What Is Sleep Apnoea?

The Greek word 'Apnoea' means 'Without Breath' which is where the name of the 'condition' called Sleep Apnoea (also spelt 'Apnea' in some countries) is derived from.  Therefore, Sleep Apnoea means stopping breathing whilst sleeping!  People with Sleep Apnoea stop breathing or struggle to breathe regularly during sleep, and most are unaware of this.

Sleep Apnoea is a medical condition which has only been widely recognised and treated since 2008 in the UK, yet the latest statistics published by 'The Lancet' in 2019 claim that 8 million people in the UK suffer from Obstructive Sleep Apnoea (175 million in Europe and 936 million worldwide).  According to the British Lung Foundation, approximately 1 in 30 children are also sufferers of Obstructive Sleep Apnoea, and unfortunately these children get branded with bad behaviour, learning problems and ADHD instead. 

It is of major concern that despite the above statistics, at least 80% of people remain undiagnosed and have no suspicion they're even suffering from this.  Sleep Apnoea is a serious 'condition' untreated, due to the other medical conditions it exacerbates, causes and is linked to, such as:-

• Heart Attacks and many other Cardiovascular Disorders and Heart Rhythm Disorders
• Strokes
• High Blood Pressure
• Type 2 Diabetes
• Driving Accidents (through sleep deprivation)
• Obesity
• Anxiety and Depression
• Hypothyroidism
• ADHD
• Brain Confusion + Memory Problems
• Fibromyalgia
• Menopause
• Chronic Fatigue Syndrome (CFS)
• Dementia, particularly Alzheimers
• Floppy Eyelid Syndrome (FES)
• Glaucoma
• Asthma
• Sleep Paralysis
• Kidney Disease
• Erectile Dysfunction Syndrome
• Parkinson's
• Heartburn and Gastrointestinal Reflux
• Vitamin D and/or B12 Deficiency
• (New research is being undertaken constantly and many more links to other medical conditions are possible)

In most cases, a person with Obstructive Sleep Apnoea will be a snorer, and mostly (unbeknown to them) will stop breathing many times a night, ranging from:-

*** AHI stands for Apnoea/Hypopnoea Index, which is the amount of times a person has an apnoea or hypopnoea PER HOUR!  Apnoeas are when a person totally stops breathing and hypopnoeas are partial lack of breathing events.

The apnoeas/hypopnoeas will happen whilst sleeping, and the brain (thankfully) sends messages to the body to start breathing again.  Unfortunately this cycle will repeat itself throughout the night.  The sufferer will often wake up feeling unrefreshed, but will not put this down to lack of sleep, as they are usually under the impression they have slept well, due to most people being unaware of what has been happening through the night.  Some people do wake up gasping or choking though.  It is normally the bed partner who may notice what is going on, and many have reported of hearing their bed partner snoring, followed by a silent pause when they suspect their partner has stopped breathing (which they have!).  The sufferer will then usually make a snorting, choking or gasping noise, and they will start breathing again, but the cycle will continue throughout the night.  It should also be pointed out that not everyone with sleep apnoea does snore.

During apnoea/hypopnoea events, this often causes oxygen levels to drop, carbon dioxide levels to raise and the heart becomes stressed, increasing both blood pressure and heart rate.  This obviously causes untold constant damage to the body, which is why it is important to treat sleep apnoea and any warning signs should not be ignored!

**Incidentally, Kath Hope of Hope2Sleep had no idea she stopped breathing at all during sleep, never woke up choking and yet her AHI (apnoea/hypopnoea index) was 32 which is just into the severe range.  Even her husband never spotted it!!

Nighttime Symptoms

A person with undiagnosed sleep apnoea may present some or all of the following symptoms:-

• Snoring, Noisy or Irregular Breathing
• Pauses in Breathing (Apnoeas) 
• Shallow Breathing and Struggling to Breathe (Hypopnoeas)
• Restless Sleep
• Interrupted Sleep
• Waking up Choking and/or with Heart Racing 
• Night Sweats
• Bathroom trips to Urinate - often more than once
• Enuresis (bed wetting)
• Bruxism (Tooth Grinding)
• Insomnia

Daytime Symptoms

• Dry Mouth and/or Sore Throat on waking
• Tiredness or Exhaustion - often with the need for naps when circumstances permit
• Memory Impairment
• Lack of Concentration and/or Confusion
• Depression, Anxiety or Irritability
• Morning Headaches and Migraines
• High Blood Pressure
• Loss of Libido (Decreased Sex Drive)
• Many other symptoms can be present due to sleep deprivation.

Causes for Obstructive Sleep Apnoea

There are several different causes why a person has Obstructive Sleep Apnoea or how it can be made worse, as follows:-

• Nasal Blockage, due to deviated septum, narrow passages, congestion, allergies etc
• Large Uvula.
• Large Neck Size
• Obesity
• Overuse of Alcohol
• Certain Medications, such as tranquillisers etc
• Large Tonsils and/or Adenoids
• Large Soft Palate
• Receding Jaw
• Large Tongue
• Smoking
• Genetics and very often runs in families due to many of the above inherited issues
• Supine Sleeping and some people will only have sleep apnoea when sleeping on their back, but this needs clarifying on a sleep study. If breathing events only happen in the supine position, the official diagnosis would be Positional Obstructive Sleep Apnoea (POSA).

Video Showing What Happens During Obstructive Sleep Apnoea

Causes for Central Sleep Apnoea

(Central Sleep Apnoea is where the brain 'forgets' to send messages to the muscles to breathe and snoring is not always a sign of this).  Sometimes there is no known cause.

