Snorers have always had it hard. The target of jokes and midnight elbow thrusts, they’re not going to win any popularity contests. But the bed-rattling snores typical of obstructive sleep apnea (OSA) are nothing to laugh about.
A sapper of sleep, breath and energy, OSA has been connected to a 46 per cent rise in the risk of dying early according to research by John Hopkins University, Baltimore, Maryland, US.
Even at its mildest it can lead to serious health problems over time, and left undiagnosed or untreated it can be fatal.
“High blood pressure, heart failure, heart rhythm disturbances, insulin resistance and even death are some of the known complications of untreated OSA,” says Dr Ines Bayarassou of the Institute for Biophysical Medicine (IFBM) in Healthcare City, Dubai.
OSA’s connection with obesity means it’s a huge problem in the UAE, where a large proportion of the population is overweight.
“We’ve seen a marked increase in the number of people suffering from OSA in the UAE in recent years, partly due to the stress of today’s lifestyles and unhealthy food choices followed by the gain of weight,” says Dr Bayarassou. “Yet it’s estimated that only 10 per cent of people with OSA are currently receiving treatment and many patients with sleep apnea remain undiagnosed.”
What is obstructive sleep apnea?
While normal snoring occurs when the soft tissue at the back of the throat relaxes, causing the airway to narrow and vibrate with passing breaths, OSA happens when the soft tissue collapses, causing the airway to become blocked.
This forces a pause in external breathing – known as apnea – and may last for up to a minute, resulting in a near-suffocating lack of oxygen and build-up of carbon dioxide. Finally the brain wakes up enough to tighten the breathing muscles and the sleeper gasps loudly for air until blood-oxygen levels return to normal.
This can happen hundreds of times a night and the sleeper may or may not be aware of it – most people only realise they’re doing it if someone tells them and are only diagnosed when complaining of other symptoms such as daytime tiredness.
“These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours,” says Dr Bayarassou.
Inconvenient as this may be, if left it untreated OSA can be devastating. “Sleep apnea sufferers are three times more likely to be the cause of a car accident than non-sufferers because of the tiredness resulting from disrupted sleep,” says Dr Bayarassou.
“Frequent drops in your blood-oxygen levels and reduced sleep quality can trigger the release of hormones that raise your heart rate and increase your risk of high blood pressure, heart attack, stroke and arrhythmias. Untreated sleep apnea can also lead to changes in how your body uses energy. These increase your risk of obesity and diabetes.”
The chronic nature of OSA can takes its toll on the body and strain relationships. Dr Shefali Verma, medical director for IFBM, says, “One patient who came to see me looked in his 40s, but he was only 21.”
His snoring disturbed his wife so much she moved into the spare room, and his lack of energy made him unable to exercise, exacerbating his weight problems and making his sleep apnea worse.
For those stuck in this catch-22 situation, there are a range of treatments available to improve the sleep quality of an OSA sufferer. These increase the patient’s energy and can help them on the road to making the sort of lifestyle changes that can eventually cure the condition. [See following page for more information].
Could I be suffering from it?
Sleep apnea can affect anyone – even children. It is seen more frequently among men than women, and about 50 per cent of the people who have the condition are overweight.
According to Dr Bayarassou, “Among obese patients, 70 per cent have OSA.” And it worsens in severity and prevalence with increasing weight.
Other risk factors include having a wide neck circumference, which may signify a narrower airway; enlarged tonsils or adenoids; nasal congestion from either a deviated septum or allergies; and having a family history of the problem. The risk of suffering from OSA increases with age and smokers are three times more likely to have OSA than those who have never smoked.
It’s easy to understand how sleep apnea sufferers could slip under the radar. The symptoms are chronic and easily mistaken for other conditions; daytime tiredness could quite feasibly be attributed to stress, while the snoring that signifies the sufferer’s struggle for breath is easily dismissed as innocuous.
