Sleep apnoea

Sleep apnoea otherwise known as Obstructive Sleep Apnoea (OSA), is a sleep disorder that
involves a significant decrease in airflow in the presence of breathing effort or cessation.
(Wickramasinghe, 2020) Sleep apnoea is the most common type of sleep- disordered
breathing and is characterised by recurrent episodes of the upper airway collapsing during
sleep. These episodes are in turn associated with low oxygen levels in your blood and
arousals from sleep. OSA that is associated with excessive daytime sleepiness is commonly
called obstructive sleep apnoea syndrome. Sleep apnoea is a potentially serious sleep disorder
in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a
full night's sleep, you might have sleep apnoea.

The main types of sleep apnoea are:

- Obstructive sleep apnoea (OSA), which is the more common form that occurs when
throat muscles relax and block the flow of air into the lungs.
- Central sleep apnoea (CSA), which occurs when the brain doesn’t send proper signals
to the muscles that control breathing.
- Treatment-emergent central sleep apnoea, also known as complex sleep apnoea,
which happens when someone has OSA, then converts to CSA when receiving
therapy for OSA.

Symptoms

The symptoms of obstructive and central sleep apnoea’s overlap, sometimes making it
difficult to determine which type you have. The most common symptoms of obstructive and
central sleep apnoea’s include:

 Loud snoring.
 Episodes in which you stop breathing during sleep — which would be reported
by another person.
 Gasping for air during sleep.
 Snorting or choking
 Awakening with a dry mouth.
 Morning headache.
 Difficulty staying asleep, known as insomnia.
 Excessive daytime sleepiness, known as hypersomnia.
 Difficulty paying attention while awake.
 irritability
Causes

Figure 1 obstructive sleep apnoea.

Obstructive sleep apnoea

This type of sleep apnoea happens when the muscles in the back of the throat relax. These
muscles support the soft palate, the triangular piece of tissue hanging from the soft palate
called the uvula, the tonsils, the side walls of the throat and the tongue. When the muscles
relax, your airway narrows or closes as you breathe in. You can't get enough air, which in
turn, lowers the oxygen level in your blood. Your brain senses that you can't breathe, and
briefly wakes you so that you can reopen your airway. This awakening is usually so brief that
you don't remember it. (Mayo Clinic)

Central sleep apnoea

This form of sleep apnoea occurs when your brain fails to send signals to your breathing
muscles. This means that your brain, lungs and heart make no effort to breathe for a short
period of time. You might awaken with shortness of breath or have a difficult time getting to
sleep or staying asleep. (Mayo Clinic)

Who does this affect?

About 1 in 4 men in Australia have obstructive sleep apnoea, significantly affecting

overweight or obese people and adult men 40 years of age or older. Men are also 2-3 times
mor likely to have sleep apnoea then are women. However, women increase their risk if their
overweight or are going through menopause. Being older also increases your risk of having
sleep apnoea, with it being significantly more likely for people over 45. (Mayo Clinic)

Effects on the respiratory system and brain

Sleep Apnoea is considered a sleep disorder as it affects you during sleep rather than all the
time. Although, a respiratory disease is simply a disease involving the respiratory system,
including the lungs. With this disorder, your breathing is interrupted while you sleep, for up
to 30 seconds or even longer at a time. This can happen all night, causing as many as
hundreds of disruptions to your breathing and sleep. The result is that your brain and body
can lack proper oxygen levels and you lose sleep, which is important to health. (Repasky) No
oxygen is therefor able to be diffused into the bloodstream which in turn triggers nerve
receptors in your brain that tells you that you need to wake up.

Treatment

For milder cases of sleep apnoea, your health care provider may recommend only
lifestyle changes, such as losing weight or quitting smoking. You may need to
change the position in which you sleep. If you have nasal allergies, your provider
may recommend treatment for your allergies. If these measures don't improve your
symptoms or if your apnoea is moderate to severe, a number of other treatments are
available. Certain devices can help open a blocked airway. In other cases, surgery
might be necessary. (Mayo Clinic)

If you have moderate to severe obstructive sleep apnoea, you may benefit from
using a machine that delivers air pressure through a mask while you sleep. If the
differet masks aren’t helping with sleep improvement, surgery may have to be the
next option. (Mayo Clinic)

Surgical options might include:

- tissue removal. A surgeon removes tissue from the rear of your mouth and the
top of the throat in order to clear the airway.
- Tissue shrinkage- Another option ius to shrink the tissue at the rear of the
mouth and back of the throat using radiofrequency ablation.
- Jaw repositioning. In this procedure, the jaw is moved forward from the
remainder of the face bones. This enlarges the space behind the tongue and
soft pallet, making obstruction less likely.
Financial and life costs

Figure 2 sleep apnoea

Financial costs-
The sleep heath foundation did a study where they concluded that over 51 billion dollars per
annum, was going into the Australian economy with combined direct and indirect costs of
sleep disorders. (Rajaratnam).
A study conducted in the United States showed that compared to those without sleep apnoea,
those reporting past year sleep apnoea had a 95% Confidence Interval, increased odds of
having depression, increased odds of suicidal ideation, increased odds of anxiety, and 95%
times increased odds of severe psychological distress. Among those with each psychiatric
outcome, individuals with sleep apnoea were substantially more likely to report unmet need
for mental health care, despite reporting greater mental health service use. (Kaufmann et al.)

Support groups-
There are a range of support groups available online for people in Australia struggling with
sleep apnoea, as well as clinic and organisations working towards finding the best solutions
to help spread awareness and raise money for extra support for those who are struggling.

Scientific research-
There are scientific studies and research, working constantly to help find better solutions to
help those with sleep apnoea. An organisation only late 2022 had a breakthrough with a sleep
apnoea treatment that works within the body while the patient sleeps by monitoring the
patients breathing and delivering mild stimulation to open the airway.

Reference:
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https://emedicine.medscape.com/article/295807-overview#:~:text=Obstructive%20sleep
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