Conditions which may be associated with Central Sleep Apnoea include, but are not limited to, the following:

• Heart Disorders, such as Heart Failure and Heart Rhythm problems like Atrial Fibrillation (AFib)
• Hypothyroid Disease
• Kidney failure
• Damage or injury to the Brainstem caused by Encephalitis, Stroke or other factors
• Certain medications like Benzodiazepines (such as Valium, Diazepam, Librium and Ativan) or Opioids (such as Morphine, Methadone, Codeine and Fentalyn)
• Cheynes Stokes Breathing, commonly associated with heart failure or stroke
• Neurological diseases, such as Parkinson's, Alzheimer's and Amyotrophic Lateral Sclerosis (ALS) 
• Living at High Altitude (over 2500 metres/8200 ft)
• Genetic Diseases such as Rett or Prader-Willi Syndromes
• Idiopathic - no known cause

Mixed Sleep or Complex Sleep Apnoea

Put simply, this is a mixture of both Obstructive Sleep Apnoea and Central Sleep Apnoea and is more complicated to treat.  Sometimes Central Sleep Apnoea can become a problem when being treated for Obstructive Sleep Apnoea as often too high a CPAP pressure can actually cause central apnoeas.

UARS (Upper Airway Resistance Syndrome)

This form of sleep disordered breathing is not classed as Sleep Apnoea, but is very common when Obstructive Sleep Apnoea is suspected, yet not diagnosed on a sleep study. UARS does also often progress into Obstructive Sleep Apnoea with age, weight gain or other reasons. Please see our information page for UARS on this link 'What is UARS?'

If You Suspect You May Have Sleep Apnoea, there are several routes to take and the most important advice is TAKE ACTION NOW!!

Action To Take

• Book an appointment to discuss this with your GP, who should refer you to your local sleep clinic to arrange a Sleep Study.
• Ask your bed partner to observe you sleeping.
• If possible, record the sound of yourself sleeping, or even a video recording.
• The Epworth Sleepiness Scale is normally the first thing you would be asked to fill in.  This will give you a good indication of whether you need further help after adding up your scores.  You could print out your results and take them to your GP.   Our advice would be to do all three!
• You can also book a Home Sleep Study from us diagnose Sleep Apnoea if your GP needs convincing to refer to a sleep clinic, or even to help you decide yourself if you need to take action.

Sleep Apnoea also affects children (possibly at least 1 in 30).  Check out our dedicated page for Sleep Apnoea in Children.

Epworth Sleepiness Scale

Although not foolproof, this Epworth Sleepiness Scale is what your GP and/or a Sleep Clinic would ask you to fill in, as a screening tool to assess the likelihood of people suffering from undiagnosed Sleep Apnoea.

Please fill in this questionnaire as to how you feel most days in the following situations, as to the likelihood of you dozing off.  Even if you haven’t done some of these things recently, try estimating how they may have affected you.

Use the following scale to work out your scores:-

• 0 = Would NEVER doze.
• 1 = SLIGHT CHANCE of dozing.
• 2 = MODERATE CHANCE of dozing.
• 3 = HIGH CHANCE of dozing.

To check the criteria your score meets, please click this link.

To download this Epworth Questionnaire to fill in and take to your GP, please click this link

The Questionnaire contact information and permission to use: Mapi Research Trust, Lyon, France

Internet: https://eprovide.mapi-trust.org

Treatment for Sleep Apnoea

• CPAP (Continuous Positive Airway Pressure) where filtered air is delivered from a CPAP Machine via a hose/tube and into a Nasal or Full Face Mask, preventing the airways from collapsing.  There are different forms of CPAP machines, such as APAP, BiPAP and VPAP etc.,  but your sleep doctor will advise the most appropriate treatment for you.
• Dental Appliances and Oral Devices can sometimes be a suitable option - especially in milder cases of of Obstructive Sleep Apnoea.
• Surgery is sometimes a consideration, although at the time of publishing it is rare to get a complete cure, but surgery can help.   Children do have a good success rate for a cure from Sleep Apnoea by tonsillectomy and/or adenoidectomy, but the same high success rate is not evident in adults.
• For Central Sleep Apnoea the most successful machines are BiPAP/BiLevel or Adaptive Servo-Ventilation (ASV).
• Again, for milder cases sleeping position can help, as can refraining from alcohol within 3-4 hours of bedtime and nicotine.  Even ensuring you don't eat a large meal within these time periods can help.  Weight loss can also improve the severity of Sleep Apnoea, and in a small minority even cure it.

Self Help

• For your own sake and other innocent prospective victims, please DO NOT drive a vehicle when tired.  The DVLA has strict rules on this and they have produced a leaflet you can download by clicking the following link 'Tiredness Can Kill.'
• Try to lose some weight.  Even losing as little as 10% of the body weight can reduce the amount of apnoeas and often reduce the level of CPAP pressure.  Many diagnosed sleep apnoea sufferers have reported how much easier it is to lose weight once they are on successful treatment.
• Try not to drink alcohol or eat within at least 3-4 hours of going to bed.
• Stop smoking.
• Try not to sleep on your back, and if possible, elevate the head of the bed by 4-6 inches.
• Ensure your nasal airways are free from congestion.

Sleep Apnoea (Apnea) is a serious condition, due to its links with other life threatening illnesses.  Not only will you lower your risks of these other medical conditions, but you should start to feel so much better in yourself when you are on successful treatment. 

PLEASE, FOR YOUR SAKE AND YOUR FAMILY, DO NOT IGNORE YOUR SYMPTOMS, AND IF YOU SUSPECT SLEEP APNOEA, SEEK MEDICAL HELP NOW!!