Sleep disorders

Obstructive Sleep Apnoea

Obstructive Sleep Apnoea or OSA is the term used to describe the more severe end of the spectrum of sleep disordered breathing conditions.

Obstructive sleep apnoea occurs during sleep when the upper airway collapses or loses muscle tone. This blocks or provides resistance to the passage of air in and out of the lungs. People who experience this syndrome will regularly stop breathing for periods of between 20-60 seconds at a time and can do so hundreds of times a night.

OSA often results in numerous mini-wakes from sleep through the night. These mini-wakes are often not remembered or recognised by the person; however, they can disrupt the efficiency and quality of the sleep, rendering the person poorly refreshed or excessively tired during the daytime.

The disruption to breathing can also result in a drop in the amount of oxygen available in the blood. Having low blood oxygen can impact cognitive or brain function, memory, concentration and mood.

Untreated apnoea is also a significant risk factor for heart conditions and stroke. It has been well correlated with the development of hypertension or high blood pressure and diabetes. Treatment of underlying sleep apnoea often helps in the control of pre-existing diabetes and hypertension.

Some of the symptoms and related conditions of untreated OSA are:

  • Poor refreshment upon waking
  • Lethargy and excessive daytime tiredness
  • Irritable mood and depression
  • Decreased libido and impotence in men
  • High blood pressure
  • Diabetes
  • Dry mouth and/or morning headaches
  • Persistent daytime cough
  • Reflux (GOR).

Diagnosis is made via polysomnography, which is a simple test which measures aspects of your sleep. This test can be organised through the clinic and you can take the equipment home and sleep in your own bed.

Treatment options

If OSA is confirmed on testing and of a significant severity to warrant treatment then there are a number of treatment options available.

If obesity or excessive weight is present then successful efforts at weight loss will generally result in a reduction in the severity of sleep-disordered breathing.

Reducing alcohol consumption will also positively affect sleep quality and reduce the severity of any sleep-disordered breathing.

If sleep-disordered breathing is assessed as being mild then a mandibular advancement splint (MAS) is often indicated. This is a mouth guard which positions the lower jaw forward and opens the space at the top of the airway. This treatment aims to eradicate snoring and mild to moderate sleep disordered breathing.

In cases of severe obstructive sleep apnoea a CPAP device is indicated. CPAP is the gold-standard treatment for sleep apnoea. It stands for Continuous Positive Airway Pressure, and consists of a mask and a hose attached to a pump. This treatment pressurises the airway during sleep, preventing collapse.

For patients with a moderate degree of apnoea or for those that don’t tolerate CPAP a new device known as EPAP is available. EPAP stands for Expiratory Positive Airway Pressure. This treatment consists of single use stickers with valves which are placed under the nostrils at night. These stickers provide resistance to breathing out and as a consequence trap some air in the body which 'splints' the airway open.

These treatments are readily available and can be trialled to assess effectiveness. Book an appointment with physiotherapist Cameron Ivchenko for an assessment.


ADEQUATE SLEEP
"Sleep disorders could contribute to up to 70 per cent of diseases. Too often sleep is sacrificed in the interests of work and social activities, and in times of stress and depression, our sleep quality can be further compromised. Adequate sleep is important for hormonal regulation and mood, and quality sleep, with normal sleep patterns, can have a significant impact on depression. Rest well to be well.
We may not be able to change the world we live in, but we can change the way we live in the world. Starting with a new year, or better still, starting today."
Professor Avni Sali, Director, National Institute for Integrative Medicine (NIIM)