Sleep apnoea: signs, causes, sleep tests and treatment, a review

Many people snore, but loud snoring with pauses in breathing can be a sign of a sleep condition that needs medical attention. This article explains obstructive sleep apnoea, which is also spelled sleep apnea, including its signs, causes, tests and treatment. It uses information from the NHS, MedlinePlus and the US National Heart, Lung, and Blood Institute (NHLBI).

1. Introduction

Sleep apnoea is a common disorder in which breathing repeatedly pauses and starts again during sleep ^{[1, 2, 3]}. Each pause can last from a few seconds to minutes, and MedlinePlus says it can happen 30 or more times an hour ^[2]. The pauses can leave the body short of oxygen ^[3].

There are two main types. Obstructive sleep apnoea (OSA) is the most common. The upper airway repeatedly narrows or becomes blocked during sleep, which cuts down or stops airflow. Central sleep apnoea is less common. In it the brain does not send the right signals to drive breathing ^{[2, 3]}. The rest of this article is mostly about OSA.

2. Signs and symptoms

Many night-time signs are easy to miss, so a partner or family member who watches you sleep can help spot them ^[1]. The NHS lists these signs ^{[1, 2, 3]}:

During sleep

• Loud snoring. MedlinePlus notes that not everyone who snores has sleep apnoea ^[2].
• Pauses in breathing, often followed by gasping, snorting or choking
• Waking up often

During the day

• Constant tiredness and excessive daytime sleepiness
• Trouble concentrating
• Mood changes
• Morning headaches

3. Causes and risk factors

OSA happens when the airway narrows too much during sleep, which stops normal breathing ^[1]. Factors that raise the risk include ^{[1, 2, 3]}:

• Being overweight or obese, and having a large neck
• Older age, although children and young adults can be affected too
• A family history of sleep apnoea
• Drinking alcohol and smoking
• Having a naturally small airway
• Enlarged tonsils or adenoids (glands at the back of the nose and throat), which can affect children
• Sleeping on your back
• Lung disease such as COPD
• Being male, and hormonal changes

4. Diagnosis and tests

If your doctor suspects sleep apnoea, they may refer you to a specialist sleep clinic ^[1]. MedlinePlus explains that doctors combine your medical and family history, a physical examination and the results of a sleep study ^[2]. A sleep study can be done at home or in a sleep centre. You wear devices that record your breathing and heart rate overnight ^{[1, 2]}. NHLBI says a sleep study may be used to confirm the diagnosis ^[3].

The NHS explains that results are scored with the apnoea-hypopnoea index (AHI), which is based on how often your breathing stops while you sleep. A score of 5 to 14 is mild, 15 to 30 is moderate and over 30 is severe ^[1].

5. Treatment and management

Treatment depends on how severe the condition is, and your doctor decides what is best for you. The main options are ^{[1, 2, 3]}:

• Lifestyle changes. Losing weight if you are overweight, stopping smoking and drinking less alcohol can help, and the NHS says they may be enough for mild cases ^[1].
• CPAP. This stands for continuous positive airway pressure. A small machine blows steady air through a mask worn over the nose, or nose and mouth, to keep the airway open. The NHS says many people need one, that it works best when used every night, and that you should tell your doctor if it is uncomfortable ^[1].
• Mouth devices. A device like a gum shield, called a mandibular advancement device, can hold the airway open while you sleep ^{[1, 2]}.
• Surgery. In some people, for example to remove large tonsils, surgery can improve airflow. Other options include a device that stimulates the nerve controlling the tongue ^{[1, 2, 3]}.

6. Prevention and self-care

If you have been diagnosed with sleep apnoea, the NHS suggests these steps ^[1]:

• Aim for a healthy weight and exercise regularly.
• Keep regular sleep habits, with a dark, quiet bedroom and fixed sleep and wake times.
• Try sleeping on your side. A special pillow or wedge can help.
• Avoid smoking, and limit alcohol, especially close to bedtime.
• Do not take sleeping pills unless a doctor advises it, because they can make sleep apnoea worse.

7. Special groups and complications

Children can have sleep apnoea, and it can be linked to enlarged tonsils or adenoids ^{[1, 2]}. Removing large tonsils is one surgical option ^[1].

Untreated sleep apnoea is linked to high blood pressure, stroke, heart attack, heart disease and type 2 diabetes. It can also lead to low mood, poor concentration and memory, and a higher risk of accidents at work and on the road because of tiredness ^{[1, 2, 3]}. The NHS (in the UK) says that if sleep apnoea with excessive sleepiness is confirmed, you must not drive until symptoms such as feeling very tired are under control. Check the rules where you live and ask your doctor ^[1].

8. When to see a doctor

See a doctor if you notice pauses in your breathing during sleep, gasping or choking at night, loud snoring with tiredness, or constant daytime exhaustion. It can help to bring someone who has watched you sleep ^[1]. Sleep apnoea can become serious if it is not diagnosed and treated ^{[1, 2]}.

Chest pain, signs of a stroke or severe difficulty breathing are always emergencies.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Obstructive sleep apnoea is common and often goes unnoticed, because the main signs happen during sleep. A sleep study can confirm it, and treatments such as lifestyle changes, CPAP and other devices can help keep the airway open. Because untreated sleep apnoea is linked to heart and other health problems, anyone with the signs should speak to a doctor.