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About obstructive sleep apnoea

Find out about the sleep condition obstructive sleep apnoea, its causes, symptoms and possible treatments.

What is obstructive sleep apnoea?
How common is OSA?
What are the signs and symptoms?
What are the risk factors?
How is it diagnosed?
How is it treated?
Lifestyle changes

What is obstructive sleep apnoea?

Obstructive sleep apnoea (OSA) affects men, women and children.

It is called OSA because:
Obstructive = obstruction of the airway in the throat
Sleep = it happens when the person is asleep
Apnoea = this means ‘without breath’ – the person stops breathing

Enlarge this diagram

The cycle of OSA

Enlarge this diagram

When we go to sleep our muscles relax, including those in our throat. In some people the relaxing muscles cause the throat to narrow, which can reduce the airflow. This results in snoring.

If the throat closes (obstructs) completely, you stop breathing temporarily – this is called an apnoea. If the throat partially closes this is called a hypopnoea. When this happens, there may be a dip in the level of oxygen in the blood.

The brain starts the person breathing again: some people wake up briefly, others are not aware of what is happening. Breathing often restarts with a gasp, and the pattern repeats.

In severe cases this cycle happens hundreds of times a night. This can cause the person to feel very sleepy during the day, because their sleep is being disrupted at night.

Diagram of OSA

Normal breathing
In normal breathing air can travel freely to and from your lungs through your airways during sleep.

In OSA your airway collapses, stopping air from travelling to and from your lungs and disturbing your sleep.

How common is OSA?

At least 4 per cent of men and 2 per cent of women in the UK have OSA with symptoms, although this figure could be even higher. This makes OSA more common than severe asthma. However, 80 to 90 per cent of these people with OSA have not even been diagnosed.

The condition is common in middle-aged people and the number of people affected could be rising due to more people being overweight.
OSA also affects up to 3 per cent of children, most of whom have large tonsils. OSA is more common among children with certain disabilities, such as Down’s syndrome, and in very obese children.

What are the signs and symptoms?

The most common signs are snoring, interrupted breathing when asleep and sleepiness when awake. We call this ‘The Triple S’:
Snoring when asleep
Stopping breathing or Struggling to breathe when asleep
Sleepy when awake

In this video, a man with OSA snores loudly and then stops breathing.

Specific symptoms include

When asleep:

  • Snoring (often loudly)
  • Feeling of choking
  • Repeated pauses in breathing (apnoeas and hypopnoeas)
  • Tossing and turning (restless sleep)
  • Sudden jerky body movements
  • Needing to go to the toilet often to pass urine, or bed-wetting in children
  • Heartburn

Often, partners will be more aware of the snoring and pauses in breathing than the person affected.

When awake:

  • Excessive sleepiness – feeling tired and actually falling asleep
  • Waking up feeling tired and unrefreshed
  • Morning headache
  • Difficulty concentrating
  • Poor memory and feeling mentally groggy, dull and less alert
  • Feeling depressed, irritable or other changes in mood
  • Poor co-ordination
  • Loss of sex drive (libido)
  • Poor quality of life

However, not all people with OSA experience all of these symptoms.

Symptoms in children
In children, daytime symptoms can include behaviour problems, hyperactivity and poor academic performance. At night they might be very restless and adopt an unusual sleep position.

“I snored very loudly, and I would stop breathing. It had a major effect on my ability to think clearly at work.” – Oliver, 38

What are the risk factors?

You are more likely to have OSA if:

  • You are a man and middle aged
  • You are a woman past your menopause
  • You are overweight or obese
  • You have a large neck size (17 inches +)
  • You have a small airway, a set-back or small lower jaw, large tonsils, a large tongue, an abnormal face shape, or nasal blockage
  • You have a disability such as Down’s syndrome

OSA can be made worse by drinking alcohol, using sedatives or smoking cigarettes. You should also avoid caffeinated drinks before bed.

If OSA goes untreated:

  • It can affect your quality of life
  • It is linked to other health problems – high blood pressure, heart attack and stroke
  • You are at higher risk of being involved in road traffic accidents and accidents at work
  • It can affect your ability to work

How is it diagnosed and assessed?

