Snoring and Sleep Apnea
What is sleep apnea?
Snoring and sleep apnea are similar in that they both occur when muscles in the tongue and upper airway relax during sleep and cause either a partial or complete blockage of the airway. When the airway slightly narrows, that’s snoring. Enough to cause vibration in the back of the airway that generates a snoring noise. Sleep apnea is when the airway gets even narrower, and either blocks completely or is narrow enough that breathing is difficult. The brain senses this during sleep and reacts by trying to breathe harder causing brief awakenings, called arousals, from sleep. These arousals can result in people feeling tired during the day, and also increase the future risk of high blood pressure and heart problems.
Who is at risk of sleep apnea?
Snoring is very common, around 25%, or 1 in 4 men snore. Sleep apnea is less common than snoring, but still common overall. Around 5% of men (1 in 20) and 3% of women (1 in 33), have bad enough sleep apnea that it is causing tiredness that is having an impact on them throughout the day.
Whilst it’s true that men are more likely to have sleep apnea, and being overweight is also a risk for sleep apnea, women and people who are not overweight can also get sleep apnea. Sleep apnea can also look different in women, particularly before the menopause, when it is not always associated with loud snoring or a bed partner noticing changes in breathing. In people who are not overweight sleep apnea can occur if they have a narrow upper airway because of large tonsils or a blocked nose. People with small jaws or an overbite are also at risk of obstructive sleep apnea.
What are the symptoms of sleep apnea?
- Regular snoring or noisy breathing during sleep
- Variation in breathing during sleep such as pauses or gasping
- A sense of waking choking or gasping
- Feeling more tired during the day than expected
- Having trouble with concentration and memory
- Feeling irritable or down when we wouldn’t usually expect to be
- Needing to pass urine often during the night
- Morning headaches on waking up
What is the testing for sleep apnea?
Sleep apnea is diagnosed with a combination of a clinical assessment and a sleep study. The role of a sleep study is to determine the degree of sleep apnea and also the impact it is having on your sleep and other parts of the body such as the heart and blood vessels. Sleep studies are usually conducted in a laboratory, such as the one at St Vincent’s Private Hospital, but in some circumstances can be done at home.
What is the treatment for sleep apnea?
There are a range of treatments for sleep apnea, ranging from general measures to using machines to prevent the upper airway from narrowing or blocking during sleep.
Weight loss: Often easy to say but hard to do. Whilst losing weight is important for those with sleep apnea it is hard especially when people are already feeing tired. Nonetheless, being diagnosed with the sleep apnea can be a motivator to get moving and work on weight loss.
CPAP: Once we’ve addressed those lifestyle factors but we’re still having problems with sleep apnea, then one type of treatment is using devices that increase the air pressure in the back of the airway. These keep the airway open and prevent the tongue from falling back towards the back of the airway and causing narrowing. The most well-known of those devices is something called CPAP which stands for Continuous Positive Airway Pressure.
CPAP is a device that sits on the bedside table and blows air down through a tube, airtight mask that fits over the nose or nose and mouth, and increases the pressure in the back of the airway. It is a very effective treatment for both snoring and sleep apnea but does take a bit of work getting used to.
Mandibular advancement splints: Another category of treatment that’s used in the treatment of sleep apnea are treatments that bring the base of the tongue forward and hold it forward away from the back of the airway. Dental appliances such as mandibular advancement splints are the most common of these. They are custom made appliances that fit in the top and bottom teeth with the aim of holding the lower jaw forward during sleep.
They’re quite effective at holding the tongue away from the back of the airway and effective at reducing therefore snoring and sleep apnea.
Surgery also has a potential role in the treatment of sleep apnea. In days gone by, surgery consisted of surgical procedures on the palate such as a uvulopalatopharyngoplasty or UPPP as it’s sometimes called. That's rarely done now as UPPP alone has not been shown to be an effective surgery for sleep apnea.
However there has been some recent Australian research showing a combination procedure of a modified uvulopalatopharyngoplasty together with tonsillectomy and tongue channelling coblation to reduce the volume of the base of the tongue can be an effective treatment for people with sleep apnea.
Importantly though, the more severe sleep apnea is, the less likely we are to get a good result with surgery.
What is the most important message for concerned individuals?
If you have symptoms of sleep apnea or any of the medical conditions that are associated with sleep apnea, you should discuss them with your doctor. They may arrange to refer you to a sleep specialist who will evaluate your symptoms and history and arrange a sleep study to determine the degree of any sleep apnea which in turn will guide treatment.
The sleep service at St Vincent’s Private Hospital has been running for over 25 years, and provides world class diagnostic testing for sleep disorders as well as participating in research for a range of conditions including sleep apnea, insomnia, narcolepsy and restless legs syndrome.