Sleep apnoea can be diagnosed easily and treated effectively in the vast majority of sufferers. It is often the sufferer's partner who first realises that something is wrong, usually because of very heavy snoring and noticeable pauses in breathing during sleep.
If you are a loud, heavy snorer and if you experience recurring episodes of restless and unrefreshing sleep with daytime drowsiness you may well be suffering from sleep apnoea and should consider seeing a sleep specialist.
Your GP will ask you a few simple questions about your sleeping pattern and will often ask you to complete a simple questionnaire about daytime sleepiness called an Epworth Sleepiness Scale and if there is a suspicion of sleep apnoea you can then be referred on to your nearest sleep centre (there are sleep clinics in many of the large hospitals).
The Epworth Sleepiness Scale provides a way for physicians to identify those patients who may need an overnight sleep study.
You could also make contact with involved organisations, such as the Scottish Association for Sleep Apnoea for advice if you think that you or your partner may have the condition.
Your nearest sleep centre can then diagnose whether or not you have sleep apnoea. This will involve studying your breathing pattern whilst you sleep with a simple piece of equipment which can usually be given to you so that the recording can take place at home in your own bed. The recording is painless and easy to perform. It usually involves measuring your oxygen level and pulse rate with a little finger probe and may also include a recording of your breathing pattern, chest movement of level of snoring if a more complicated piece of equipment is used. Occasionally an overnight stay in a hospital sleep clinic is necessary to allow the diagnosis to be confirmed but this is not always necessary.
Once the diagnosis of sleep apnoea is confirmed some general advice about treatment is given such as weight reduction if necessary, avoiding excessive amounts of alcohol consumption late in the evening and avoiding sedatives or sleeping tablets as they can produce marked relaxation of the throat muscles leading to worsening of the apnoeic episodes. Any additional treatment varies from persons to person, depending on the severity of their condition. Such additional treatment options usually involve either a mask based treatment called continuous positive airways pressure (CPAP) or a jawsplint (mandibular advancement device – MAD / or mandibular repositioning splint – MRS). Whichever treatment option is chosen it has to continue long term and be used each night as there is no effective cure for sleep apnoea in most people – all that can be achieved is that the condition is controlled and the symptoms improved.
Surgery, either by operation or laser, does not have a role in the treatment of this condition and is no longer recommended. Indeed it can make effective treatment with CPAP more difficult to tolerate. Similarly there are no effective drug treatments for sleep apnoea at present.
Nasal continuous airway pressure (CPAP) is the most effective therapy for sufferers from sleep apnoea.
During sleep, the patient wears a mask over the nose which allows a gentle stream of air, from a portable and quiet blower unit, to flow into the throat thus preventing airway collapse. The pressure generated from the blower is adjusted to the individualís requirements to ensure that the stream of air is just sufficient to produce benefit but not too intense to cause discomfort. Approximately 80% of those people started on CPAP therapy find it helpful and comfortable to wear.
CPAP therapy has been shown to reduce daytime sleepiness and improve concentration, intelligence, driving performance, general quality of life and mood. There is some also increasing evidence that it also reduces blood pressure and therefore may reduce the risk of a future heart attack or stroke in a person with sleep apnoea although more research is needed to confirm this finding.
In some patients, particularly those with simple snoring or mild sleep apnoea, a device worn in the mouth, similar to an athletic gum-shield, can be useful in controlling symptoms. This is described as a mandibular (Jaw) repositioning splint.
The splint holds the lower jaw forward during sleep and tends to widen the throat a little thus reducing snoring (vibration) and the tendency towards breathing pauses. It has proved to be effective in reducing snoring but it has yet to be proved very effective against anything other than very mild sleep apnoea. It does not appear to be useful at all in more severe degrees of sleep apnoea and is not as effective as CPAP therapy if CPAP can be tolerated. The splint devices tend to make the wearer salivate more than normal and can cause discomfort in the jaw joints as well as potentially damaging the teeth so although they may seem to be a very attractive first option compared to CPAP they are not always ideal.