But there are more specific signs to look for. Loud and frequent snoring, long pauses in breathing and choking or gasping during sleep are all telltale symptoms. “But not everyone who snores has sleep apnea and not everyone who has sleep apnea snores,” says Dr Bayarassou. “The biggest sign is how you feel during the day.”
Felling tired no matter how long you’ve slept for is a major symptom. Less common but nonetheless telling signs of sleep apnea include waking up with a dry mouth or sore throat, morning headaches, going to the bathroom frequently during the night and difficulty concentrating during the day. However, all of these symptoms could still be put down to other causes.
Keeping a sleep diary can help with a diagnosis and a doctor may examine your mouth, nose and throat for extra or large tissue that could be causing problems.
But the only way to be certain of whether or not you have OSA is through a sleep study. This can be done either in a hospital or sleep centre using a polysomnogram – which records brain activity, eye movements, heart rate and the amount of oxygen in your blood – or at home using a portable monitor that records the same factors and can be more comfortable for the patient.
“Our clinic has teamed with Oxygen Breeze, a company to run diagnostic sleep testing at home,” says Dr Verma. “Sleep testing in the hospitals is unnatural for the patient and therefore they sometimes do not sleep well, which can have a negative effect on test reliability.”
Once diagnosed with sleep apnea, there are a variety of treatment options available to restore regular breathing during sleep and relieve the snoring and daytime tiredness symptoms.
The use of a machine known as a CPAP (Continuous Positive Airflow Pressure) can transform the life of an OSA sufferer. A mask-like device, usually the size of a tissue box, it provides a constant stream of air, which keeps breathing passages open while sleeping.
In many cases of using this machine the sufferer experiences immediate symptom relief and a huge boost to mental and physical energy, says Dr Verma.
If sleep apnea is caused by obesity then the CPAP can calm and rest patients so that they are more able to lose weight and potentially come off the machine.
According to Dr Verma, if it is a structural issue causing the apnea then the CPAP is revelatory, because it enables the patient to sleep soundly without making the snoring noises that may be so destructive to family relationships. That way, the spouse of the patient is also able to sleep and the both lives can get back on track.
Other treatments for OSA include treating underlying medical conditions causing the apnea, such as a heart or neuromuscular disorder. Treatment may improve other medical problems linked to OSA such as high blood pressure. It can also reduce your risk of heart disease, stroke and diabetes.
“Medications are only available to treat the sleepiness associated with sleep apnea, not the apnea itself, so should only be used in conjunction with other proven sleep apnea treatments,” says Dr Bayarassou.
In extreme cases, surgery to increase the size of the airway is needed. It’s done by removing tonsils or excess tissue at the back of the throat or inside the nose, or even reconstructing the jaw to enlarge the airway. “Surgery should be considered only after all the risks, benefits and alternatives are understood,” says Dr Bayarassou.
“It carries risks of complications and infections, and in some rare cases, symptoms can become worse.”
How to avoid OSA?
If you’re worried you may have sleep apnea, it’s worth getting checked out, but remember the majority of cases are mild and the number of sufferers are relatively low. “In one study of people over 18, OSA was estimated to develop in 1.5 per cent of people per year over the five year study,” says Dr Bayarassou.
There are many things you can do on your own to help with mild sleep apnea, and these should also help with normal snoring too.
Lifestyle modifications, including losing weight, avoiding sleeping pills, caffeine and heavy meals before going to bed, stopping smoking and maintaining regular sleeping hours, can help.
“Sleeping hygiene and other behavioural modifications known to improve the quality of sleep are also recommended,” says Dr Bayarassou.
These include reducing lighting and noise in the bedroom, avoiding reading or watching TV in bed, keeping work-related activities outside of the bedroom and trying a period of physical and mental relaxation such as meditation before going to bed.
And for the non-snorers out there; before you tease your loved one about their window-rattling snores, think about how it could be affecting their health as well as yours. And, as ever, if in doubt, see a doctor.