Sleep Apnoea

What’s Sleep Apnoea? 

 

There are 3 types of sleep apnoea. They are obstructive sleep apnoea (OSA), central sleep apnoea, and mixed sleep apnoea. OSA is the commonest form of sleep apnoea (about 4% of men and 2% of women). OSA is a condition where breathing repeatedly stops or significantly decreases during sleep because of a narrowing or obstruction in the upper airway. These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 10 times every hour.

Central sleep apnoea (CSA) is a less common type. It is triggered by completely different circumstances, and is a result of the brain’s inability to properly control breathing during sleep, due to the fact that it temporarily stops sending signals to the muscles that control breathing. Mixed sleep apnoea (MSA) is a combination of both obstructive and central sleep apnoea. It’s estimated that up to 90% of individuals with sleep apnoea are unaware of their condition. Ironically, they may consider themselves to be good sleepers, since they are often able to fall asleep quickly, anywhere under varying circumstances.

Sleep apnoea is usually accompanied by chronic, noisy snoring. The individual often gasps for breath or chokes during the night, but usually sleeps through such incidents without waking up. This results in a poor night’s sleep, time and time again. Symptoms include daytime exhaustion and sleepiness, poor memory and concentration, dry mouth, sore throat and morning headache. The most common type of sleep apnoea, obstructive, occurs when the tongue and throat tissues relax during sleep, dropping enough to block the airway. Those at greatest risk are middle-aged males who are overweight and have thick necks.

When someone experiences an episode of apnoea during sleep, their brain will automatically wake them up, usually with a very loud snore or snort, in order to breathe again. People with OSA will experience these wakening episodes many times during the night and consequently feel very sleepy during the day.

OSA doesn’t develop spontaneously. Instead, it could be described as being on the end of a snoring continuum. The first stage on this continuum would be typified by a young man between about 25 and 30 years old, who snores occasionally, possibly after consuming a large amount of alcohol. By the time such a ‘social snorer’ has reached the age of 30 to 35, without his snoring being addressed, the likelihood of him progressing to become a ‘regular snorer’ (i.e. snoring every night) is high.

If snoring has not been dealt with, by the time a ‘regular snorer’ has reached the age of 40 to 45 years, the snoring will most likely have developed into the more serious condition of OSA. Due to this slow progression over many years, it is often not recognised, as the sufferer is unaware that their seemingly harmless snoring has worsened to the extent that it has become a clinically serious condition.

 

How might I know if I have sleep apnoea?

 

People with sleep apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner who notice the symptoms first.

Sufferers may experience some of the following:

  • Extremely loud heavy snoring, often interrupted by pauses and gasps
  • Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness, from which we all suffer from time to time)
  • Irritability, short temper
  • Morning headaches
  • Forgetfulness
  • Changes in mood or behaviour
  • Anxiety or depression
  • Decreased interest in sex

 

Sleeping Position

 

Body position plays an important role during sleep and can often make the difference between having a good night’s sleep or not. For snorers and individuals who suffer from obstructive sleep apnoea (OSA), this is a particular problem as several studies have found that individuals who sleep in the supine position (on the back) are more likely to snore or have increased apnoeas than those who sleep in the lateral position (on the side).

The clinical evidence, suggests that both sleeping position and sleep stage have a considerable impact on snoring and sleep apnoea, and other sleep disorders. Sleep stage seems to have more of an effect on snoring independent of body position. Sleep stage affects snoring time and intensity. However, there are differing opinions as to what stage of sleep is of more significance. Some studies report snoring and apnoeas are more prominent in SWS (slow wave sleep), followed by Stage 2, and least in Stages 1 and REM (rapid eye movement) sleep. Other studies report snoring and apnoeas are more prevalent during REM sleep.

 

Effect of alcohol and sleeping pills

 

Alcohol travels to all areas of the body and slows the brain’s responses, causing the muscles to relax even more than during a normal night’s sleep. The added relaxation of the musculature causes the oropharynx (the upper part of the throat behind the nose) to collapse more readily and can induce OSA in people who are otherwise just snorers.

Alcohol also causes nasal airway irritation and congestion that increases the airway resistance when breathing. Whilst most people have sufficient muscle tone to prevent the airway from collapsing during sleep, this situation may alter if they are taking sedative drugs.

