- The throat may collapse so much that not enough, or no air can get into the lungs – this is known as obstructive sleep apnoea (OSA).
- This causes you to stop breathing until your brain notices and sends you a wake-up call. The brain briefly arouses itself from sleep to get the throat muscles working again to allow air into the lungs.
- This process can repeat hundreds of times each night, causing you to have very broken sleep.
- Around 1 in 4 men over the age of 30 years have some degree of sleep apnoea.
- Sleep apnoea is highly treatable and includes certain lifestyle changes (such as losing weight loss and cutting back on alcohol) and using a CPAP device while sleeping to blow air into the throat to stop it collapsing. Other treatment options include dental devices and surgery.
- Sleep apnoea can cause fatigue, and concentration difficulties which may affect different aspects of your life and lead to increased risks to your health.
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What is sleep apnoea?
Sleep apnoea (also known as obstructive sleep apnoea or OSA) occurs when the throat muscles relax too much during sleep. This is the common form of sleep apnoea.
A rarer form is central sleep – where breathing stops during sleep and there is a pause before breathing begins again. It is caused by a disruption to the mechanisms that control the rate and depth of breathing.
If you have sleep apnoea, the walls of your throat will collapse and become narrow as you breath in while you sleep. Air tries to travel through the narrowed airway and causes vibrations in tissues in the back of the throat – these vibrations produce sounds known as snoring.
Sometimes the throat can collapse so much that not enough air can get into the lungs (hypopnea), or it blocks off completely and no air gets into the lungs (apnoea).
You may have partial or complete obstructions where your breathing may decline or stop for a short time (generally between 10 seconds and up to one minute). These are sometimes called episodes or interruptions.
When these things happen, the brain gets messages that something is wrong and will arouse itself from sleep for a few seconds. Most people are not aware of these arousals.
This pattern can repeat itself hundreds of times every night, causing you to have fragmented sleep. This can leave you feeling unrefreshed in the morning with fatigue and sleepiness throughout the day and contributing to poor concentration and work performance.
Who gets sleep apnoea?
Anyone can get sleep apnoea. It’s estimated that about 5% of Australians have sleep apnoea, with around 1 in 4 men over the age of 30 affected. In the over-30 age group, the disorder is about 3 times more common in men than women.
People with narrow throats are more likely to have sleep apnoea and snore during sleep as their throat muscles relax.
Degrees of severity of sleep apnoea
The severity of sleep apnoea depends on how often your breathing is interrupted. As a guide:
- normal sleep – fewer than 5 interruptions per hour
- mild sleep apnoea – between 5 and 15 interruptions per hour
- moderate sleep apnoea – between 15 and 30 interruptions per hour
- severe sleep apnoea – more than 30 interruptions per hour.
Symptoms of sleep apnoea
Some of the symptoms of sleep apnoea include:
- Poor quality sleep – with regular periods of reduced or absent breathing often accompanied by loud snoring and/or gasping for air.
- Daytime sleepiness and fatigue.
- Dry mouth and headaches upon waking.
- Poor concentration, poor memory and slow reaction times.
- Irritability and mood changes.
- Depression and anxiety.
- Impotence (erectile dysfunction) and reduced sex drive (libido).
- Need to get up to toilet frequently at night.
Sleep apnoea can affect your driving ability
People with significant sleep apnoea have an increased risk of motor vehicle accidents. Driving authorities (such as VicRoads) recognise certain sleep disorders, including sleep apnoea that can affect driving fitness.
If you live in Victoria, you are legally required to notify VicRoads of any serious or chronic medical condition, injury or disability or the effects of certain treatments that may affect your ability to drive. Failure to do so may affect your insurance cover.
People with sleep apnoea will be assessed on a case-by-case basis and you may be advised to provide medical reports on the severity and treatment of your sleep apnoea. Options may include the issue of a conditional licence until your sleep apnoea is adequately treated.
People with sleep apnoea should also be aware of safety in other situations (such as work) in which falling asleep could pose a danger to other people.
Sleep apnoea and other health risk factors
Sleep apnoea can increase your chance of having high blood pressure. It may increase your risk of heart attack and stroke and abnormal heart rhythms – especially if it is severe enough and been untreated for a long time.
What causes sleep apnoea?
Contributing factors for sleep apnoea include:
- Being overweight or obese – fat on the inside of the neck surrounds the throat making it narrower.
- Age – people get older their throat muscles tend to relax more during sleep.
- Alcohol also makes the throat muscles relax more during sleep leading to sleep apnoea and snoring.
- Certain illnesses – such as reduced thyroid production (hypothyroidism) or the presence of a very large goitre.
