New Guidelines for treating Obstructive Sleep Apnoea (OSA)

If you already suffer from sleep apnoea, or think that you or your partner may have this dangerous problem, and it remains undiagnosed for whatever reason, then the new rules that have been issued in the United States will have some real meaning for you.

The American College of Physicians (ACP) has published new clinical practice guidelines regarding the management and treatment of OSA in adults. It deals with the known detrimental effects of the problem, and discusses the limitations of the various available treatments. These findings endorse those of the AASM – the American Academy of Sleep Medicine but take recommendations further.

As ever, the USA is ahead of the UK in dealing with this huge problem, partly because it is so much more widespread in the community there. Much of this can be linked to obesity, a major problem in the USA, and which is rapidly becoming so here due to changes in our diet, lower exercise levels in youth, and sedentary occupations now being the largest group by far versus manual workers. Alcohol also often plays a significant role in the equation – mostly due to the high calorific intake and the effect that alcohol can have on sleep hygiene.

What is OSA?

OSA disrupts breathing during sleep, and this is usually as a result of the muscles and soft tissues in the throat relaxing and collapsing to block the airway. It can last for about 10 seconds or even more. It affects people of all ages, but particularly those of us in middle age, and particularly the elderly.

However, we believe that around 80% of cases remain undiagnosed. OSA is easy to treat but when left undiagnosed and untreated, is linked with a range of serious health concerns that include heart disease and stroke, diabetes and high blood pressure, called hypertension. Fatigue becomes a huge problem too.

Current approved treatments for OSA and sleep disordered breathing

OSA is a chronic medical disorder that requires immediate action, but also requires long term, and often lifelong. therapy. Obviously a healthier lifestyle will come high on the list from any GP but this will not stop the problem of your snoring immediately, and sometimes does not succeed at all.

As well as recommending weight loss in overweight and obese patients, it recommends and approves the following treatments as it is recognised that weight-loss intervention alone will not achieve the desired objectives.

Medical Treatments and Clinical Recommendations for OSA

CPAP Mask wearer

  • Continuous Positive Airway Pressure (CPAP) is recommended for more serious sufferers but it is readily identified that many patients reject this treatment for various reasons, particularly having to wear a mask for such long periods of time, claustrophobia, having a dry mouth, or the associated discomfort of the mask amongst others.
  • It is still however strongly recommended for chronic sufferers if acceptable.

Sweet dreams

  • Mandibular Advancement Devices (MAD’s or Splints) are fully recommended as a primary treatment route and a strong option in many cases versus CPAP. They are more readily accepted than masks and have many distinct advantages over them including, ease of wear, instant results, high rates of effectiveness and also being inexpensive by comparison – even bespoke mouthpieces or the now available self-fit versions which are highly adjustable compared to the standard oral appliance – although this may be the best starting point.
  • Strongly recommended by ACP for less severe versions of OSA.

Snoring Surgery

  • Surgery however is not listed in the ACP’s summarized recommendations, but the guideline does specifically discuss its role as a treatment for OSA. It highlights that surgical procedures, which are intended for sleep-disordered breathing, are not as effective as either CPAP or using MAD’s. Currently success rates vary greatly and can be as low as 20%, as well as it sometimes requiring several procedures.
  • Not currently recommended by ACP to American Physicians.

More and more clinics, doctors and hospitals in the USA now recommend using oral appliance technology in the form of a mouthpiece to be used when sleeping and this is now becoming more accepted as a route here in the UK, particularly now that higher quality MAD’s are NHS Approved.

By John Redfern

 

 

 

 

 

 

 

 

 

 

 


Snoring mothers-to-be are linked to low birth weight babies

The British Press have covered this subject extensively this week based on the results of a new research study that has just been completed in the United States. The research was published in the journal ‘Sleep’.

Snoring can be more than just an annoyance to others who are trying to sleep in the same room. For pregnant women, snoring could indicate certain higher risks. Experts say that snoring may be a sign of breathing problems that could deprive an unborn baby of oxygen.

Snoring is often a key sign of obstructive sleep apnoea, which results in the airway becoming partially blocked, said the researchers, whose findings appear in the journal Sleep. This can reduce blood oxygen levels during the night and is associated with serious health problems, including high blood pressure and heart attacks. The experts stress sleep apnoea can of course be easily treated.

The study found that chronic snorers, who snored both before and during pregnancy, were two thirds more likely to have a baby whose weight was in the bottom 10%.

Newborn baby girl sleeping

They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Dr Louise O’Brien, from the University of Michigan’s Sleep Disorders Centre, said: “There has been great interest in the implications of snoring during pregnancy and how it affects maternal health but there is little data on how it may impact the health of the baby.

