Overview
Sleep apnoea is a condition in which breathing stops and starts repeatedly during sleep. In the common form, obstructive sleep apnoea, the muscles of the throat relax so far that the airway narrows or closes, and the sleeper has to rouse briefly to open it again.
This can happen many times an hour, all night long. The sleeper rarely remembers any of it, which is why sleep apnoea is usually first noticed by a partner or a family member who hears the snoring and the pauses.
A less common type, central sleep apnoea, happens when the brain does not send the signals needed to breathe. It is linked to other health conditions rather than to a blocked airway.
Symptoms
At night there is breathing that stops and starts, gasping, snorting or choking noises, loud snoring, and waking up again and again.
During the day there is often heavy sleepiness, difficulty concentrating, mood swings and irritability, a headache on waking, and a dry mouth or sore throat in the morning.
In children, large tonsils or adenoids are a common reason, and the condition may show as snoring, restless sleep, breathing through the mouth, and trouble concentrating at school.
When to see a doctor
Make an appointment if someone has seen your breathing stop and start in your sleep, if you snore loudly with gasping or choking, or if you are very sleepy through the day, wake with headaches, or cannot concentrate.
It helps to take the person who shares your room to the appointment, since they have seen what happens while you are asleep.
Causes
Obstructive sleep apnoea happens because the airway at the back of the throat narrows too far during sleep. Anything that reduces the space there, or relaxes the muscles further, makes it more likely: extra weight around the neck, large tonsils or adenoids, alcohol in the evening, sedative medicines and lying on the back.
Central sleep apnoea is different. The brain stops sending the signal to breathe for a while, usually because of another condition affecting the brain or the heart.
Risk factors
- Being overweight or obese
- A wide neck
- Being male
- Getting older
- Sleep apnoea in the family
- Large tonsils or adenoids, especially in children
- A naturally narrow airway
- Smoking
- Alcohol, particularly in the evening
- Sleeping on the back
- Having COPD
Complications
Sleep apnoea that is left untreated has effects well beyond tiredness:
- High
- Heart disease
- Stroke
- Type 2 diabetes
- Depression and low mood
- Road accidents and accidents at work caused by sleepiness
- Difficulty concentrating at work or in study
Prevention
- Keeping to a healthy weight, and losing weight that has crept on
- Exercising regularly
- Not smoking
- Limiting alcohol, especially in the hours before bed
- Not taking sleeping pills unless a doctor has prescribed them
- Going to bed and getting up at the same times each day
- Sleeping on your side rather than on your back
Diagnosis
A doctor asks about snoring, sleep and daytime sleepiness, and about weight, alcohol, smoking and other health conditions, then examines the nose, mouth and throat.
A sleep study confirms it. Most are now done at home: small devices worn overnight record breathing, heart rate and the oxygen level in the blood. The result is reported as the number of breathing pauses in an hour, which is graded mild, moderate or severe.
Treatment
CPAP is the main treatment for moderate and severe obstructive sleep apnoea. A small machine blows a gentle stream of air through a mask and holds the airway open all night. It works on the nights it is used, and it usually takes a few weeks to settle in with the mask.
Milder cases may be helped by a mandibular advancement device, a fitted mouthpiece worn at night that holds the lower jaw forward. Exercises for the muscles of the mouth and throat are sometimes suggested as well.
Losing weight, stopping smoking, cutting down alcohol and sleeping on the side reduce the number of pauses and for some people are enough on their own. Surgery, such as removing large tonsils, is considered in selected cases, and a small implanted device that stimulates the nerve to the tongue is an option for a few. Heavy sleepiness makes driving unsafe, so anyone who feels sleepy at the wheel should not drive until the condition is treated.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Snoring is harmless, and loud snoring just means deep sleep.”What is true?
Fact
Plenty of people snore without any illness. Snoring that comes with pauses in breathing, gasping or choking sounds is the classic pattern of sleep apnoea, which is a treatable condition and worth testing for.
Myth“Only very overweight people get sleep apnoea.”What is true?
Fact
Extra weight and a wide neck are the strongest risk factors, but sleep apnoea also occurs in people who are not overweight. Large tonsils, a naturally small airway, family history, older age, smoking, alcohol and sleeping on the back all play a part, and children with large tonsils or adenoids get it too.
Myth“Feeling sleepy through the day is just laziness or a bad habit.”What is true?
Fact
Heavy daytime sleepiness is one of the main symptoms of sleep apnoea, along with poor concentration and mood changes. It also raises the risk of road and workplace accidents, so it is a medical problem rather than a character one.
Myth“A sleeping tablet at night would sort this out.”What is true?
Fact
Sleep apnoea is not a difficulty falling asleep: it is the airway closing once you are asleep. People with sleep apnoea are advised not to take sleeping pills unless a doctor has prescribed them.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is snoring the same as sleep apnoea?
No. Snoring is the sound of air passing a narrowed throat and is very common on its own. Sleep apnoea is snoring plus actual pauses in breathing, often with gasping or choking, followed by sleepiness in the day. A sleep study is what tells the two apart.
Will I need CPAP for the rest of my life?
CPAP treats the problem rather than curing it, so it works only on the nights it is used. If losing weight, stopping smoking or treating large tonsils reduces the number of pauses, your doctor may repeat the sleep study and review the treatment. That decision rests on a test result rather than on how rested you feel.
Could sleep apnoea be why my blood pressure will not come down?
It can be part of the picture. Untreated sleep apnoea raises the risk of high blood pressure, and blood pressure that stays high despite treatment is one of the reasons doctors ask about snoring and daytime sleepiness. Mention it at your next appointment so it can be looked into.
Is it safe for me to drive?
Sleepiness at the wheel causes accidents, and this is one of the most serious risks of untreated sleep apnoea. Do not drive when you feel sleepy, and ask your doctor about driving before your treatment is settled, so you get advice that fits how severe your apnoea is.
