What is Sleep Apnoea?
Sleep apnoea is a potentially serious sleep disorder in which breathing repeatedly stops and starts whilst you sleep. These breathing pauses typically last between 10 to 20 seconds and can happen from 5 to over 100 times per hour.
The lack of oxygen during a sleep apnoea episode jolts you awake, and this is usually so brief that you don’t remember it. But these disruptions to your natural sleep rhythm mean that you spend more time in light sleep and less in the deep, restorative sleep you need to be energetic, mentally sharp, and productive the next day.
If you snore loudly and feel tired even after a full night’s sleep, you might be suffering from sleep apnoea.
The main types of sleep apnoea are:
Obstructive sleep apnoea is the most common type of sleep apnoea. It occurs when the muscles that support the soft tissues in the upper airway relax during sleep and block the normal flow of air in and out of the nose and mouth. This usually causes loud snoring and interrupted breathing.
Causes of Sleep Apnoea
While anyone can have sleep apnoea, certain factors increase the risk:
Gender: Men are much more likely to have sleep apnoea than women, although after menopause, frequency in women increases.
Age: While sleep apnoea can occur at any age, it is more common as you get older.
Weight: The risk of sleep apnoea is much higher in those who are overweight, and higher still in those who are obese.
Physical attributes: Certain physical attributes can increase the risk of sleep apnoea and these include a small upper airway, a small or receding jaw, a long soft palate, a high tongue position, a deviated septum, and enlarged tonsils and adenoids.
Smoking: Smokers are three times more likely to have obstructive sleep apnoea than people who’ve never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
Use of alcohol, sedatives or tranquilizers: These substances relax the muscles in your throat, which can exacerbate obstructive sleep apnoea.
Neck circumference: People with thicker necks might have narrower airways. If your neck circumference is greater than 17 inches (43.2 cm) in men or 16 inches (40.6 cm) in women, you have a greater chance of developing sleep apnoea.
Nasal congestion: If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you’re more likely to develop obstructive sleep apnoea.
Medical conditions: Congestive heart failure, high blood pressure, type 2 diabetes and Parkinson’s disease are some of the conditions that may increase the risk of obstructive sleep apnoea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.
Family history: Having family members with sleep apnoea might increase your risk.
Symptoms of sleep apnoea
Symptoms of sleep apnoea mainly happen while you sleep and are generally noticed by a partner.
These symptoms include:
- Your breathing stops and starts
- You wake up at night feeling short of breath
- You are choking, snorting, or gasping during sleep
- You wake up a lot
- Loud snoring
- Restless sleep, night-time awakenings, or insomnia
- Frequent need to use the toilet during the night
- You wake up with a dry mouth or sore throat
During the day, you may also notice that you:
- Feel very tired and fatigued
- Find it hard to concentrate
- Have mood swings
- Have a headache when you wake up
Consequences of untreated sleep apnoea
Sleep apnoea is a serious sleep disorder and there are many consequences if left untreated. Sleep apnoea can increase the risk of health problems, including:
- High blood pressure
- Heart failure, irregular heartbeat, and heart attacks
There are also many non-health related consequences to untreated sleep apnoea that can have a huge affect on your life. These include:
- A higher risk of a car accident due to lack of concentration or falling asleep whilst driving.
- Lost productivity at work due to excessive tiredness or absenteeism.
- Mood swings and irritability which may have a detrimental effect on relationships.
- Loss of libido.
- Causing a strain in a relationship by keeping your partner awake at night.
Take our 2 minute sleep test
How likely are you to doze off or fall asleep in the following situations, in comparison to feeling just tired? This refers to your usual way of life in recent times. Even if you haven't done some of these things recently, try to work out how they would have affected you.
Sitting and reading
Sitting still in a public place (e.g. a theatre, a cinema or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when the circumstances allow
Sitting and talking to someone
Sitting quietly after lunch without having drunk alcohol
In a car or bus while stopped for a few minutes in traffic
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Diagnosis of sleep apnoea
If you have symptoms of excessive daytime sleepiness such as feeling drowsy, a lack of energy and poor memory, ask a partner, friend or relative to observe you while you sleep. They may be able to spot episodes of breathlessness that could help to confirm a diagnosis of sleep apnoea. If these symptoms have been spotted, or if you are still concerned, then please contact us to arrange a sleep study.
A sleep study is a comprehensive test used to diagnose sleep disorders and it records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements. The test registers your body’s shifts between the stages of sleep, which are rapid eye movement (REM) sleep, and non-rapid eye movement (non-REM) sleep. Non-REM sleep is divided into “light sleep” and “deep sleep” phases.
During REM sleep, your brain activity is high, but only your eyes and breathing muscles are active. This is the stage in which you dream. Non-REM sleep involves slower brain activity. A person without a sleep disorder will switch between non-REM and REM sleep, experiencing multiple sleep cycles per night.
By observing your sleep cycles, along with your body’s reactions to the changes in these cycles, we can help identify disruptions in your sleep patterns, and if you are suffering from sleep apnoea.
What is CPAP therapy?
