What is Sleep Apnoea?
The origin of the word ‘apnoea’ is Greek and means ‘without breath’. There are three kinds of sleep apnoea, the most common one being Obstructive Sleep Apnoea (OSA). This is when air is unable to flow in and out of a person’s nose or mouth at times whilst asleep. Central Sleep Apnoea (CSA) is a neurological condition, where the brain fails to send signals to the respiratory muscles. Then there is Complex Sleep Apnoea Syndrome (CompSAS), which is a combination of both.
OSA happens when the upper airway collapses, whilst CSA is due to a lack of respiratory effort. CSA tends to happen in patients with heart failure, brain cancer, or a nervous system disorder. It can also occur in people who have too much carbon dioxide in their blood. Whilst snoring can also be a symptom, this isn’t always the case for CSA.
Why is Sleep Apnoea a Problem?
The scary thing about sleep apnoea is that the pauses in breathing can last for 10 seconds or longer. In severe cases, this can happen 30 times or more within an hour. The body is starving for oxygen on an unconscious level, so patients are often unaware of the problem. They usually learn about it through their loved ones, who are usually disturbed by their chronic snoring, or gasps for air in the middle of the night.
Sleep apnoea can also lead to serious impaired mental function, heart attack, hypertension, stroke, diabetes, or even sudden death. It is important to watch out for the symptoms, and see a doctor if you suspect that you or a loved one might be suffering from it.
What are the Symptoms & do I Have it?
Many people who snore may in fact, be suffering from sleep apnoea. This affects the over all quality of your life, as a poor night’s sleep can spill over to affect your entire day. This can turn into a vicious cycle, and further affect your activities and people around you. In fact, sleep apnoea is considered a public health risk, and has caused many accidents on the road.
Symptoms for Obstructive Sleep Apnoea (During the Night):
- Choking sensation
- Gasping for air
- Frequent waking from sleep
- Nocturia (frequent urination at night)
- Loud snoring
Symptoms for Obstructive Sleep Apnoea (During the Day):
- Fatigue and drowsiness
- Poor concentration
- Morning headaches
- Waking with a dry mouth
- Poor memory
- Depression or mood changes
- Sexual dysfunction or decreased sex drive
- Shortness of breath, problems with swallowing, weakness or numbness in the body or voice changes (all of which are more common for individuals with CSA)
CompSAS is usually only discovered after treatment for OSA shows little to no improvement.
Who Does Sleep Apnoea Affect?
An estimated 30 million people in the United States and 15% of Singaporeans suffer from sleep apnoea. In Singapore, one in three have moderate to severe symptoms, and one in ten have severe sleep apnoea.
It can also occur in children, and some of the symptoms include snoring and irritability in the day. Such children are often diagnosed with ADHD when the problem is in fact, sleep apnoea.
Some of the common risk factors include:
- Adults over 40 years of age
- Structural problems in the mouth, such as an enlarged tongue or tonsils, a smaller or misaligned lower jaw
- Heart or kidney failure
- A larger neck size (17” or more in men and 16” or more in women)
- Genetics, affecting Chinese and Malays more than Indians
- Family history of sleep apnoea
- GERD (gastroesophageal reflux)
- Nasal obstruction due to allergies, sinus problems, or a deviated septum
- Type 2 Diabetes
- Mixing alcohol with certain medication
- Brain tumours or infections, strokes, or any other condition which affects the brain stem
- Neuromuscular conditions
- Endocrine disorders
- Premature birth (usually improves as the brain matures)
How is Sleep Apnoea Diagnosed?
Your doctor will first conduct a physical examination, after learning more about your medical history. They may recommend a sleep study (polysomnography) if needed. Whilst you may need to stay over at a sleep disorder clinic, many of these studies can be done at home these days. Recordings of your blood oxygen levels, heart rate, air flow and pauses in breathing are taken whilst you sleep.
Additional tests may be necessary for those with other medical conditions, to rule out certain issues. For example, your doctor may order an echocardiogram to exclude signs of heart failure. An electrocardiography checks for irregular heart beats. Arterial blood gases measure levels of oxygen and carbon dioxide in your blood.
Blood tests to check on your hormone levels may be necessary to rule out endocrine disorders, which can affect sleep apnoea as well. Pelvic ultrasounds examine the ovaries or detect cysts, to rule out conditions such as PCOS. Your doctor will then conclude and form a diagnosis based on all this information.
What Can I do to Manage Sleep Apnoea?
In some cases, you can manage it with healthy lifestyle changes. Here are some things that might help:
- Maintaining a healthy weight through good eating and exercise habits. Eat more heart healthy foods. such as vegetables, fruits and whole grains.
- Avoid smoking.
- Avoid taking certain medications together with alcohol. These include sedatives, benzodiazepines and opioids.
- Avoid drinking right before bed.
- Avoid sleeping on your back.
In many cases however, intervention and treatment are necessary.
Treatment Options Available
The most common treatment for sleep apnoea is a CPAP (Continuous Positive Airway Pressure) machine. You will need to wear a mask when you go to sleep at home, and this device puffs pressurised air into it. Whilst it is an effective treatment that is proven to work, many find the mask uncomfortable.
Your dentist may suggest using an oral device (a.k.a. a Mandibular Advancement Device) if CPAP machines aren’t working for you, or before you try one at all. These are mouthpieces custom-fit by your dentist, and are usually for mild to moderate cases of sleep apnoea. They can be particularly helpful for OSA. They can be used in combination with CPAP in certain cases.
Surgery is sometimes done if none of these treatments work. Removal of tonsils, adenoids or tissue creates more space within your throat. Surgery may be necessary to remove blockages caused by polyps or a deviated septum.
In rare and life-threatening cases, a breathing tube is inserted into the trachea itself. Surgery to advance the jaw forward is particularly useful in opening up the upper airways. In many cases it also serves as a definitive cure for OSA. However, not everybody may be suitable, or want to undergo surgery.
One of the most promising developments are implants that are embedded beneath the skin of the neck and chest. It is a pacemaker-like device that monitors your breathing patterns as you sleep. It automatically stimulates muscles in the respiratory tract to keep the airway open.
How Nourish Dental Care Can Help with Sleep Apnoea
Nourish Dental Care uses the latest technology to diagnose, treat and manage each patient’s condition. Dr. Eric Chionh who runs the practice has many years of experience. He focuses on pain and sleep dentistry, TMD, orofacial pain, dental implants and other mouth and jaw conditions.
He holds full membership in all four Royal Surgical Colleges of the United Kingdom & Ireland. He has also gone through formal residency training in Orofacial Pain and Dental Sleep Medicine, to earn his certification and accreditation in these areas. Find out more details about him on our About page.