Sleep Apnoea: Breathlessness in bed

Raghu who is now in his early 40s was always a heavy snorer. He would get hit by bouts of excessive sleepiness and had no energy in the evenings to play with his kids. While it was embarrassing falling off to sleep at work meetings, it was downright scary when he once nodded off while driving. He used to find himself waking up on some nights gasping for air. A web search of his symptoms indicated that this was something more serious than a plain snoring habit. Consultation with a chest specialist and a few tests later, his diagnosis was confirmed. It was obstructive sleep apnoea, which literally a means pause in breathing during sleep due to obstruction. You may have one or more pauses in breathing or shallow breaths while you sleep.  The pauses can last from a few seconds to minutes and they may occur 30 times or more in an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Are you at risk of sleep apnoea?

Almost half of the people suffering from sleep apnoea are overweight. A thick neck and a double chin that presses on the airway when they lie down, is also seen as a cause. It’s more common in men than in women and the risk increases with age. The signs to look for are disruptive snoring, excessive sleepiness [not found in children though] and gasping in sleep [as witnessed by a bed partner]. Also, watch out for increased blood pressure, morning headaches, sexual dysfunction, and behavioural changes [this one especially in children].

Also read » Sleep Apnoea

The upper part of our airway system that includes the area around the back of the tongue is soft without any bony supports. They totally depend on muscle tone to maintain patency. In patients with sleep apnoea, this part of the airway is narrower, either due to obesity or due to the structure of the bone and soft tissues. In children, the enlarged tonsils and adenoids could pose as an obstruction to free breathing. When awake, the receptors and reflexes come into play making sure that the airway remains open. However, during sleep, the tongue falls back against the back of the throat, mechanically closing the airway and causing obstructive sleep apnoea.

Research done in a U.S. based hospital showed that this condition affects approximately 20 per cent of adults, out of which about 90 per cent are undiagnosed.

Is sleep apnoea really something serious?

Sleep apnoea, undiagnosed and untreated could lead to a few life-threatening situations—the main cause of concern being road accidents that could happen if the person falls asleep while driving, or accidents from falling asleep while operating machinery. The medical complications that could occur because of untreated sleep apnoea include high blood pressure, abnormal heart rhythms, and stroke. A study showing the relationship between sleep apnoea and abnormal heart rhythms found that the chances of a heartbeat abnormality were 18 times higher immediately after an episode of sleep apnoea than, during periods of normal breathing of sleep. An article in the John Hopkins University Gazette quotes Dr Naresh Punjabi who specialises in sleep medicine there, “Low blood oxygen levels during sleep are a particularly worrisome sign and that is the single biggest predictor of death in people with sleeping disorders.”

Apart from these, the person suffering from sleep apnoea may also face weak memory, further weight gain, headaches and impotence.

Change how you live, to sleep better

A few lifestyle changes go a long way in reducing sleep apnoea. The first focus should be on reducing weight. Weight loss reduces number of apnoea episodes, improves quality of sleep, reduces snoring and improves oxygen levels.

Taking alcohol or sedatives towards bedtime in the hope of a better night’s sleep is a big mistake and should be avoided at all costs, for it may make the problem worse. Sleeping on the side instead of the back may help in milder cases.

The first treatment option is the CPAP [Continuous Positive Airway Pressure] machine, which is the most common treatment for adults with moderate to severe sleep apnoea. The device is like an oxygen mask worn over the nose. A tube connects the mask to the machine, that forces air into the airway passages preventing it from collapsing and thereby preventing a dip in oxygen levels. The airflow pressure has to be adjusted such that it is strong enough to keep the airway open while sleeping.

The person needs to be connected to this device before going off to sleep every time and this may take a while getting adjusted to sleeping with a tube attached to the nose. The good news is that when sleep apnoea is treated with a CPAP machine, the blood pressure lowers not only during the night but also during the day. Sleep apnoea patients who also suffer atrial fibrillations [a common type of abnormal heart rhythm] when treated with methods like CPAP have only a 40 per cent chance of coming back for further treatment of their atrial fibrillation as against 80 per cent recurrence of atrial fibrillation in untreated patients. Treatment therefore reduces the complications associated with sleep apnoea to a considerable extent.

Another treatment option is to use dental devices in the mouth that keep the lower jaw forward, thereby leaving a space for the air to enter the lungs.

In some cases, where indicated, surgery to remove excess tissue from back of the throat, or having tonsils/adenoids removed in children facing sleep apnoea due to their enlargement are options. A study from the Henry Ford Hospital, Detroit found that patients with sleep apnoea who undergo surgery to improve their breathing are able to sleep better at night and have reduced daytime sleepiness. In the past, tracheostomy or making an opening in the windpipe was performed in these patients, but this is rarely done nowadays.

Raghu has finally gotten used to strapping on the CPAP machine before sleeping every night. He says that the effect on his energy levels is remarkable and he never falls asleep during the day anymore. His doctor has advised him to maintain an active lifestyle so that he doesn’t gain weight.

Difference between snoring and sleep apnoea

Snoring is a very common condition. All people with sleep apnoea snore but all snorers don’t have sleep apnoea. Snoring is more of a social problem while sleep apnoea is a disease condition that needs immediate attention. Snoring happens due to the vibration of the soft tissues in the throat as the air passes from the mouth/nose to the lungs. In snoring the airway may be narrow, but there is never a stoppage in breathing, while patients with sleep apnoea actually stop breathing up to 400 times throughout the night. There is a high chance though that a snorer may develop sleep apnoea.

According to the European Respiratory Journal, there are two main factors that determine if your snoring will progress to sleep apnoea —Body Mass Index [BMI] and Age. While you can’t prevent yourself from growing older, exercise and proper diet to ensure your body weight stays within limits, is a good way to prevent sleep apnoea.

This was first published in the February 2013 issue of Complete Wellbeing.