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

 

 

 

 

 

 

 

 

 

 

 


Sleep is the Cornerstone to Good Health – So You Must Stop Snoring

Part Two

Getting good quality sleep every night is imperative to both good physical and mental health. It is often said that restful sleep is the glue that keeps us functioning normally as human beings.

In this article, Sleep and Physical Health, I will describe the four specific consequences of sleep and physical health and my accompanying article will deal with four specific consequences of Sleep and Mental Health.

1. Sleep and Memory – Researchers have found that not getting enough sleep distracts the brain from focusing and being able to retain information. According to accepted authorities there are three parts to “making memories” – the acquisition phase, the consolidation phase, and the recall phase. While the acquisition phase and the recall phase happen while we are awake, it is believe that sleep is required for the consolidation phase of forming memories, or in other words, making facts or episodic-type memories stick. So, keeping late hours and “cramming” for a test as a student may not be the best strategy to performing well with recall. Better to make sure that a restful night of sleep is had before that big test.

2. Sleep and Learning – Similar to sleep and memory, it’s very difficult to learn new facts, ideas, or concepts without having first gotten adequate sleep. An interesting study was done with bees to illustrate the lack of ability to learn appropriately when not getting enough sleep. The bees’ sleep was interfered with, which caused them real difficulty in remembering experiences they had learned a day previous. It is widely accepted that this is the same with humans.

3. Sleep and Moods – All of us have experience the temper and bad mood of someone who has “woken up on the wrong side of the bed”. Lack of sleep causes irritability, and disorientation. Not getting enough sleep can cause individuals to become quite emotional. Sleep deprivation is tied to depression as well. In fact, those who are repeatedly awakened during the R.E.M. sleep state can become very angry. Extended periods of sleep deprivation can even cause hallucinations or delusions and even death in extreme cases, when it was used as part of certain types of ‘cross questioning’. It just makes sense that getting enough sleep can mitigate some of the stresses we face on a daily basis, and help to keep emotions and moods on a more even keel.

4. Sleep and Creativity and Imagination – Having good quality sleep on a consistent basis does lend itself to better creativity and imagination. The phrase “sleep on it” is actually very sound advice. During sleep our subconscious can go to work to help us solve problems. Often dreams can provide insight that we hadn’t considered during waking hours. Dreams are often the product of our imaginations, wrapped together with portions of true experience. There is an interesting BBC article covering notable examples of “dream discoveries”. Get your sleep and create something wonderful! Look out for it soon in our March Newsletter – 5 Dream Discoveries.

Some of the reasons for sleep are plain common sense, while others have yet to be discovered. For now though, there’s plenty of evidence to suggest that getting 7-8 hours of sleep per night (for adults) is the best recipe for good, sustainable health and longevity.

As we know of course, most disturbed nights are caused by someone snoring – both partners actually having a disturbed night, but for different reasons. This is so easy to prevent and with little cost. A range of NHS approved remedies from SleepPro, such as their high quality but inexpensive mouthpieces will soon solve the problem. They have a record of working well, do it quickly and are a low cost solution that is readily and quickly available without prescription.

However make sure that you keep in touch with your GP or local Clinic because they’ll give you good advice on how to stop snoring and check out if it’s caused you any health problems.
By John Redfern