CPAP (continuous positive airway pressure} therapy is the gold standard in treatment method for patients who have sleep apnoea. CPAP machines use mild air pressure to keep the airways open and are typically used by patients who have breathing problems during sleep. CPAP therapy essentially makes sure that your airway does not collapse when you breathe while asleep.
CPAP therapy requires the use of a machine that is connected to a mask via a tube. The machine must be set to your prescribed setting, so it’s vital that you consult a qualified respiratory physician. There are 3 different types of machine:
CPAP Machines are the most common machines used for treating sleep apnoea. A CPAP machine delivers a constant flow set to the same pressure setting all night. You breathe in with the assistance of this pressure setting, and you exhale against this same pressure setting.
BiPAP machines offer two levels of airway pressure: one for inhalation and another one for exhalation. BiPAP machines allow for those with severe OSA to cycle air in and out of their lungs easier.
APAP machines are automated to work within a pre-set pressure range. An APAP machine automatically adjusts throughout the night to fit your specific pressure needs on a breath-by-breath basis.
There are 3 main types of mask and deciding which mask suits best is generally based on what position you sleep in, and the pressure setting of your CPAP machine.
Nasal pillows masks are suitable for those who sleep on their side or stomach. They are ideal for people who may feel claustrophobic using a mask that covers more of their face, or people with facial hair as this may interfere with the seal of a full face mask. They are not suitable for use with high pressure settings.
Nasal masks are suited for people who move around a lot whilst sleeping and require a higher pressure setting. Like the nasal pillows mask, a nasal mask is a better alternative for those who find a full face mask claustrophobic or have facial hair.
Full face masks are ideal if you require a high pressure setting. A full face mask fits over your nose and mouth so they are suitable for people who may have a nasal obstruction or congestion that makes breathing through their nose difficult. Full face masks are not suitable for users with a lot of facial hair as this can compromise the seal.
Lifestyle changes to consider
While a diagnosis of sleep apnoea can be scary, it is a treatable condition. In fact, there are many steps you can take on your own to help, particularly for mild to moderate sleep apnoea. Simple lifestyle modifications can go a long way in reducing sleep apnoea symptoms. However, they should not replace medical evaluation and treatment.
If you suffer from mild to moderate sleep apnoea, lifestyle changes can make a big difference. These include:
- Losing weight if you are overweight.
- Establishing a regular bedtime routine and ensure you bed is comfortable.
- Regular exercise.
- Moderate alcohol consumption, if at all, and try not consuming alcohol before bedtime.
- If you smoke, quit.
- Avoiding naps in the evening.
- If possible, don’t sleep on your back.
- Avoid taking sedative medications if possible.
Benefits of CPAP therapy
CPAP therapy works and it will change your life. When used consistently, most people find that their CPAP machine alleviates most, if not all, of the negative effects of their sleep apnoea.
Many notice the change after the first night, others may take a week or two to get used to the CPAP therapy. Like a lot of changes in life, it may take time to get adjust to the therapy, but the benefits are certainly worth it. These benefits include:
- Better Heart Health – Sleep disorders increase the stress on your heart
- More Energy – No more daytime fatigue
- Lower Risk of Diabetes – Sleep apnoea can directly impact glucose metabolism by increasing glucose resistance and inflammation.
- Improved Weight Loss – No more cravings for sugary items and more energy to exercise
- Improved Mood – We all know that tiredness leads to irritability
- Better Skin – It’s called beauty sleep for a reason
- Improved Intimacy – Sleep apnoea is linked to erectile dysfunction
- Fewer Headaches – A lack of oxygen causes headaches
- Stronger Immune System – this means fewer colds and viruses
- Reduced Risk of Traffic Accidents – Driver fatigue is a contributory factor in as many as 1 in 5 driver deaths in Ireland every year
- Improved Performance at Work – That promotion may be just around the corner
And most importantly, better sleep, because everyone deserves a good night’s sleep!
Is there funding for my CPAP therapy?
In Ireland, there are three methods of financing your CPAP equipment.
Medical Card Holders: If you have a medical card, you are covered by the HSE. Once you are suitably set up with treatment therapy, you can give your Medical Card details to the Service Provider. The Service Provider will then handle all the necessary paperwork and submit the relative forms to The Health Service Executive to ensure payment. Payment for replacement masks is handled similarly.
Drugs Payment Scheme: This scheme covers rental agreements (monthly payments), and consumables (masks, headgear etc). It is effectively a ‘co – pay’ scheme whereby the patient pays the first €144 per month of the total cost of all pharmacy, monthly payments and consumables, with any excess refunded by The Health Service Executive. The onus is on the patient to initiate the claim, by sending the relevant claim form and receipts (pharmacy, homecare monthly payment, mask/tubing/filter purchases) to the drugs payment scheme.
Outright Purchase: If you are ineligible for a medical card, you decide to fund the treatment privately. Some Private Health Insurers contribute to those insured and you should check with your insurer to see if there is any coverage. Tax relief is available for all equipment costs and receipts should be included on the Med 1 Form. Mask/hose/filter replacements are covered under the Drugs Payment Scheme.
If you are new to therapy, it’s always advisable to rent a machine until you are happy with the settings and familiar with its use. If you buy outright, you may also be required to submit your machine data to your sleep consultant, whereas if you rent, your provider will do this for you.