Sleep Apnoea

CPAP3 Sleep apnoea is a common condition affecting about 10% of the middle aged male population and is even more common in those with obesity or a family history of this condition. It is not restricted to men, and is quite common in women, particularly those who have gone through the menopause or are overweight.

Sleep apnoea only became well recognised in the early 1980’s after Professor Colin Sullivan, a sleep physician in Sydney, invented the CPAP pump, which is the main treatment.

The word “apnoea” comes from the Ancient Greek words “a” meaning “not” and “-pneo” meaning I breathe.

It is an interruption to the regular breathing cycle that occurs during sleep and can be subdivided into two main types; central sleep apnoea and the more common, obstructive sleep apnoea.

The former is due to the loss of the brain’s ability to regulate breathing and more commonly occurs in patients with strokes, neurological conditions and severe heart failure.

Obstructive sleep apnoea is due to the intermittent obstruction of the upper airways which stops air flowing into the lungs. As result, the level of oxygen in the blood can drop and the constant interruption to sleep causes broken sleep and as result, tiredness, unrefreshing sleep, short-term memory loss, reduced concentration, falling asleep during the day and while driving, reduced libido and impotence, high blood pressure, the passing of excessive urination at night and also mood changes such as irritability and even depression. When the oxygen level in the blood falls to low levels in some people with obstructive sleep apnoea, it can cause stroke, heart attack or dangerous alterations to the heart’s rhythm we call arrhythmias. There is an increased incidence of death in patients with moderate to severe sleep apnoea, including motor vehicle accidents. It is common in middle aged truck drivers because they have a sedentary job and many are overweight.

For those of you who think you are safe because you are thin or are a young woman, you can still get sleep apnoea. In this group some of the commonest reasons are an abnormal bite (called a malocclusion) such as a small lower jaw or mandible, a constitutionally narrow throat, large tonsils or adenoids and a chronically blocked nose. If one family member has sleep apnoea, it is more likely others will too. “The apple doesn’t fall far from the tree”.

Alcohol makes it worse and many women will say that their partner snores more after a night out (i.e. drinking). Children can suffer from this too but they tend to be hyperactive rather than sleepy or tired. It is probably implicated in cot death too.

How do we diagnose it? If you suspect it, see your family doctor who will either send you to a sleep physician or arrange a diagnostic sleep study which can be done in a sleep laboratory or now sometimes, at home. When the diagnosis is made, the treatment depends on a number of factors including the severity and the type of patient.

Weight loss is essential as well as reducing alcohol and treating blood pressure. In more severe cases, CPAP is the main treatment. This acronym stands for continuous positive airway pressure or in other words the application of a small mask of the nose or both nose and mouth attached to a small pump which pumps a set low pressure of air through the mask to keep the back of the throat patent during sleep. It is quite comfortable and affords a good night of refreshing sleep. Many patients dream more in the first week on CPAP as they are catching up on REM sleep (rapid eye movement sleep) which is essential part of sleep.

The other treatment is a mandibular advancement splint which is a sort of mouth guard you wear at night to bring the lower jaw forward which in turn opens up the narrow space behind the tongue.

If you don’t have private health insurance, you can still get a sleep study done privately as most sleep labs have a bulk bill facility too.

Sleep studies can be performed in your home also which many people prefer. If you have sleep apnoea and it is affecting your driving, you must report it to Queensland Transport so you can be issued with a provisional licence saying you need to be treatment for sleep apnoea (see their website). If you don’t there is a $5,000 fine and you could lose your licence.

tongue anatomy

Tips for CPAP

Continuous positive airway pressure (CPAP) is the treatment of choice for sleep apnoea. A pressure of 4-20cm of water is applied to the mouth or nose continuously throughout sleep to prevent airway collapse and consequently airway occlusion.

CPAP will reverse obstructive apnoeas and put an end to chronic hypercapnia (excess of carbon dioxide in the blood leading to oxygen desaturation) and life-threatening hypoxia. Reversal of daytime hypersomnolence may be dramatic.

Follow a few simple steps to get used to your new CPAP machine.

Getting used to the mask

While you are awake wear your CPAP mask. You may need to do this for a few days until the mask no longer feels uncomfortable to wear.

Switching the machine on

During the day while you are watching TV, listening to the radio, reading a book or performing other sedentary activity turn the machine on. To get use to the machine, start by using the Ramp mode (most machines should have this button). By hitting the Ramp mode the machine starts at a low pressure for 20 minutes. After this time the machine will automatically rise to the prescribed pressure. Hitting the ramp switch several times allows you to become comfortable with your CPAP. Try this a few times – until you get used to the CPAP machine.

Naps with your CPAP

Now you are ready to extend the use of your CPAP. Try lying down with your CPAP during scheduled one hour naps at home. Look for a nice place to take a nap and try falling asleep with your CPAP machine on. Once you are able to initiate sleep, you can move on to steps 4 and 5.

Your first night

You are one step closer to sleeping with your CPAP machine, don’t give up yet. It may be little difficult at first but once you get through it you will feel great in the morning. Use the CPAP during the initial 3-4 hours of nocturnal sleep. When you can no longer stand using the CPAP (at about 3 hours), take the mask off and sleep for the rest of the night without it.

Getting through the night

Many patients want to pull the mask off at exactly the same time each night. Now is the time to push yourself through the entire night. If you wake up at 2 or 3am take a short break (5-10mins), and go to the bathroom or have some water. When you come back, start using the CPAP again in Ramp mode (remember you did this while training). Keep using the ramp mode if you need to all night or until the time when you normally get up. If you make yourself comfortable and relaxed, you will fall asleep.

It is extremely important that you eventually sleep the entire night with the CPAP machine on. You will not get the full effect by taking the CPAP off at 2-3am.

Remember that it may take about 2 weeks before you can use the CPAP machine the entire night. But after that you will not be able to sleep without it. It is also important to remember that once you start this process DO NOT take a night off. One night may turn into a week, and a week could turn into not doing it at all.