What is Sleep apnoea?
Sleep apnoea is a disorder in which there is excess daytime sleepiness,insomnia,nightmares,sleep deprivation,snoring.In this condition breathing stops and starts during the night. It is caused by a blockage of the airway, which makes breathing difficult. This can happen for short periods of time, called an apnea event, or it can happen for long periods of time, called an apnea episode. Sleep apnea is a condition in which the walls of the throat relax, narrowing the airway. This leads to a brief cessation of breathing. Sleep apnea is more common in overweight people and those who snore loudly. Sleep apnea is a common sleep disorder that causes the person to stop breathing over the night. It can be caused by the narrowing of airways during sleep, or it can happen because of some other condition, such as obesity.
Apnoea means a condition in which an individual stops breathing for a while. Sleep apnoea is a condition in which breathing stops in between during sleep and then starts again. It creates lot of disturbances during sleep .
There are several episodes of sleep apnoea during one sleep period.
As the individual is not able to have routine night sleep, his routine sleep hrs are not complete, so he feels sleepy during the day.
He is not able to concentrate on his work.
During night time he has got restless sleep, and undue loud snoring is present which also disturbs the sleep of other family members.
Most of the people suffering from sleep apnoea have obstructive sleep apnoea a condition in which there is physical obstruction to breathing due to blockage in the upper airway. Obstructive sleep apnoea is much more common.
Other type is-
- Central sleep apnoea -in which the Central nervous system is responsible .The impulse required for breathing from the Central nervous system stops temporarily. In a normal individual the brain sends signals to the respiratory muscles so that the lungs contract and expand during respiration .
- In central sleep apnoea these signals are reduced or interrupted.
- Loud snoring is less common in patients of Central sleep apnoea as compared to patients with obstructive sleep apnoea.
- Complex apnoeas are a condition that occurs in a patient of obstructive sleep apnoea in whom positive pressure ventilation is given.
- In the present day medical science it is not completed understood how these apnoeas develop.
- They usually develop and resolve on their own.
- When they persist they require specific treatment.
- In any case whether there is physical obstruction to breathing airway or due to signally problem from the Central nervous system as in case of Central sleep apnoea the breathing stops temporarily .
- It resumes again.
- This occurs repeatedly during sleep.
- When the Breathing starts again there is snoring, deep breathing.
- The individual may wake up completely but there is feeling of choking, gasping.
- The individual has to wake frequently during sleep and go for urination.
- In the morning there is headache ,irritability and the individual may suffer from memory loss.
Complications of Sleep apnoea-
- If untreated sleep apnoea can lead to complications like –
- Heart disease
- Depression .
- Due to decreased sleep during night time ,the individual feels drowsy during the day time.
- He is not able to concentrate on his work.
- If he is driving a vehicle then it can lead to accidents.
- It can lead to mishaps at the place of work. .
Symptoms and signs of sleep apnoea. No
An individual with sleep apnoea may be totally unaware of these symptoms.
These may be detected by his family members-
Family members detect that in between during sleep there is cessation of breathing .
This is followed by noisy breathing.
loud snoring is present
gasping is observed
Things noticed by individual-
- Due to lack of sleep during night they get fatigued easily
- Difficulty in concentration
- They have to wake several times during night
- As mouth breathing ,snoring is present, they wake up with a dry mouth ,upper respiratory tract infection.
- headache due to lack of sleep, acidity ,
- decreased libido and erectile dysfunction.
Treatment of sleep apnoea –
- Aims of the treatment are to reduce the breathing problems during night sleep and to treat the underlying causes.
- The line of treatment depends on the underlying cause and the severity of the symptoms.
- If there is snoring due to obstructive sleep apnoea, first of all weight reduction is advised.
- Dieting and rigorous physical exercise should be done as per the advice of dietitian and MD General Medicine doctors .
- We never recommend too much rigorous dieting as it can spoil the health.
- Whether the individual has obesity or not, he should follow heart healthy diet.
- Minimum 6-7 hrs sleep out of 24 hrs is recommended.
- Ear to bed ,ear to rise makes a man healthy wealthy and wise.
