Most of us are unaware that we might have sleep apnoea. Undetected and untreated, it can lead to poor sleep and more.

Some of us may not be aware that we are suffering from obstructive sleep apnoea (OSA) and have left it untreated. If left untreated, it can cause health problems.

Ageless Online talks to Dr Mimi Yow, senior consultant in the Department of Orthodontics, National Dental Centre Singapore, about what OSA is, why we snore and how we can treat OSA. She is also the director of clinical services at SingHealth Duke-NUS Sleep Centre and clinical associate professor at the National University of Singapore (NUS) and Duke-NUS Medical School.

 

OBSTRUCTIVE SLEEP APNOEA

What is sleep apnoea?

Sleep apnoea literally means absence of breath during sleep. There are three types of sleep apnoea and OSA is the most common. Less common are central sleep aponea (CSA) and mixed or complex sleep apnea, which is a combination of OSA and CSA. A person with OSA breathes well while awake but during sleep, the airflow is blocked due to recurrent partial and complete collapse of the upper airway.

Blood oxygen falls during OSA events and carbon dioxide builds up as airflow is inadequate even though breathing is going on. The brain and the heart are constantly working to reopen the choked airway and to supply oxygen to the body at the expense of restful sleep and heart health. In CSA and mixed sleep apnea, the brain signals for breathing are interrupted. If undetected and untreated, all types of sleep apnea can cause serious health problems.

What are the signs and symptoms of sleep apnoea?

Common signs and symptoms associated with OSA are snoring, choking or gasping for air during sleep, waking up from sleep to go to the toilet a few times during the night, difficulty staying asleep and daytime sleepiness. Snoring is the noise of soft tissues vibrating in the upper airway that may or may not be associated with OSA. Many with OSA have poor sleep. Chronic sleep deprivation leads to irritability, mood changes, poor concentration in the day, excessive daytime sleepiness with reduced daytime vigilance that can cause occupational injuries and road traffic accidents.

Individuals with untreated OSA are at risk for high blood pressure, irregular heartbeats, and blocked blood vessels that can lead to heart attacks and strokes. They are also prone to obesity, diabetes, glaucoma, poor memory and depression. Snorer’s bed-partners become sleep-deprived as the noise disrupts their sleep. Relationships take a toll as bed-partners resort to sleeping separately. It is important to seek a proper medical assessment with a sleep study to determine if snoring is associated with OSA.

What is the prevalence of sleep apnoea in seniors?
Global estimates indicate one billion of 30- to 69-year-old adults suffer from OSA and approximately 13 to 32 percent of people above 65 years have OSA. In Singapore, one in three in the age group from 21 to 79 years were found to have moderately severe to severe OSA. More than 90 percent were unaware of their condition and untreated.

SNORING

Why do seniors snore?

The airway is a muscular tube. The muscles in the tongue, soft palate and throat become weak as seniors lose muscle mass and strength with ageing. With poor muscle support, the soft tissues sag and the airway becomes more collapsible. Parts of the airway become small and narrow due to partial collapse. Airflow is fast and turbulent in a small airway causing the soft tissues to vibrate. Snoring is the noise of vibrations in the airway.

What is the prevalence of those age 60 and above who snore? More men, is there a reason why?

Snoring is common. About 30 percent snore in those aged 30 years and above. The prevalence increases to 40 percent for middle-aged people. The proportion of male to female snorers are approximately 2:1 but equalises to 1:1 after women reach menopause, possibly due to loss of soft tissue elasticity from reduced hormonal levels. Almost 90 percent of loud and chronic snorers in Singapore have OSA.

How does one reduce snoring?

Nasal congestion, weight gain, taking alcohol, antihistamines, sedatives and tranquillisers, and smoking can make snoring worse. It is best to seek a medical consultation for an assessment and diagnosis before trying out snoring remedies. It is important to determine if snoring is noise from vibrating loose tissues or an indicator of an underlying sleep-disordered breathing condition.

After determining the diagnosis, the doctor may prescribe an appropriate combination of therapies based on the causes of snoring that may involve prescriptions for weight loss, nasal hygiene, nasal steroids, muscle exercises for the tongue and throat, side-sleeping rather than back-sleeping, tongue stabilising device, mandibular advancement device, continuous positive airway pressure (CPAP) device or surgery to remove blockages in the nose or throat.

How does one get diagnosed for snoring and sleep apnea?

Get a proper assessment and consultation by a sleep-trained doctor or team at a sleep centre. Detailed medical and sleep histories with examinations of the nose, mouth, throat and jaws for possible causes will be carried out. An overnight sleep study in the hospital or at home is necessary to diagnose the presence or absence of sleep apnea, and to confirm the type of sleep apnoea. The doctor or team of doctors will take you through the outcomes of the sleep study and diagnosis. Further investigations may be necessary to determine the causes before the decision on appropriate treatment options.

What are some treatments for OSA?

Different therapies or a combination of them may be needed based on the diagnosis and causes. The mainstay in OSA treatment is the CPAP device with a prescribed level of positive air pressure to keep the airway open. Other treatment options include weight loss, side-sleeping, nasal hygiene, nasal steroids, exercises for the tongue, throat and jaw muscles, tongue stabilizing device, mandibular advancement device, or surgery to remove blockages in the nose or throat, implant for nerve stimulation of the tongue, or jaw surgery to set the upper and lower jaws forward to widen the airway.

Diagnosis is all-important as there are different types and causes of sleep-disordered breathing. There is no one-size-fits-all treatment. A multidisciplinary sleep team comprising sleep-trained doctors with different expertise can offer appropriate treatment or combinations of therapies best suited for the needs of different individuals.

Any other tips or anything else you would like to add?

A person who snores or has sleep apnoea is usually unaware if not for reports from the bed-partner, family or friends. Most discover they have sleep apnoea several years after the effects and medical consequences of sleep apnoea have set in before getting a doctor’s consultation. Those who are at risk for snoring and developing OSA are the overweight or obese, middle-aged males, menopaused women, individuals with small narrow upper and lower jaws, and those with allergic rhinitis and blocked noses. Use this link to access the STOP-BANG calculator to check if you are at risk for OSA: www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea. It is a screening tool and not used to diagnose if you have or don’t have OSA. Even if you achieve a low-risk score but snore loudly or regularly (three times a week or more), you should see a sleep-trained doctor.

Recent evidence-based findings show damage of the soft palate in those who are chronic and loud snorers, with or without sleep apnoea. The throat and soft palate of a snorer look different from that of a non-snorer. The soft palate in a snorer is swollen and droopy with inflammation at the back of the throat. Vibratory trauma from snoring causes neuropathy and myopathy with degeneration of the nerves and muscles. Persistent snoring prevents healing of damaged nerves and muscles due to constant tissue vibrations. Muscle function to support airway patency becomes impaired. The risk for snoring increases with the following: Sedentary lifestyles, weak muscles, obesity, ageing, smoking, drinking alcohol before sleep, nasal allergy and congested nose, small narrow upper and lower jaws that are associated with a small airway. Listen out for family and friends who snore, it is a sign that they need medical help.

(** PHOTO CREDIT: Shutterstock)