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Snoring occurs when the throat narrows during sleep causing soft tissue to vibrate, anything that increases this, for example enlarged tonsils or a setback lower jaw, will block the airway further and cause the sleeper to wake up throughout the night gasping for air. This condition is sleep apnoea and it is a lot more common than many think. 25% of the UK population suffers from a sleep disorder that causes excessive daytime sleepiness, with three in every one thousand men suffering from severe sleep apnoea.
Causes can include having a partially blocked nose as this encourages the walls in your throat to be sucked together, but the most common factor that can result in sleep apnoea is being overweight (for men having a 17 inch collar or more) as the additional fat squashes the throat from the outside.
Sleep apnoea sufferers tend to be middle-aged men; an estimated 4% of men in the UK and only 2% of middle-aged women suffer from this condition. It is particularly hard to diagnosis women as it is not obesity, but fat distribution that can cause the sleep disorder, making it harder for specialists to measure. However, there are cases where specialists are dumbfounded as to why some people suffer from the condition as they are not particularly overweight and are quite young. Children can also be diagnosed with sleep apnoea, which is often caused by enlarged tonsils – some specialists will encourage that they have their tonsils taken out.
Symptoms of sleep apnoea
There are many symptoms that can indicate you’re suffering from sleep apnoea. However, the most prevalent is fatigue that interferes with every day activities. To begin with sufferers may fall asleep if the task is mundane. When sleepiness gets progressively worse, it can hinder your work performance, can cause you to fall asleep mid way through a conversation or even to fall asleep when eating. However what is more pressing is how it can affect your driving; those who suffer from sleep apnoea are seven times more likely to be involved in accidents. You’ll find further information about sleep apnoea and driving below.
The best pointer to a diagnosis is the twin symptom of snoring and daytime fatigue, but there are other symptoms which are listed below:
• Episodes of snoring, silence and loud snorting
• Sleeping partner is aware of irregular breathing
• Increased visits to the toilet
• Waking up choking
• Heart beat is rapid and pulse is racing
• Sore throat
• Dry mouth
• Reduced sex drive
• Poor memory, mood swings and difficulty concentrating
• Feeling un-rested and waking up with a fuzzy head
• High blood pressure
Driving and sleep apnoea
When diagnosed with sleep apnoea the DVLA and your insurance company must be informed, failure to inform the DVLA is an offence (you can be fined up to £1,000) and if undeclared your insurer may refuse to support any claim (you may also be prosecuted). For Group 1 (private cars) and Group 2 (PSV/HGV) drivers, driving must cease after diagnosis and will only be permitted to drive again once you have control over the symptom(s), which has been confirmed by a specialist. Clinics may be able to prioritise your treatment if your livelihood depends on driving.
Further information regarding driving and sleep apnoea can be obtained by either calling the DVLA’s medical unit on 0300 790 6806 (car or motorcycle) or 0300 790 6807 (bus, coach or lorry), or taking a look at their downloadable brochure ‘Think! Tiredness Can Kill’.
Diagnosing sleep apnoea
If you believe you’re suffering from sleep apnoea, we suggest that you seek advice from your GP who will then transfer you to a sleep specialist to conduct a sleep study to confirm your diagnosis. There are many measurements that the specialist can make, the most common being sleep oximetry, which monitors the oxygen level in your blood through a clip on your finger.
Other techniques that may be used in the sleep study
• During Transcutaneous CO2 monitoring a probe will be attached to your ear to measure the CO2 levels in your blood
• During Autoset Sleep Study a probe will be placed on your finger and you’ll also wear a nasal probe throughout the night
• When undergoing Polysomnography, you will be attached to a monitor that will measure your breathing and respiration throughout the night. Your heart rate, chest, abdomen and leg movements and blood oxygen levels will be monitored and recorded
• You may also be given a CPAP Trial where you will be attached to a machine and wearing a mask that delivers air up your nasal passage to help keep your airways open during sleep. During this trial, the specialist will test different pressures to see what setting is best for you. The mask may take some time to get used to, but many find it comfortable to wear. If the trial is successful you will be issued with a machine and mask to take home
• A CPAP Retitration is often conducted to reassess your progress with the CPAP machine that was issued to you. It is advised that you bring it with you to this test as the pressure setting may need to be altered
Please be aware that specialist health units may use video recording with sound during the study to observe any disturbances you may experience during sleep.
Nocturnal Hypoventilation Syndrome
Nocturnal Hypoventilation Syndrome is a condition related to sleep apnoea, but the symptoms are far greater. As the brain’s respiratory central centre doesn’t send enough nerve impulses to the breathing muscles, sufferers sometimes experience complete cessation of breathing, rather than obstructed breathing due to narrowing airways. Snoring is not a symptom of Nocturnal Hypoventilation Syndrome and can indicate further medical implications such as neuromuscular disease and chest wall deformities. It is a less common condition than OSA, but treatment is very similar. An overnight ventilation nose or face mask system similar to that of a CPAP is used.
Treating Sleep Apnoea
If your case of sleep apnoea is not severe there are a few changes that you can implement into your routine that will help to improve your sleep. Keep your nasal passages clear, this can be accomplished through the use of a nasal spray, nasal rinse or nasal strips, and ensure you sleep on your side or slightly up-right. Mouth guards (Mandibular Advancement Devices) can also help if you have a setback lower jaw. Other measures you can take at home include:
• Losing weight
• Stop smoking
• Don’t drink alcohol four to six hours prior to going to bed
• Avoid sedative drugs
As a last measure an operation on your back or throat can be conducted, but this should only be done after a sleep study has been conducted, and it’s been reported that your snoring is what is affecting your sleep rather than sleep apnoea.
The only real chance of treating sleep apnoea effectively is through the use of a CPAP machine and mask. The pressurised air that passes through the mask once the machine is fully operational will help to hold your airways in the throat open. The effects of this are usually dramatic with many patients reporting improved sleep and reduced daytime tiredness.