What is Sleep Apnoea (Sleep Apnea)?
Obstructive Sleep Apnoea (O.S.A.) is defined as an interruption to airflow during sleep preventing air from entering the lungs, caused by an obstruction of the airway. These periods of breathing cessations only become clinically significant if the cessation lasts for more than 10 seconds each time and occurs more than 5 times every hour. O.S.A. only happens during sleep, caused by a lack of muscle tone in the upper airway that causes the airway to collapse inward. The upper airway is then overcrowded. During the day we have muscle tone, keeping the airway open, and allowing for normal breathing. When you experience an episode of apnoea during sleep the respiratory centre in the brain will automatically wake you up, usually with a very loud snore or snort, and your breathing restarts.
People with OSA will experience these waking episodes many times during the night. Often the bedpartner will become aware of the night-time startling and also become concerned. Daytime Somnolence (feeling sleepy in the daytime) is a very common symptom. This feature of Sleep Disordered breathing can become incredibly frustrating, causing difficulties in many areas, such as driving, concentrating on work, and inability to focus on jobs requiring a lot of concentration, among many other problems.
How Do I Know I Have Sleep Apnoea?
People with Sleep Apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following:
• Extremely loud heavy snoring, often interrupted by pauses and gasps
• Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation, watching TV, at a meeting or movie (This should not be confused with excessive tiredness with which we all suffer from time to time)
• Irritability, short temper
• Morning headaches
• Forgetfulness, brain fog
• Changes in mood or behaviour
• Anxiety or depression
• Decreased interest in sex
Remember, not everyone who has these symptoms will necessarily have sleep apnoea. We possibly all suffer from these symptoms from time to time however, people with sleep apnoea demonstrate some or all of these symptoms all the time.
Diagnosing Sleep Apnoea
OSA can range from very mild, moderate or severe. The severity is often established using the apnoea/hypopnoea index (AHI), which is the number of apnoea’s plus the number of hypopnea’s per hour of Sleep – (hypopnoea being reduction in airflow). An AHI of less than 10 is not likely to be associated with clinical problems. To determine whether you are suffering from sleep apnoea you should talk to your GP. He or she will refer you to a Sleep Centre with a Respiratory Consultant specialising in Sleep. A respiratory consultant will request an overnight sleep study. This may involve a night in hospital where equipment will be used to monitor the quality of your sleep.
The results will enable a specialist to decide on your best course of treatment. The ultimate investigation is polysomnography PSG, which will include:
• Electro-encephalography (EEG) – brain wave monitoring
• Electromyography (EMG) – muscle tone monitoring
• Recording thoracic-abdominal movements – chest and abdomen movements
• Recording oro-nasal airflow – mouth and nose airflow
• Pulse oximetry – heart rate and blood oxygen level monitoring
• Electrocardiography (ECG) – heart monitoring
• Sound and video recording
Sleep studies are available in public and private hospitals. In public hospitals, the waiting list may be long and it may take a very long time to get a diagnosis. Some centres are able to offer testing routinely for all suspected sleep apnoea patients www.beacondentalsleep.ie . A Home sleep study can also be prescribed in Beacon Dental Sleep Medicine clinic www.beacondentalsleep.ie
Treating Sleep Apnoea
The treatment for sleep apnoea is generally determined by the severity of the illness. In mild and moderate the use of mandibular advancement devices M.A.D., can be very successful. In severe cases of Sleep Apnoea very specific mandibular advancement device prescription may be necessary in cases where C.P.A.P. continuous positive airway pressure (C.P.A.P.) which arise normally prescribed, however, cannot be tolerated.
Central & Mixed Sleep Apnoea
O.S.A. is the most common form of sleep apnoea (about 4% of men and 2% of women). There is also a condition called Central Sleep Apnoea (CSA). This is a condition when the brain does not send the right signals to tell you to breathe when you are asleep. In other words, the brain ‘forgets’ to make you breathe. It can also be associated with weakness of the breathing muscles. The assessment for CSA is more detailed than for OSA and the treatment has to be carefully managed.
There is also a condition called Mixed Sleep Apnoea which is a combination of both obstructive and Central Sleep Apnoea. If you suspect you have a Sleep-disordered breathing condition, please discuss your concerns with your GP and have them refer you to the Beacon Dental Sleep Medicine clinic where you can undergo a full medical investigation and have a prescription for M.A.D. (Mandibular Advancement therapy or C.P.A.P therapy (Continuous Positive Airways Pressure), dependent on your diagnosis.
For further information, contact us today