiene practices
• Finding other sleep positions

Continuous Positive Airway Pressure Machines (CPAP)

CPAP is a machine that is used to treat sleep apnoea. The CPAP comes with a mask and attachments worn over the face at night. Pressurised air taken from the room is delivered through the airways to keep it open whilst sleeping [5]. This treatment prevents the collapse of the airways during sleep time.

Dental Splints

Dental splints may help treat mild to moderate sleep apnoea. These splints are shaped like mouthguards and worn overnight to keep the lower jaw forwards [5]. Changing the jaw’s position makes the airways more likely to be kept open. These splints need to be custom-made due to the different jaw shapes and sizes.

Surgery

Surgery may be considered an option if other treatments are ineffective or appropriate. In children, large tonsils and adenoids found at the back of the throat may contribute to sleep apnoea. Surgery to remove these tissues may be required to help keep the airways open [5]. Surgery in adults may include fixing areas that contribute to sleep apnoea, including the nasal septum (the part of the nose that separates the two nostrils), nasal passages, sinus, tongue, jaw and mouth [6].

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Recovery

Sleep apnoea is generally treatable. However, long-term outcomes will depend on being able to continue adhering to lifestyle changes and treatment (e.g. wearing the dental splint and CPAP mask, etc.) [7]. Despite its effectiveness, around 50% of people who are recommended for CPAP stop using it within the first month.

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Complications

The consequences of prolonged and severe sleep apnoea can be dire. In the short-term, sleep apnoea can lead to fatigue and brain fog. This can lead to more significant problems, such as workplace and motor vehicle accidents. If left untreated, sleep apnoea can increase the risk of developing long-term health conditions, including:

• High blood pressure (hypertension)
• Type 2 diabetes
• Stroke
• Heart disease
• Heart attacks
• Depression

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References

1. https://www.sleephealthfoundation.org.au/obstructive-sleep-apnea.html
2. https://www.aihw.gov.au/getmedia/6ea49796-0272-4182-b5bd-b93445bd0f06/aihw-phe-294-Obstructive-sleep-apnoea-OSA.pdf.aspx?inline=true#:~:text=This%20represents%20a%20rate%20of,studies%20(2.1%20per%201%2C000).
3. Eckert, D. J., & Malhotra, A. (2008). Pathophysiology of adult obstructive sleep apnea. Proceedings of the American thoracic society, 5(2), 144-153.
4. Hamilton, G. S., & Chai-Coetzer, C. L. (2019). Update on the assessment and investigation of adult obstructive sleep apnoea. Australian journal of general practice, 48(4), 176-181.
5. Kee, K., & Naughton, M. T. (2009). Sleep apnoea-a general practice approach. Australian family physician, 38(5), 284-288.
6. https://www.sleephealthfoundation.org.au/surgery-for-obstructive-sleep-apnoea-osa.html
7. Slowik, J. M., & Collen, J. F. (2021). Obstructive sleep apnea. In StatPearls [Internet]. StatPearls Publishing.