What is Sleep Apnoea?
The origin of the word ‘apnoea’ is Greek and literally means ‘without breath’. There are three kinds of sleep apnoea, with the most common one being Obstructive Sleep Apnoea. This is when air is unable to flow in and out of a person’s nose or mouth at times while asleep. Central Sleep Apnoea is a neurological condition where the brain fails to send signals to the respiratory muscles. Then there is Complex Sleep Apnoea, which is a combination of both.
Obstructive Sleep Apnoea happens when the upper airway collapses, while Central Sleep Apnoea is due to a lack of respiratory effort. Central Sleep Apnoea 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. While snoring can be a symptom of sleep apnoea, this isn’t always the case for Central Sleep Apnoea.
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 may be disturbed by their chronic snoring, or gasps for air in the middle of the night.
Sleep apnoea can also lead to a 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 specialist if you suspect that you or a loved one might be suffering from it.
What are the Symptoms and do I Have it?
Many people who snore may in fact, be suffering from sleep apnoea. This affects the overall 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
- Waking up from sleep frequently
- Nocturia (frequent urination)
- 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 Central Sleep Apnoea)
Complex Sleep Apnoea is usually only discovered after treatment for Obstructive Sleep Apnoea shows little to no improvement.
Who Does Sleep Apnoea Affect?
An estimated 30 million people in the United States and a third 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 really the problem is sleep apnoea.
Some of the common sleep apnoea risk factors include:
- Adults over 40 years of age
- Structural problems in the mouth, such as enlarged tongues 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. While 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 while 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, and 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 sleep apnoea 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, further treatment will be needed.
Treatment Options Available for Sleep Apnoea
The most common treatment 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. While it is an effective treatment that has been proven to work, some people do 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 Obstructive Sleep Apnoea. They can even be used in combination with CPAP in certain cases.
Surgery is sometimes done if none of these treatments are working out. 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 as well. In rare and life-threatening cases, a breathing tube is inserted into the trachea itself. Surgery, in particular, to advance the jaws forward is particularly useful in opening up the upper airways and in many cases, serve as a definitive cure for OSA. However, not everybody may be suitable, or want, 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 help 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. Chionh who runs the practice has many years of experience, and specialises in dental implants, TMD, 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. (Click here for more information.) Visit him today for a consultation if you are considering dental implants, suffering from TMD, sleep apnoea or other orofacial pain.