- Large tonsils and adenoids, which may cause sleep apnoea in children.
- Certain medications (such as sleeping tablets and sedatives).
- Nasal congestion and obstruction.
- Facial bone shape and the size of muscles (such as an undershot jaw).
How is sleep apnoea diagnosed?
If you think you or someone you know has the signs and symptoms of sleep apnoea, see a GP. If your GP suspects you may have sleep apnoea, you may be referred to a sleep specialist.
Depending on their examination and assessment, your GP or sleep physician may arrange for you to have a sleep .
A sleep study is a medical test used to diagnose a range of sleep disorders – including sleep apnoea. A sleep study looks at what you do when you go to sleep. Most sleep studies measure:
- brain signals
- oxygen levels in the blood
- sleep position and limb movements
- heart rate
- breathing and snoring.
You will be attached to a portable machine and monitoring leads will be placed on your body to track your sleep throughout the night.
Sleep studies can be done at home or by staying overnight in a special sleep clinic and are provided in public and private health services.
Treatment for sleep apnoea
Sleep apnoea is a very treatable condition. Treatment may range from lifestyle changes to surgery.
In addition, if you have any contributing medical conditions (such as low production of thyroid hormone or large tonsils) these may also need to be corrected.
Lifestyle changes for sleep apnoea
The first line of treatment for sleep apnoea is making changes to your lifestyle. This includes:
- Weight loss – in people who are overweight or obese, losing weight may improve your sleep apnoea and possibly cure it. Losing weight also has other health benefits.
- Cutting down on your alcohol intake.
Continuous Positive Airway Pressure (CPAP) device
In addition to lifestyle changes, the most effective treatment available is a mask worn at night that transmits increased air pressure into the airway to prevent the throat from collapsing. This is called ‘nasal continuous positive airway pressure’ (CPAP).
is the most common treatment for sleep apnoea. It is non-invasive and uses a small pump that blows air through tubing into a mask that is worn on the nose and/or mouth. This air pressure goes into the back of the throat holding it open, even if the throat muscles have relaxed too much during sleep.
The key to CPAP treatment is finding a mask and machine that match your needs.
Dental devices
If you have mild to moderate sleep apnoea, another possible treatment is the use of an oral appliance – a specially made mouthguard (such as a mandibular advancement splint or . These are designed to pull the lower jaw forward to create more room in the throat, but they do not prevent the throat collapsing during sleep.
They need to be fitted by a dentist and worn whenever sleeping. They are also used as a treatment for snoring.
Positional devices
Some people only have sleep apnoea when sleeping on their backs. You may be someone who moves around in your sleep without even realising it.
You may like to attach something (such as a tennis ball sewn into a T-shirt or pyjama top) to keep you off your back when asleep. Commercial products are also available from some CPAP suppliers.
Upper airway surgery
Sometimes an operation is considered when other treatments for sleep apnoea have not worked. Surgery to the palate and base of tongue may be suggested, especially for school aged children and young adults.
The purpose of upper airway is to create more room in the throat by removing tissue from the throat. However, there is a limit to how much tissue can be removed, and it does not prevent the throat collapsing during sleep, so it may not be effective.
It is important that any surgery of this nature is undertaken by a specialist ear, nose and throat surgeon (known as an otolaryngologist). Your treating team can address any concerns you may have and help you weigh up the health benefits.
Treatment for obstructive sleep apnoea (OSA) in children
Large tonsils and adenoids can block the throat during sleep and cause snoring. In some cases, this is bad enough to cause obstructive sleep apnoea (OSA).
The more severe your child’s OSA is, the more likely it is that removing the tonsils and adenoids will help improve their health and quality of life.
Tonsillectomy for sleep apnoea is considered if your child usually breathes noisily during sleep and has at least 2 of these other related problems when they are not sick:
- Struggling to breathe while asleep.
- Pauses in breathing during sleep.
- Gasping or choking during sleep.
- Persistent daytime mouth breathing.
- Daytime tiredness, concentration or behaviour problems not related to other causes.
Two out of three children with mild sleep apnoea get better over 6 months without surgery. If your child is young, you may wish to wait 6 months before deciding whether surgery is an option.
If you are unsure, you may like to read this fact sheet by Safer Care Victoria which can help you make an informed decision about with the support of your child’s doctor.
Safer Care Victoria has also developed several personal story and fact sheets on tonsil surgery for families. These include:
Where to get help
- Your GP (doctor)
- A sleep specialist
- Sleep disorders clinic
- A dentist
- Tel. 13 11 71, 8am–5.30pm Monday–Friday and 8.30am-12.30pm Saturday
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