Apnoea or apnea (AP-ne-ah) simply is the suspension of breathing. Voluntarily doing this is called holding one's breath.
Apnoea can be voluntarily achieved, drug-induced, mechanically induced (for example, by strangulation or choking), or it can occur as a consequence of neurological disease or trauma. During sleep in patients who are suffering from sleep apnoea, these events can occur up to 20–30 times or more per hour, every night.
Apnoea can also be observed during periods of heightened emotion, such as during crying or when a person laughs.
Many people treat snoring as a joke or something to feel embarrassed about. But loud snoring, especially when accompanied by daytime fatigue, may be a sign of sleep apnoea, a common disorder in which breathing repeatedly stops and starts as you sleep.
Most people who have sleep apnoea don't know they have it because it only occurs during sleep. Sleep apnoea affects more than three in 10 men and nearly two in 10 women, so it's more common than you might think.
What is Sleep Apnoea?
Sleep apnoea is a common potentially serious disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnoea usually is a condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnoea is a leading cause of excessive daytime sleepiness.
There are two types of sleep apnoea:
Obstructive sleep apnoea (OSA): The more common of the two forms of apnoea, is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnoea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnoea.
Central sleep apnoea: Unlike OSA, the airway is not blocked, but the brain fails to signal the muscles to breathe, due to instability in the respiratory control centre.Central sleep apnoea can affect anyone. However, it's more common in people who have certain medical conditions or use certain medicines.
Central sleep apnoea can occur with obstructive sleep apnoea (known as complex or mixed sleep apnoea) or alone. Snoring typically doesn't happen with central sleep apnoea.
If you think you might have any form of sleep apnoea, see your doctor. Treatment can ease your symptoms and may help prevent heart problems and other complications.
Symptoms of Sleep Apnoea
The signs and symptoms of obstructive and central sleep apnoeas overlap, sometimes making the type of sleep apnoea more difficult to determine. The most common signs and symptoms of obstructive and central sleep apnoeas include:
Waking up with a very sore or dry throat
Occasionally waking up with a choking or gasping sensation
Sleepiness or lack of energy during the day
Sleepiness while driving
Forgetfulness, mood changes, and a decreased interest in sex
Recurrent awakenings or insomnia
In children, sleep apnoea can cause hyperactivity, poor school performance, and angry or hostile behaviour. Children who have sleep apnoea also may breathe through their mouths instead of their noses during the day.
Remember, these symptoms may not always relate to sleep apnoea, so please discuss any concerns you may have with your doctor to ensure that an accurate diagnosis is made.
When to see a doctor
Consult a medical professional if you experience, or if your partner notices, the following:
Snoring loud enough to disturb the sleep of others or yourself
Shortness of breath, gasping for air or choking that awakens you from sleep
Intermittent pauses in your breathing during sleep
Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving
Not everyone who snores has sleep apnoea, and not everyone who has sleep apnoea snores. So how do you tell the difference between normal snoring and a more serious case of sleep apnoea?
The biggest telltale sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep as much as sleep apnoea does, so you’re less likely to suffer from extreme fatigue and sleepiness during the day.
Record yourself sleeping or ask your sleep partner to keep track of your snoring, taking note of how loud and frequent it is, and if you’re gasping, choking, or making other unusual sounds. But be sure to talk to your doctor if you experience these signs.
Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness (hypersomnia) may be due to sleep apnoea or to other disorders, such as narcolepsy.
How Is Sleep Apnoea Diagnosed?
Sleep apnoea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, no blood test can help diagnose the condition.
Your doctor may make an evaluation based on your signs and symptoms or may refer you to a sleep disorder centre. There, a sleep specialist can help you decide on your need for further evaluation.
Such an evaluation often involves overnight monitoring of your breathing and other body functions during sleep. Home sleep testing may also be an option. Tests to detect sleep apnoea may include:
Nocturnal polysomnography. During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
Home sleep tests. In some cases, your doctor may provide you with simplified tests to be used at home to diagnose sleep apnoea. These tests usually involve measuring your heart rate, blood oxygen level, airflow and breathing patterns. If you have sleep apnoea, the test results will show drops in your oxygen level during apnoeas and subsequent rises with awakenings.
If the results are abnormal, your doctor may be able to prescribe a therapy without further testing. Portable monitoring devices don't detect all cases of sleep apnoea, so your doctor may still recommend polysomnography even if your initial results are normal.
If you have obstructive sleep apnoea, your doctor may refer you to an ear, nose and throat doctor to rule out any blockage in your nose or throat. An evaluation by a heart doctor (cardiologist) or a doctor who specializes in the nervous system (neurologist) may be necessary to look for causes of central sleep apnoea.
How Is Sleep Apnoea Treated?
Sleep apnoea is treated with lifestyle changes, mouthpieces, breathing devices, and surgery. Medicines typically aren't used to treat the condition.
The goals of treating sleep apnoea are to:
Restore regular breathing during sleep
Relieve symptoms such as loud snoring and daytime sleepiness
Treatment may improve other medical problems linked to sleep apnoea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.
If you have sleep apnoea, talk with your doctor or sleep specialist about the treatment options that will work best for you.
Lifestyle changes and/or mouthpieces may relieve mild sleep apnoea. People who have moderate or severe sleep apnoea may need breathing devices or surgery.
If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you're getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and teens need more. For more information, go to "HOW MUCH SLEEP IS ENOUGH?" post.)
If treatment and enough sleep don't relieve your daytime sleepiness, your doctor will consider other treatment options.
If you have mild sleep apnoea, some changes in daily activities or habits might be all the treatment you need.
Avoid alcohol and certain medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.
Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
Exercise. Regular exercise can help ease the symptoms of obstructive sleep apnoea even without weight loss. A good goal is to try to get 30 minutes of moderate activity, such as a brisk walk, most days of the week.
Sleep on your side or abdomen rather than on your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
Avoid caffeine and heavy meals within two hours of going to bed.
Maintain regular sleep hours. Sticking to a steady sleep schedule will help you relax and sleep better. Sleep apnoea episodes decrease when you get plenty of sleep.
How Can Family Members Help?
Often, people who have sleep apnoea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnoea.
Family members can do many things to help a loved one who has sleep apnoea.
Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
Encourage the person to get medical help.
Help the person follow the doctor's treatment plan, including CPAP treatment.
Provide emotional support.
What Are the Effects of Sleep Apnoea?
If left untreated, sleep apnoea can result in a growing number of health problems, including:
High blood pressure
Heart failure, irregular heart beats and heart attacks
In addition, untreated sleep apnoea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, and academic underachievement in children and adolescents.
Sleep apnoea can affect anyone at any age, even children. Risk factors for sleep apnoea include:
Being over age 40.
Having a large neck size (17 inches or greater in men and 16 inches or greater in women).
Having large tonsils, a large tongue, or a small jaw bone.
Having a family history of sleep apnoea.
Gastroesophageal reflux, or GERD.
Nasal obstruction due to a deviated septum, allergies, or sinus problems.
Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
Smoking. Smokers are three times more likely to have obstructive sleep apnoea than are people who've never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway.
Heart disorders. People with congestive heart failure are more at risk of central sleep apnoea.
Using narcotic pain medications. Opioid medications, especially long-acting ones such as methadone, increase the risk of central sleep apnoea.
Stroke. People who've had a stroke are more at risk of central sleep apnoea or treatment-emergent central sleep apnoea.