Obstructive Sleep Apnoea (OSA)
The most common condition requiring treatment is Obstructive Sleep Apnoea (OSA) which is a type of snoring associated with stopping breathing during sleep. All sufferers from OSA were once pure snorers who have worsened with age! Sufferers from snoring and OSA do NOT wake themselves up because of the noise they are making. They wake because of the reduction in the quality of their breathing which results from the snoring and apnoea.
Often, sufferers do not wake from sleep completely, but are repeatedly aroused into very light sleep which is inadequate. This can happen in both sleep apnoea and in snoring. This causes a lack of morning refreshment and daytime sleepiness in both patients and their bed partners (how well do you sleep?). OSA lies at the end of a spectrum of snoring which has become increasingly worse through adulthood. The typical patient with OSA is overweight, under exercised and leads a sedentary lifestyle at work and home. OSA matters for two reasons social consequences and health consequences.
OSA disrupts the household, disturbs and worries bed partners. Many couples regularly sleep in separate rooms due to the disruption, and even neighbours have been known to complain! Sleeping apart does nothing to maintain the important bond in any relationship, and the night times become increasingly fraught with an increased incidence in breakdown of the relationship.
Daytime fatigue from disrupted sleep at night gives way to frank sleepiness during the day as measured by the Epworth Sleepiness Scale. Sufferers feel tired and lack motivation, and there is ‘less doing and more sitting’ at the weekends when not working. One partner recently summed the situation up when she said “his get up and go has got up and gone!” Most sufferers say that they cope well when they are doing things and concentrating, for example at work, but that they tend to go to sleep when they are sitting or inactive. Many sneak a quiet snooze during work breaks, and some simply cannot stay awake even during that important board meeting!
Driving and Sleep Apnoea
The most serious social consequence is the increased risk of road traffic accidents from lack of concentration and sleepiness when driving. It is a serious criminal offence to drive when sleepy leading to a lengthy term of imprisonment if convicted of causing harm, and there are specific guidelines produced on medical conditions by the Drivers and Vehicle Licensing Agency (DVLA). Diagnosed OSA should be notified to the DVLA by law.
OSA is associated with medical complications such as high blood pressure, Type II Diabetes and disturbance of cholesterol metabolism (collectively called Metabolic Syndrome) which greatly increase the risk of developing heart disease and strokes. Treating sleep apnoea reduces these risks significantly.
The IDF estimates that a quarter of the population of the world have metabolic syndrome, and they are three times more likely to have a heart attack and five times more likely to develop adult (Type II) diabetes as a result. Diabetes is itself a major risk factor for cardiovascular disease and premature death.
The IDF latest definition of metabolic syndrome comprises:
- Waist circumference of 94cms (39 inches) or more in men.
- Waist circumference of 80cms (33 inches) or more in women.
Together with two of the following factors:
- Raised triglyceride levels in the blood of 1.7mmol/L or more – or on treatment for this abnormality.
- Reduced high density lipoprotein (cholesterol) in the blood of 1.03mmol/L or less in men – or on treatment for this.
- Reduced high density lipoprotein (cholesterol) in the blood of 1.29mmol/L or less in women – or on treatment for this.
- Raise systolic blood pressure of 130mmHg or more, OR raised diastolic blood pressure of 85mmHg or more OR currently normal BP but on continued treatment for previously raised BP.
- Raised fasting blood sugar levels of 5.6mol/L during fasting (without food) or known adult diabetes on treatment.
If you fit these criteria, and you snore or stop breathing at night, it is essential that you get a referral to a physician who can investigate you properly – including assessing your breathing at night.
You should definitely seek medical advice if you suffer from some of the following:
- Stopping or struggling to breath when sleeping
- Heavy snoring
- Weight gain over your adult life (especially in the belly region)
- Increased collar size as an adult approaching 17 inches or more
- High blood pressure and adult diabetes
- Excessive tiredness or sleepiness in the daytime
- Declining motivation in life