Good sleep is critical to good health. But what if someone stops breathing for short pauses in the middle of the night, breathes shallowly, snorts, snores, gasps for air, or breathes infrequently? This is known as sleep apnoea and it could be contributing to a great number of health issues. Those disruptions through the night may last from 30 seconds to several minutes and may occur hundreds of times. This results in a lack of oxygen to all tissues, but this particularly includes the brain.
It can be tricky to diagnose, as there is no blood test for it. What’s needed is for someone to be sleeping in the same room to notice the snoring, gasping, snorting, and pauses through the night, in order to raise concern.
It occurs in two types, which differ in how serious they are, although both have major implications for health if untreated. Obstructive sleep apnoea is the most common form, with central sleep apnoea being less common.
Someone with obstructive sleep apnoea has an airway that becomes partially or fully blocked during sleep due to either excess weight, large tonsils compressing the area, or simply to anatomical defects. Central sleep apnoea on the other hand occurs when the part of the brain that handles breathing does not correctly communicate with the muscle required for breathing, resulting in pauses or infrequent breaths while sleeping. A combination of the two can occur but is not common,
In all cases the body receives less oxygen than it needs, and it responds by releasing the hormones involved with stress such as cortisol and adrenaline.
The increase in these hormones coupled with a lack of oxygen can put a person with sleep apnoea at higher risk for high blood pressure, heart attack, stroke, irregular heartbeats, and heart failure. These people often also wake up with a headache, are very tired, and experience brain fog through the day, due to this lack of oxygen and quality sleep.
Some people have sleep apnoea in a mild or even moderate form that might be quite subtle, in that their snoring or pauses doesn’t wake up others, yet they themselves wake feeling tired and unrested without knowing why. Others with more severe sleep apnoea are often told that their snoring sounds like a freight train, or their own gasping for air wakes them up, such that they feel like they were choking.
Doctors and researchers have described the recent continuous growth of sleep apnoea as an epidemic. It is well established in men, but is showing rapid increases amongst women and it is estimated to affect somewhere between 25% and 30% of adults, but often undiagnosed and untreated.
The key telltale sign is snoring. Sufferers may also gasp for air and choke briefly whilst sleeping, but have no recall of it when waking up. They will usually feel sleepy during the day, be tired, and as a result often irritable too.
Historically the main treatment for moderate to severe sleep apnoea has always been to keep the airway open via a mask. The CPAP mask and machine (continuous positive airway pressure) has been around since the early 1980’s and this is highly effective – but there are problems.
Patients often reject it for various reasons that include discomfort, dry mouth, noise disturbance, claustrophobia, and of course it doesn’t travel well.
This may involve removal of the adenoids or excess flesh, or be one of the recent pacemaker type of implants that place a generator in the upper chest which has an electrical stimulation lead to the neck to keep the airways open. This is usually only for those severe cases that reject CPAP.
Most sleep apnoea patients suffer worst when they lie on their back causing the tongue to fall back and obstructing the airway. The old method was a tennis ball sewn into the back of the pyjama jacket but special pillows are now available, both for users of oral appliances and CPAP users too.
Dental Appliance Therapy
Often called an Oral Appliance or mouthpiece, this treatment makes use of something called an M.A.D. (mandibular adjustment device) – a simple well fitting gum shield that is comfortable to wear and highly effective. They work by moving the jaw forward slightly, which then opens the airway; breathing is smooth and continuous, and snoring stops immediately.
This is by far the most popular and the easiest to use. It’s comfortable to wear, shapes itself to your dental profile and has proved effective in 98% of cases. It has the added advantage of being easy to take wherever you go – either away on business, or on the family holiday.
Quality mouthpieces are now highly recommended by the NHS for all who snore, and also for cases of mild to moderate sleep apnoea and they are now even proposed as a replacement for CPAP intolerance.