“We’ve found that chronic snoring is associated with both smaller babies and C-sections, even after we accounted for other risk factors. This suggests that we have a window of opportunity to screen pregnant women for breathing problems during sleep that may put them at risk of poor delivery outcomes.”

Previous research has already shown that women who start to snore during pregnancy are at risk from high blood pressure and the potentially dangerous pregnancy condition pre-eclampsia.

More than a third of the 1,673 pregnant women recruited for the new US study reported habitual snoring. They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Scientists found that women who snored in their sleep three or more nights per week had a higher risk of poor delivery outcomes, including smaller babies and Caesarean births.

The very worst cases of sleep apnoea can be treated with CPAP (continuous positive airway pressure), which involves wearing a mask attached to a machine during sleep, which pumps oxygen to keep the airways open. Most other forms of sleep apnoea can be treated with the wearing of a simple snoring mouthpiece, similar to a gumshield that is worn for sports.

Dr O’Brien added: “If we can identify risks during pregnancy that can be treated, such as obstructive sleep apnoea, we can reduce the incidence of small babies, C-sections and possibly NICU (neo-natal intensive care unit) admission that not only improve long-term health benefits for the newly born but also help keep costs down.”

By John Redfern


Snoring can cause Women to put on weight

Lack of sleep affects food choices and if you don’t sleep well it can cause you to choose more high-calorie foods. So, not only does being overweight cause you to snore, it would appear that snoring causes you to gain weight too.

It’s obviously normal for a poor night’s sleep to affect you the next day and make you feel tired; if it’s a constant problem then it could have some wide-ranging effects on your health.

Several studies have suggested that a lack of sleep can increase the chance of weight gain and obesity. It may be that a lack of sleep affects hormones that help control our appetite, that people eat more calories to make up for the tiring effects of lost sleep, or that people who stay up late tend to sleep less overall and eat more calories during their extended waking hours.

Snoring and Weight gain

However, these are mostly theories, as few good-quality studies have explored the link between sleep, eating, and weight gain. To help fill this gap in what we know, researchers recruited 225 healthy, non-obese people (aged 22 to 50 years old) to live in a sleep laboratory for 12 to 18 days.

They randomly selected participants to have five nights of either:
Restricted sleep, with four hours in bed, from 4 a.m. to 8 a.m., or
Unrestricted sleep, with 10 hours in bed, from 10 p.m. to 8 a.m.

During the day, people had regular meals and could also eat at other times, as food was always available in the kitchen. What food they ate and their weight were closely monitored, so the researchers could compare the two groups to see whether restricted sleep increased the chance of weight gain.

What did we learn?
People who had restricted sleep consumed more calories than those who had unrestricted sleep.
All of the extra calories – around 550 per day on average – were from food consumed between 10 p.m. and 4 a.m.
When eating late at night, people also got more of their calories from higher fat foods than at other times of the day.
On average, people with restricted sleep gained nearly a kilo of weight, while those with unrestricted sleep gained only one-tenth of a kilogram.

How reliable is the research?
This was a good-quality study. However, it’s worth noting it only included people who were healthy, fairly young, and not obese. So it’s not clear whether these findings will definitely apply to other groups of people. Also, the participants weren’t able to exercise during the study and might not have had access to all the foods they usually ate. These things might have had an effect on the findings.

What does this mean for me?
It provides good evidence that restricted sleep can increase how many calories you eat and leads to weight gain, at least in the short term. If you tend to stay up late and/or get little sleep, it may be especially pertinent to you as after 10 p.m. was when people typically got their extra calories, rather than during the day.

By John Redfern


Snoring, sleep apnoea, and sleep loss in women

Snoring, and sleep apnoea in particular, were both generally considered to be conditions predominantly affecting men but we now know this not to be the case, with the ration of men to women estimated at approximately 2:1. Since sleep apnoea is mainly a problem that is self-reported , men were more likely to seek help for this and heavy snoring, even if prompted to do so by their partner.

Approximately 50% of women snorers are believed not to report their symptoms to their GP, mostly due to being embarrassed. Some studies show that as many as 90% of more severe cases go undiagnosed in women, and women have a tendency not to report apnoea events, choking or restless sleep, whereas most men did report these matters.

Treatment however can be both simple and inexpensive and it can prevent major health problems in later life. Sufferers are often put off by the thought that the treatment most used historically was CPAP, where air is forced via a mask into the lungs throughout the whole night. More recent thinking is to recommend the use of an oral appliance for mild and moderate cases of sleep apnoea.

Sleep apnea in womenComparison showing Continuous Positive Airway Pressure (CPAP and an Oral Appliance (MAD)

The contrast is shown in the photography above where one patient is using a mask

for CPAP and the other an oral appliance – just distinguishable in the inset, with the result that this method is now much more appealing to those who suffer – both men and women. This treatment, although not quite so effective, works very well.

