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Health and Wellbeing

What is Sleep Apnoea?

Dr Nerina Ramlakhan

Dr Nerina Ramlakhan

9th May, 2024

man sleeping with a CPAP machine

Do you know that, on average, we breathe around twenty to twenty-five thousand times per day? Your breath and your lungs are incredibly vital to your optimal functioning and sleep. But what happens if your sleep is disrupted? As a sleep expert I am often asked about sleep apnoea so in this blog I want to help you to understand what this condition is all about as well as providing some practical solutions for dealing with it and maybe even overcoming it.

What is sleep apnoea?

First of all, let’s start with the important question of what sleep apnoea actually is. This condition is when your breathing stops and starts while you sleep. The most common type of sleep apnoea is called obstructive sleep apnoea (OSA). It has earned its name due to the airways collapsing while you sleep, so when you breathe, the tissues of the airways vibrate (which causes snoring) and impede the flow of air.

Symptoms of sleep apnoea tend to occur mainly while you sleep and include stopping and starting breathing, frequent waking, gasping and choking noises during sleep and loud snoring. Those who have several sleep apnoea episodes per night can end up feeling exhausted, unable to focus, emotionally off balance and they might suffer from headaches.

Sleep apnoea can be hard to diagnose, and it is usually the person sleeping beside you who, not surprisingly, becomes worried and alarmed by these symptoms and then tells you about it.

The long-term implications of having untreated sleep apnoea can be severe and include high blood pressure, inability to focus and increased risk of accidents, increased risk of having a stroke, type 2 diabetes, heart disease, chronic fatigue, and mental health problems such as depression. The effects of sleep apnoea are not just on your health and wellbeing, they can impact your relationship with your partner and their sleep and health too.

It is important to see your GP to get a referral to a specialist clinic for assessment and then a treatment plan in place if your condition is severe. The severity of your condition will be determined by the number of episodes of sleep apnoea that you experience in one hour while you sleep. This is called the Apnoea Hypopnoea Index (AHI):

  • Severe obstructive sleep apnoea means that your AHI is greater than 30 (more than 30 episodes per hour)
  • Moderate obstructive sleep apnoea means that your AHI is between 15 and 30
  • Mild obstructive sleep apnoea means that your AHI is between 5 and 15
man in bed with a sleep mask on and snoring with his mouth open.

What causes sleep apnoea?

Sleep apnoea is caused by narrowing of the breathing airways while you sleep which, in turn, can be caused by a number of factors. These include:

·  being overweight and having a large neck and shirt collar size over 15.

·  getting older (although children and young people can also get it).

·  genetics – having other family members with sleep apnoea could mean that you have a predisposition.

·  dehydration caused by high caffeine, alcohol and not drinking enough water.

·  smoking – this causes airways to constrict and increase lung dead space or the volume of the lung tissue that is not available for gas exchange.

·   having a condition called coronary obstructive pulmonary disease (COPD

Treatment of sleep apnoea

If you have a diagnosis of severe sleep apnoea you may have to wear a device called a CPAP (continuous positive airway pressure) machine which is available for free on the NHS. Ideally, every night the device is worn over your face as you sleep, and it provides air at a pressure that is just high enough to prevent the collapse of your airway. Understandably, this can feel uncomfortable and unwieldy to start with and the noise produced by the machine can take some getting used to, especially for your bed partner. Thankfully, most people report that they eventually get used to wearing it and the technology is evolving so that the machines are now smaller, more comfortable to wear and quieter.

More recent developments in treatment include a less intrusive device provided by a dentist. Mandibular advancement devices (MADs) are also called mandibular advancement splints, or mandibular repositioning appliances. They work by pulling your lower jaw (mandible) forward which in turn opens the airways and enables more easeful breathing. Surgery can also be undertaken to remove large tonsils – again to facilitate breathing. These forms of treatment are thought to be less effective than wearing CPAP machine, but it depends on the severity of your symptoms and each individual is different.

Proactive measures

If you have been diagnosed with sleep apnoea that is not severe, you could really benefit from taking proactive action which, in the long term, could reduce your need for the medical interventions described above. However, even if you suffer from severe sleep apnoea and are wearing a CPAP every night, you could still benefit from the following:

Seek support for giving up smoking

It has been shown that smokers are three times more likely to have obstructive sleep apnea.  Smoking can affect the upper airways by increasing inflammation and fluid retention.

Lose weight and take regular exercise

Being active can help you breathe more efficiently and even strengthen your lung airways.

Optimise your rest and sleep quality and avoid taking sleeping pills

These can worsen sleep apnoea. This means getting into good habits and for more on how to do this please check out my blog – https://drnerina.com/5-ways-to-get-better-sleep/.

Minimise caffeine and alcohol

Both are diuretics that cause more fluid loss from the body and dehydration. Dehydration can cause the airways to become flaccid and more prone to collapsing while you sleep. Aim to drink, throughout the day, around 8 glasses of water. Adding a pinch of pure sea salt to your water helps to optimise the hydration process.

Improve sleep posture

 Avoid sleeping on your back and opt for sleeping on your side. This minimises airway collapse. Some people find it helpful to tape a tennis ball to the back of their pyjamas, or to use a special pillow or bed wedge that helps to keep them on their side.

woman sitting on a bed with her eyes closed doing breathing exercises.

Finally, and this one is really important, rather than losing hope, work on optimising your breathing. I highly recommend that you explore, with a good yoga teacher, exercises called pranayama that enable you to strengthen your lung airways and breathing patterns. Additionally, the pioneering work of leading international breathing expert Patrick McKeown has made amazing advances in the treatment of various health conditions including sleep apnoea. To learn more about this and his work I recommend his book The Oxygen Advantage (Piatkus, 2015) and watching this fascinating clip:


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