Positive Health Online

Sleep apnoea is a serious disorder which stops people’s breathing every few seconds during sleep and impacts between three and six per cent of the world’s adult population.

It is also associated with high blood pressure and arrhythmia, and increases the risk of stroke, heart attack and heart failure. So, without seeking medical advice and taking action to treat it, sleep apnoea can, in the long-term, be life-threatening.

https://en.wikipedia.org/wiki/File:Obstruction_ventilation_apn%C3%A9e_sommeil.svg

The number of tests carried out by NHS England to diagnose people with sleep apnoea has doubled in the past decade.[1] NHS Digital data also shows that the number of hospital admissions of children and teenagers with a primary diagnosis of sleep apnoea has shot up over the past four years.[2] In this article, I’ll outline a number of ways to tackle this increasingly widespread medical condition:

1. Surgery

If you have been diagnosed with sleep apnoea, your doctor will surely have told you the cause. If you haven’t yet been diagnosed, please see your doctor as soon as possible – the problem may be able to be fixed through surgery.

For adults, surgery is usually an option after other treatments fail. It’s recommended that other treatments are tried for at least three months before considering surgery. However, for people with structural problems in the jaw, surgery is a good initial option.

Nose-mouth-neck surgery is often required for children with large tonsils or adenoids that hinder the passage of air through the respiratory tract and result in sleep apnea. The goal of the surgery is to enlarge the airways through the nose or throat.

Surgical options may include the following:

• Septoplasty and Turbinate Reduction: The nasal septum is the dividing bone inside the nose that separates the nostrils, which, when deviated, can block the airflow.  Septoplasty is the procedure used to straighten the septum. Turbinates are the curved bones that are found in the walls of the nasal passages, which can obstruct the flow of air and contribute to sleep apnoea. By reducing its size, a wider airway is obtained;
• Maxillomandibular Osteotomy (OMM) and Maxillomandibular Advancement (MMA): These are the most effective treatments for severe sleep apnoea. The upper and lower jaws are moved to enlarge the airway and increase airflow. It’s a complicated technique that requires hospitalization;
• Implants: The insertion of plastic rods in the soft palate allows upper airways to remain tense without collapsing the respiratory tract. Other types of surgery can help reduce snoring and contribute to the treatment of sleep apnoea by clearing and enlarging the airways.

2. Continuous Positive Airway Pressure (CPAP) devices

CPAPs are the gold standard for treating moderate or severe sleep apnea. The process involves a machine that insufflates air under pressure through the nose to keep the upper airways slightly open when we sleep, stopping apnoeas and snoring.

Traditional CPAPs require a plastic tube about two meters in length that connects to a mask on the nose or mouth. Most CPAPs also require air humidifiers as applying continuous pressured air to the upper airways dries the nasal cavities.

As a sleep apnea suffer myself, using a CPAP helped to transform my life, allowing me to finally get a reasonable night’s sleep. However, the device is not without its downsides. Alongside the tube, traditional CPAPs are outdated, bulky, noisy, tabletop devices that require a plug connection, all of which make them unsuitable for travelling with.

Airmony has attempted to solve these problems and presented its new CPAP at the Medica 2018 trade fair in Düsseldorf. This modern take on the device does not require a tube to connect the machine, mask or humidifier. Patients can also choose between different models of adjustable masks to best suit their profile.

Airmony’s CPAP was designed to be easier to use and without having so many negative side effects.

3. Other Assistive Breathing Devices

There are some devices that can automatically modify the air pressure for each user when they sleep.

• Expiratory positive airway pressure (EPAP) devices are a lot more discreet than traditional CPAP devices. These single-use, disposable devices attach to your nostrils to keep your airways open but are ineffective for even moderate cases of sleep apnoea.
• Bilevel Positive Airway Pressure (BiPAP) devices are like CPAPs, but more suited for people who need high pressure to support their breathing. BiPAPs have two pressure settings: both for inhaling and exhaling.
• Adaptive servo-ventilation (ASV) devices are a bit more intuitive – they record data on your normal breathing patterns, using an algorithm to regulate your breathing during sleep.