Snoring often results in a disturbed night and it is very common to hear a comment such as – “I barely slept last night. I just couldn’t get comfortable” – or – “I tried to fall asleep, but my mind kept racing.”

Sleep, and the lack of it, is a common talking point, and disturbed sleep generally is much more common in women than men. A woman’s experience of sleep loss is different and sometimes feminine factors are involved that may cause and maintain sleep difficulties. However, focusing on quality sleep is important to help prevent many aspects of both physical and mental health.

Disruption of sleep leads not only to daytime sleepiness, but memory lapses, weight gain, headaches, irritability and poor work performance overall. It can also contribute to psychological disorders such as depression and for the more severe cases, there’s an increased risk of high blood pressure, premature heart disease and stroke.

It’s not an area to neglect.

The best solution is an approach on several fronts including exercise, reduced alcohol consumption, healthy eating and treatment for the sleep apnoea or heavy snoring which will stop the snoring immediately whilst other things take time.

There are several treatment solutions including surgery, CPAP (Continuous Positive Airways Pressure) a full-face mask which works by stopping the airways from collapsing, or a mandibular advancement device, like a sports mouth-guard, that holds the lower jaw slightly forward, making more space to breathe.

Many women now opt for the mouthpiece. It’s easy to wear, quite comfortable, non-claustrophobic unlike the mask, and doesn’t create dryness of the mouth, which CPAP has a tendency to do. Mouthpieces are easily acquired as they are non-prescription, but some are NHS Approved, which is preferable, and they will bring you immediate results.

SleepPro now have a special product in their range dedicated to women only – the only oral appliance technology company to do so.

By John Redfern


Sleep Apnoea and Snoring: What's the Difference?

Sleep apnoea is a disorder that is characterized by abnormal pauses in breathing (apnoeas) or abnormally low breathing during sleep. These apnoeas can occur due to a lack of respiratory effort, due to a physical blockage to airflow, or a combination of both. Obstructive Sleep Apnoea (OSA) is the most common type of apnoea and occurs where there is a physical blockage of airflow.

Individuals with OSA are rarely aware of having difficulty breathing. In fact, the person’s sleeping partner or someone that sleeps in the same room often recognises the problem. Patients suffering from OSA often feel very tired during the day and report daytime sleepiness, which they often become used to. It is not unusual for a patient with sleep apnoea to take naps during the day, fall asleep watching television or sitting in a car, or fall asleep while talking to someone. Sleep apnoea can also affect your work performance, vigilance, motivation and other behavioural or cognitive effects.

Snoring, on the other hand, is caused by the vibration of respiratory structures due to obstructed air movement during breathing while sleeping. This is often caused by the uvula (the tissue that hangs down in the back of your throat), an elongated soft palate, a large tongue or obstructions in the nasal area.

Statistics on snoring suggest that as many as 50 per cent of adults snore, while as many as one in 20 of us are affected by sleep apnoea. While someone who snores may also suffer from sleep apnoea, not all patient with sleep apnoea snore. This means that even though you do not snore, it does not mean that you do not have sleep apnoea.

If you suffer from daytime sleepiness and fatigue, and don’t feel refreshed in the morning after a good night’s sleep, you should probably consider getting medical advice. You may be advised to go to a sleep centre, where you will sleep overnight while you are connected to a variety of devices that will monitor your body functions. These include brain activity, eye movements, muscle activity, heart rhythm and oxygen saturation. An alternative to this is to take a home testing device, which will also monitor certain of your body functions, but in the comfort of your own home and bed.

Treatment options for persons suffering from snoring and obstructive sleep apnoea vary a great deal, from quite conservative treatment to invasive surgical treatment. Treatment for snoring includes positive airway pressure devices (CPAP), dental appliances (MAD) and surgeries that are customized to best address your quite individual needs.

There are many treatment options for patients with obstructive sleep apnoea. The first one is called Continuous Positive Airway Pressure device (CPAP), which is a machine that keeps the patient’s airway open during sleep by delivering a continuous flow of pressurized air into the throat. Another option is to use Oral Appliance Therapy (OAT), where a custom-made mouthpiece shifts the lower jaw forward, thereby opening the airway.

If you suspect that you suffer from snoring or sleep apnoea, the first step to take is to schedule an appointment with your GP or a sleep specialist who will perform a comprehensive examination and perhaps a sleep study. Once your doctor reviews your sleep study, your treatment plan can then be customized to address your condition and specific needs.

The outcome is often simple – a dental mouthpiece can minimise your snoring and safeguard your health – but make sure to take qualified advice. The latest developments of mouthpiece even offer self-fitting adjustable devices (SFA) to improve anti-snoring performance and give much more comfort. Choose wisely.

Take a look at our YouTube video for more info!

By John Redfern