Obstructive sleep apnoea (OSA) is a common sleep disorder where your upper airway repeatedly closes when you sleep. This stops your breathing and results in extremely poor quality and fragmented sleep. It causes a huge negative impact on quality of life and is associated with developing a wide range of significant physical and mental health problems.
Your upper airway is made of either hard structures, like the hard palate found in the roof of your mouth, or soft structures, like the back of the throat and the base of the tongue. Hard structures stay in place by themselves, but muscles hold soft structures in place. As you fall asleep, your muscles relax, and this causes the airway to narrow in on itself slightly. With a narrower airway, the airflow can become turbulent, which causes the soft structures to vibrate and cause the snoring sound. If the airway narrows in even further, the airflow itself starts to reduce until the airway actually closes entirely and breathing stops. This pause in breathing is called an apnoea.
With no breathing, your oxygen levels start to drop, which your body can only tolerate for so long. After a few seconds, it becomes so alarmed that it has to pull you back into a shallower state of sleep, or even completely awake, so your muscles regain their tone, pull open your airway, and your breathing can restart – often with a loud snort or gasp. This means you never fall into the deep, restorative states of sleep that you need to feel refreshed in the morning because whenever you do, your airway closes, your breathing stops, and your body has to wake you up.
The short answer is – anyone can. For some people, it’s just how their airway is shaped that causes their OSA, but a few factors can make it more likely. Anything that can press in on the airway and make it narrower will contribute, such as carrying a bit of extra weight, particularly if it is associated with an increased collar size. This tends to affect men more than women, which is why being male is a risk factor for OSA.
Other factors related to the airway muscles’ relaxation include alcohol intake and some sedative medications. These cause the airway muscles to over-relax, making snoring and OSA worse.
The last way the airway can be narrowed is through anything that causes swelling of the soft airway structures. The two key causes are smoking and airway allergies like hay fever.
Overall, the greatest risk factor for OSA is age due to the changes in airway muscle function and airway shape that come with this. In fact, the rate of OSA varies considerably across the lifespan. In the 30-39-year-old age group, OSA can affect up to 12%, whereas in the over 65 years bracket, it can be as high as 32%.
The rate of OSA is increasing, mainly because the two most significant risk factors, age and weight, are also growing. In addition, of all the people with OSA, a whopping 85% are undiagnosed.
OSA affects your life in two ways: the short-term effect of poor sleep and the development of long-term health conditions.
We all know how it is after a bad night’s sleep – usually feeling extremely tired and falling asleep when you should be awake – this could be in meetings, as soon as you are home from work, or more worryingly, it could be when behind the wheel. Insufficient sleep can make you irritable, unable to focus and with a dreadful memory. Your productivity at work can drop through the floor, and it can put tremendous strain on your family relationship – which then has the potential to cause a whole new set of problems. People with OSA can feel like this every day, which can greatly impact their quality of life.
We discussed in an earlier article the long-term health impact of poor sleep. As a cause of poor sleep, OSA causes the same physical and mental health conditions, but because of how the OSA works, the health effects are usually much worse, particularly regarding cardiovascular health.
When your body strains to breathe against a closed airway, it can cause significant pressure swings in the chest, which can cause appreciable damage to your heart walls over months and years. When your airway finally opens at the end of an apnoea, it is often accompanied by a burst of adrenaline. This shoots your heart rate and blood pressure up, which, over months and years, can lead to greater furring up of the blood vessels, contributing to strokes and heart attacks. Irregular heart rates become more common, and due to the body’s overall ‘stressed state’, an imbalance of hormones can lead to raised blood sugars and diabetes.
The other key area to mention is the effect the OSA can have on the sleep quality of bed partners. As OSA is frequently associated with loud snoring, it can be really difficult to live with. This can lead to couples sleeping in separate bedrooms and can mean holidays become out of the question, as couples often cannot afford to book two separate rooms.
If you think you have OSA due to night or daytime symptoms, then speaking to a sleep doctor is essential. They will ask some questions about your sleep and general health and may ask you to complete a questionnaire to assess how sleepy you are during the day. You will need to carry out a home sleep test – these are watch-like devices that are worn overnight as you sleep and take extremely detailed measurements, including your oxygen levels, heart rate, snoring volume, as well as measuring the activity of your ‘fight-or-flight’ system, which OSA can activate. Such home sleep tests can give you results within a couple of days, enabling you to start discussing treatments.
The wonderful news about OSA is that, even though it can significantly impact your quality of life, it does have effective treatments. These treatments can be divided into lifestyle measures, dental devices and ‘CPAP’, which is explained below.
If you think back to what factors make OSA more likely, you can see areas that can be targeted for treatment. Chief among these is weight loss – if you can reduce some of the weight that presses in on your neck, you can substantially improve symptoms, especially if your OSA is mild.
Reducing alcohol intake and stopping smoking can also cause a modest improvement and have additional health benefits beyond OSA treatment.
Another lifestyle intervention that can help involves changing your sleeping position. Snoring and OSA are typically worse when you lie on your back because your airway is naturally narrower in this position. Sleeping on your side can cause snoring and OSA to improve and, in some cases, resolve entirely. Specialist mattresses are designed to assist you in sleeping on your side, usually of soft or medium tension, with additional support at the shoulders and hips to avoid discomfort at these pressure areas. Other techniques include sewing a tennis ball into the back of your pyjamas to prevent you from wriggling onto your back as you sleep or using a triangular-shaped pillow to hold yourself in position.
The gold standard treatment for OSA is CPAP, which stands for continuous positive airway pressure. This small device sits on your bedside table and blows air at low pressure through a tube to a mask held over your nose or mouth and nose. The air pressure gently holds your airway open from the inside, preventing it from closing. This might seem like an unlikely treatment, but if you consider someone who has had years of terrible quality, fragmented sleep, the CPAP device can cause a very prompt return of deep, restorative sleep. The impact can be pretty dramatic – sometimes, within as short as two weeks, CPAP users look like new people. The benefit is also felt by bed partners, who can now finally sleep in the same room and afford holidays together again.
The key messages of OSA are that it’s a common disorder with a huge health impact. Most people who have it are undiagnosed, but treatment is effective and straight forwards.
If you’d like to book a consultation, visit www.thebettersleepclinic.co.uk.