 

Treating Sleep Apnoea

 

The most common treatment method for sleep apnoea is continuous positive airway pressure (CPAP).This involves wearing a nose and mouth mask that is connected to an air blower. It forces air into the lungs raising air pressure in the mouth, nose and throat just enough to prevent the airways from collapsing, and allowing for ‘normal’ breathing and sleeping. It should be noted this does not cure sleep apnoea, but offers a way of managing the symptoms.

Snoring and sleep apnoea are fundamentally problems with the way an individual breathes during sleep. The faulty breathing habits are also present during the day. This is why improving breathing during the day can help an individual breathe better and sleep better at night. The Buteyko Method can enable a snorer or sleep apnoea sufferer to become a slow, smooth, soft breather, day and night. CPAP has a number of problems associated with it. These include:

 

  • Nasal congestion and a sore or dry mouth
  • Chest muscle discomfort
  • Eye irritation
  • Irritation and sores over the bridge of the nose
  • Nosebleeds
  • Upper respiratory tract infections
  • A feel of being closed in (claustrophobia)

 

Despite the potential effectiveness of CPAP in treating OSA, adherence to therapy continues to be a major problem. A study published in the journal Sleep found that only 40 percent of 162 newly diagnosed patients who were given CPAP therapy accepted the treatment. Other researchers have found that failure to comply with treatment has been reported to be as high as 50 percent, with patients typically abandoning therapy during the first 2 to 4 weeks of treatment.

In another study of 300 patients referred to the London Chest Ventilatory Support Unit, it was found that 96% of patients complained of at least one side effect resulting from the therapy, while 45% complained of a side effect from the nasal mask.

Also, in a study of 80 patients, Verse et al; found that the most prevalent side effects were disturbance of the mask during the night (71.3%), dry mouth (47.5%), dry nose (46.3%), pressure marks from the mask (41.3%), crusts within the nasal cavity (38.8%), and hearing loss (26.3%). Mouth and nose dryness were considered the most irritating side effects.

The Buteyko Method of breathing training normalises both daytime and night-time breathing. A return to normal sleep patterns is observed in the vast majority of people who undertake a Buteyko course. Disturbed breathing and disturbed sleep go hand-in-hand. Signs of disturbed breathing patterns may be seen in people with sleep apnoea both when they are awake and when they are asleep. These signs and symptoms include mouth breathing, fast and/or heavy breathing, excessive yawning, frequent sighing, snoring, erratic or irregular breathing and a predominantly upper chest breathing pattern.

The Buteyko Method of breathing training addresses dysfunctional breathing habits through breathing training exercises and through education and awareness of posture, sleeping positions and lifestyle behaviours that influence breathing. The Buteyko Method teaches people to recognise their incorrect breathing patterns/habits, and teaches them how to improve their breathing which may assist with improving sleep patterns.

In October 2012, an article was published in the Australian Nursing Journal concerning a survey of Buteyko practitioners’ experiences in teaching breathing retraining to clients with sleep apnoea. The results suggest that breathing retraining using the Buteyko Method may offer an alternative to current therapies such as continuous positive airway pressure (CPAP) machines or oral devices such as mandibular advancement splints.

The Buteyko practitioners who responded to the survey provide estimated outcomes  from their individual practices. The practitioners who provided data had collectively taught the method to over 11,000 clients with sleep apnoea. The majority of responses came from Australia, with other responses from New Zealand, Canada, the United States, and the United Kingdom.

The results of the survey indicated that following Buteyko Method breathing retraining courses:

  • Over 95 percent of clients with sleep apnoea had improved sleep.
  • Approximately 80 percent of clients had been able to cease use of their CPAP machine or oral appliances.
  • Symptoms such as snoring, headaches, restless legs, low concentration levels and decreased energy levels also improved in the majority of clients.

The survey report contends that given the results of the sleep apnoea survey, the relationship between disordered breathing patterns, hyperventilation and sleep apnoea warrants further study.”

To access the journal article click here

To access the full survey report click here

To access an interesting article on sleep apnoea and dysfunctional breathing click here

 

Buteyko Breathing Clinics (Dublin and County Wicklow)