- Remaining awake for too much late hrs in night is not good for health.
- Smoking, alcohol should be given up.
- To avoid sleeping in the prone position.
- To sleep in supine position or lateral positions.
- Continuous positive airways pressure (CPAP) -At present this is the main line of treatment for sleep apnoea .
- This by providing positive pressure though air administered will help to keep the airway open.
- Constant stream of positive pressure air is given by mask. Moisture is added to the inspired air to prevent health problems of dry air.
- This is done to stiffen the excess tissues, to remove excess tissues ,
- to remove enlarged tonsils if any.
- Mandibular repositioning device (MRD) –
- This is used in cases of mild to moderate sleep apnoea.
- This is a mouthpiece device which holds the jaw forward during sleep .This increases the space behind the tongue .
- Thus the upper airway remains open and prevents snoring and sleep apnoea.
Side effects of MRD-
- If an individual is already having temporomandibular disease then it gets aggravated.
- Even if an individual is not having temporomandibular diseases then also it can cause jaw pain and dental pain, due to the pressure exerted by it .
- These should be taken only after consultation with qualified and experienced MD General Medicine doctors or with chest physician.
- These have several adverse effects –
- Triazolam, Acetazolamide
Causes /Eitiology of sleep apnoea –
- Lax tissues and muscles of the mouth and throat
- Chronic rhinosinusitis or deviated nasal septum since a long time -Whatever it may be -these things cause nasal congestion and nasal congestion is contributing factor in sleep apnoea.
- Obesity causes thickened tissues, irregular tissues and additional fat stores, around airway,enlarged tonsils -contributing to obstructive sleep apnoea
- neurologic disorders
- genetic factors
- heart, kidney problems ,
- thyroid disorders,
- preterm infants .
Risk factors association with sleep apnoea –
- Many of these are already discussed previously in this article -Old age,
- large neck,
- Down ‘s syndrome
- family history,
- recessed chin,
- racial origin.
Sleep apnoea is associated with the following disorders –
- Patients taking frequent pain relief medications.
- Excess use of pain relief medications should be avoided.
- All medicines should be taken only after consultation with qualified and experienced MD General Medicine doctors .\
- CNS disorders like encephalitis
- high altitudes travel
- medicines taken for depression and opioids
- heart failure and stroke .
- Complications of sleep apnoea –
- Atrial fibrillation
- Type 2 diabetes
- In female patients if there is pregnancy then it can cause pregnancy related complications.
- Cardiac problems due to reduced blood supply
- Kidney problems
- Decreased ability to focus cognitive problems
- Respiratory system problems like asthma
- As soon as any of these earliest signs and symptoms of sleep apnoea are noticed then immediate consultation with qualified and experienced MD General Medicine doctor should be sought to avoid progress and undue complications.
- Sleep studies and Sleep MRI
- In case of snoring we advise sleep MRI in which the patient is asked to sleep in sleep laboratory.
- During deep sleep a sleep MRI is performed.
- Video record of this sleep MRI is done which actually indicates the site of obstruction in cases of obstructive sleep apnoea.
- In any case of snoring first weight reduction is advised.
- Only and only after weight reduction and correction of associated deviated nasal septum sinus problems, this sleep MRI is done .
- If any obstruction is detected in sleep MRI then various surgical modalities like mandibular advancement techniques
- reduction of tongue mass by laser
- Surgery for vocal cords polyps, if any is advised
- In the sleep laboratory the equipment records brain waves,
- Eye and leg movements
For further health related articles pl visit www.healthuseful.com
every 10-15 days as new health related articles are posted in it by MD General Medicine and ENT specialist doctors in this duration.
Prabha ENT clinic, plot no 345,Saigram colony, opposite Indoline furniture Ambad link road ,Ambad ,1 km from Pathardi phata Nashik -Dr Sagar Rajkuwar (MS-ENT), Cel no- 7387590194,9892596635
For clinic appointments through website pl click on the link given below
For additional information on ENT surgeries pl click on the link given below
This one above is the link for the article on ENT surgeries in our website www.healthuseful.com