4. Other Devices

• Mandibular advancement/repositioning devices are essentially gum shields worn during sleep to hold your jaw and tongue forward, increase the space at the back of your throat and allow for better breathing. A similar result can be achieved with tongue retainer, but such devices are not effective treatments for moderate-to-severe cases of sleep apnoea. Also, wearing these devices can be sore and uncomfortable and, in the long-term, can permanently shift the position of your jaw;
• Buccal devices are similar – they’re designed to push the jaw forward, keep the throat open and facilitate the entry and exit of air. These devices can relieve snoring and mild sleep apnoea and are recommended by some dentists when there is a bad position of the jaw;
• In the US, a pacemaker system that stimulates muscles to keep airways open during sleep has been developed. This could provide an interesting new solution to alleviating sleep apnoea but is suitable only for mild cases of sleep apnoea. It’s also likely to be some time before the system is available in the UK;
• Positive Expiratory Pressure (PEP) devices sit in the respiratory tract. These are small, disposable devices that are placed in each nostril before going to sleep. The device consists of a valve that allows air to enter freely when you breathe in, but when you breathe out, the air is slowed down by passing through small holes in the valve. This increases the pressure in the airways to keep them open. This small device can help people with mild sleep apnoea to reduce snoring, but it is not an effective treatment for this condition.

5. Electrical stimulators:

Hypoglossal Nerve Stimulator – this technique involves the subcutaneous implantation of a sensor-connected stimulator similar to a pacemaker in the anterior chest area. The sensor cable is inserted through a small incision into the wall of the chest where it detects respiration.

The sensor then sends a signal to the stimulator and, through a cable, emits an electric stimulation to the hypoglossal nerve. This way, the muscles of the base of the tongue and the palate are stimulated forward, opening the airway and facilitating normal breathing.

The activation of the device is performed by the patient through a command each night before sleep. After 30 minutes, the device starts to act.

6. Health and Lifestyle

Many factors can exacerbate sleep apnoea, including those associated with an unhealthy lifestyle. Even if changing your lifestyle doesn’t cure your sleep apnoea, it can certainly make it a lot more bearable.

It’s well known that smoking is bad for circulation and for breathing in general – it causes dry mucous membranes and denaturation of tissues, worsening obstructive sleep apnoea. Quitting the habit is essential for sleep apnoea sufferers. Add the fact that nicotine is a stimulant and you can see why it doesn’t promote good sleep.

Alcohol is also known to disrupt sleeping patterns. As it relaxes your muscles, drinking in the evening is not a great idea for those with sleep apnoea – sufferers already struggle with their throat muscles relaxing and obstructing breathing! The same is true of sleeping tablets and sedatives.

Obesity can also exacerbate sleep apnoea. So, reaching a healthy weight can lead to remarkable improvements – the most obvious route to this is more exercise – yoga in particular – which promotes sleep, muscle flexibility and improved circulation.

Exercising periodically can help relieve sleep apnoea symptoms. Just 30 minutes of moderate activity, such as walking a few days a week, can work wonders.

Even a slight loss of excess weight can help relieve the constriction of the throat and sleep apnea can be completely reversed in some cases if you regain a healthy weight. However, it may return if you regain weight.

Avoiding caffeine in the afternoon along with bright screens and heavy meals in the evening will all help to improve sleep. Using a saline nasal spray will keep your nasal passages open, while decongestants or antihistamines can be used when there’s another illness associated – such as a cold.

Finally, sleeping on your side or on your stomach is preferable to sleeping on your back, as the latter causes your tongue and soft palate to rest in the back of your throat and block the airway.

To avoid sleeping on your back, try sewing a tennis ball to the back of the pajamas and the discomfort will cause your body to naturally adopt a different position. It sounds nonsensical, but it really works!

References and Citations

1. The number of tests carried out by the NHS England to diagnose people with sleep apnea has doubled in the past decade, NHS figures show:   https://www.bbc.co.uk/news/uk-england-40122979 

2. Data from NHS Digital shows that the number of hospital admissions of children and teenagers with a primary diagnosis of sleep apnoea has shot up over the past four years:

https://www.theguardian.com/society/2018/mar/17/sleep-apnoea-children-teenagers-admitted-hospital-uk