If you think you, or someone you know, might have OSA, try taking the following steps:

  • Do the Epworth Sleepiness Scale test
  • Ask family and friends if you snore loudly and have breathing pauses, or tell someone if they do this
  • Visit your GP
  • Ask for a referral to a sleep clinic

Diagnosis of OSA usually happens at a sleep clinic and is made using these assessments:

  • Sleepiness scale – you will fill in a form (usually the Epworth Sleepiness Scale) about how sleepy you are when awake.
  • Patient history and physical examination – you will be asked some questions, your weight and height will be measured, and your blood pressure taken. You might be asked to do some breathing tests and the doctor will look in your mouth.
  • Sleep study – this is often carried out at home, although sometimes a more detailed sleep study will be done in hospital. You will wear some equipment as you sleep that will take a range of measures.

You will receive your results and discuss the best treatment with your health care professional.

Driving and employment

Because people who have OSA are sometimes very sleepy in the day, their ability to drive safely can be affected.

If your job requires you to drive, you might be able to get assessed and treated more quickly. Drivers who are diagnosed with OSA and feel sleepy during the day must tell the DVLA (Driver and Vehicle Licensing Agency). The DVLA will then assess you to see if you are able to drive safely.

Once you are being successfully treated, you are safe to drive. However, you may have to stop driving until then. More information:

  • Advice on OSA and driving
  • Tiredness can kill leaflet

Your working life can also be significantly affected by the tiredness caused by OSA. If your condition has not been properly diagnosed, or you have not yet received any treatment, you may feel that your employer is not being supportive or understands. The Government provides advice on employment rights, or for more information contact the BLF Helpline.

How is it treated?

CPAP – continuous positive airway pressure
This is the treatment recommended for adults with moderate or severe OSA, including symptoms. It is a mask worn while you sleep, attached via a tube to a machine that generates a pressurised flow of air to keep your airway open.

The mask is worn over the nose, or the nose and mouth. It can take a bit of getting used to, and it is very important that you have it fitted properly so it is comfortable and air does not leak out. The machine is very simple to use and will be adjusted to give you the right amount of air. If the air feels too dry or cold, a heated humidifier can be attached to the machine, making it more comfortable.

This treatment can make you feel much better, and it reduces the risk of heart disease and stroke.

There are operations that remove parts of the soft tissue at the back of the mouth. These are rarely effective so are not performed often.
However, if you have large tonsils then having them removed can help. If you have a set-back lower jaw, surgery can be beneficial and weight loss surgery for people who are obese can also help.

Most children with OSA and no other health issues will be cured by an operation to remove their tonsils and adenoids (at the back of the mouth).

MAD – mandibular advancement device
This is worn over your teeth as you sleep. It brings your lower jaw forward, helping to keep your airway open. This can be used if you have mild to moderate OSA or if you find CPAP difficult or unpleasant to use.

My treatment
“After my first night on CPAP, I felt like a million dollars. It felt like someone had lifted a fog.” – Tony, 50

Lifestyle changes

There are things that you can do to help yourself:

  • Lose weight
  • Avoid alcohol, caffeine, nicotine and sedatives
  • Sleep on your side or with the head of the bed tilted upwards
  • Practice good ‘sleep hygiene’ – go to bed at a regular time, get seven to eight hours sleep a night and ensure that your bedroom is quiet

Here are some tips on how to have good sleep hygiene*:

  • Go to bed only when you feel sleepy
  • If you do not fall asleep within 20 minutes, get up and do something boring until you feel sleepy
  • Do not take long naps (more than 30 minutes)
  • Try to go to bed at the same time each night. Develop rituals for going to bed
  • Use your bed only for sleeping or having sex. Avoid watching TV in the bedroom
  • Avoid taking caffeine, nicotine or alcohol for at least four to six hours before going to bed
  • Ensure that your bedroom is quiet and comfortable

*These tips are reproduced with permission of the European Respiratory Society. See the full article.

Version: 2
Last medically reviewed: February 2012
Due for medical review: February 2014
For references call 020 7688 5555

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