Obstructive sleep apnoea | Mate hoto hau

If you have OSA, the muscles in your airways relax and block your airways while you are asleep. When this happens, you stop breathing for a short time until your brain wakes you up to begin breathing again. This cycle can repeat hundreds of times a night. Often you don't know this is happening, but it can reduce the quality of your sleep.

You are at higher risk of getting obstructive sleep apnoea if you:

• are obese (the most important risk factor)
• are a man (men are 2 times more likely to get OSA than women)
• aged 40 or over
• are Māori or Pacific Peoples
• have a family history of OSA
• have a small jaw, small throat or nose/throat abnormalities
• have a neuromuscular disease
• are pregnant or have pre-eclampsia
• have hypothyroidism
• have polycystic ovary syndrome (PCOS)
• have big tonsils (most common in young people).

Video: What causes snoring and obstructive sleep apnea?

 (Capital Otolaryngology Head and Neck Surgeons, US, 2010)

Image credit: 123RF

Symptoms of OSA include:

• snoring
• waking up in the morning feeling tired (daytime sleepiness) and groggy
• having early morning headaches 
• difficulty concentrating and finishing tasks
• altered mood
• stopping breathing during sleep for 10 seconds or longer (your partner can report this)
• waking up frequently with choking
• a dry mouth or sore throat for no apparent reason
• getting up 2 or 3 times a night to go to the toilet.

Some of the symptoms of OSA are similar to other conditions, so it’s important to see your doctor to find out what is causing your symptoms.

If left untreated, OSA can cause:

• poor sleep quality
• poor work performance
• work accidents if you have a high-risk occupation, eg, heavy machine operator
• motor vehicle accidents
• short-term memory problems
• depression
• hypertension (high blood pressure)
• arrhythmia (irregular heartbeat)
• cardiovascular diseases such as heart disease and stroke
• impaired development in children.

Your doctor will take a detailed history of your problem and examine your throat, neck or nose for signs of narrowing. Your doctor will also review your medicines to find out if any of them is causing your sleepiness. You may also be asked to complete a questionnaire, called the Epworth sleepiness score (ESS)(external link). It may often be helpful for your spouse or partner to be present, as they can explain what happens to you during sleep.

Tests may be used to confirm the diagnosis of OSA, including:

• blood tests such as full blood count, thyroid function test or renal function test
• sleep study or polysomnography.

Sleep study or polysomnography

Polysomnography is a detailed sleep study to see how well you sleep. It records a number of measurements such as pauses in your breathing, brain wave activity, sleep cycle (amount of deep sleep and rapid eye movement sleep).

Treatment depends on the severity of your OSA. If you have mild OSA, such as snoring only without daytime sleepiness, it can be treated through lifestyle changes. If your OSA is more severe, treatment may include continuous positive airway pressure (CPAP), dental or oral appliances, or surgery.

Lifestyle changes

Changes that can help your OSA include:

• losing weight if you are obese or overweight (reducing your weight as little as 10kg can make a big difference)
• quitting smoking if you smoke
• avoiding alcohol and medicines that make you sleepy before bed
• exercising regularly
• avoiding sleeping on your back
• maintaining good sleep habits and sleep hygiene. Read our sleep tips to help with this.

Continuous positive airway pressure (CPAP)

Continuous positive airway pressure (CPAP) is the most commonly prescribed treatment for OSA. It uses a small air pump that produces pressure to keep your airway open while you sleep. You wear a mask fitted to your nose. It is the gold standard treatment for OSA as it helps hold your airways open, allowing you to sleep properly.

CPAP should be used for at least 5 nights per week and a minimum of 5 hours per night. Many people feel much better within a few days of beginning CPAP, as they get the benefit of deep restorative sleep.

Dental or oral appliances

Dental appliances, such as special mouthguards and other devices, can be used if you have less severe OSA, are not obese or can’t use CPAP.

Surgery

Surgery might be helpful when specific abnormalities, such as enlarged tonsils or a blocked nose, are contributing to the condition. There is also some evidence that it might be an option for some other people if CPAP doesn't work for them. 

Apps reviewed by Healthify

You may find it useful to look at some Sleep apps, Snoring apps, and Breathing apps.

The following video presented by an ear, nose and throat (ENT) surgeon provides some background to snoring and sleep apnoea and some simple exercises you can try.

A shorter version(external link) is available, but in this one he talks quite quickly so you might want to use your player settings to slow it down a little.

One of the main symptoms of OSA is daytime sleepiness and fatigue. If you need to drive, this can be extremely dangerous as driver fatigue is one of the most common causes of motor vehicle accidents in New Zealand.

If you experience drowsiness while you are driving, it's important to let your doctor know. They will need to find out the causes of your sleepiness and treat it accordingly. 

It is also a legal requirement for you to only drive when you are medically fit, which means not to drive if you are too tired and sleepy. The New Zealand Transport Agency has some fatigue resources(external link) to make it easier to manage driver fatigue. See also drowsy driving tips(external link).

See your GP as soon as possible if you feel very sleepy during the day while driving or your job involves operating machinery or aircraft.

Members of the Sleep Apnoea Association of NZ Inc (SAANZ) are available to provide support for queries by phone (021 344 253) or email saanz.editor@gmail.com). If you have any queries about sleep apnoea, diagnosis, or treatment or are struggling to get used to using CPAP, they are happy to be contacted.