Obstructive sleep apnoea

Obstructive sleep apnoea (OSA) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Obstructive sleep apnoea Obstructive sleep apnoea About obstructive sleep apnoea Diagnosing obstructive sleep apnoea Treating obstructive sleep apnoea About obstructive sleep apnoea Obstructive sleep apnoea (OSA) is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. Thismay lead to regularlyinterrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions. Apnoea and hypopnoea There are two types of breathing interruption characteristic of OSA: apnoea  where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; its called an apnoea when the airflow is blocked for 10 seconds or more hypopnoea a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more People with OSA may experience repeated episodes of apnoea and hypopnoea throughout the night.These events may occur around once every one or twominutes in severe cases. Asmany people with OSA experience episodes of both apnoea and hypopnoea, doctors sometimes refer to the condition as obstructive sleep apnoea-hypopnoea syndrome, or OSAHS. The term obstructive distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain not sendingsignals to the breathing muscles during sleep. Symptoms of OSA The symptoms of OSA are often first spotted by a partner, friend or family member who notices problems while you sleep. Signs of OSA in someone sleeping can include: loudsnoring noisy and laboured breathing repeated short periodswhere breathing is interrupted by gasping or snorting Some people with OSA may also experiencenight sweats and may wake up frequently during the night to urinate. During an episode, the lack of oxygentriggers your brain to pull you out of deep sleep either to a lighter sleep or to wakefulnessso your airway reopens and you can breathe normally. These repeated sleep interruptions can make youfeel very tired during the day. Youll usually have no memory of your interrupted breathing, so youmay be unaware you have a problem. When to seek medical advice See your GP if you think you might have OSA. Theycan check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre. As someone with OSA may not notice they have the condition, it often goes undiagnosed. Read more about diagnosing OSA . Causes of OSA Its normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesnt cause breathing problems. In people with OSA the airway has narrowed as the result of a number of factors, including: being overweight excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles; excess stomach fat can also lead to breathing difficulties, which can make OSA worse being male its not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution being 40 years of age or more  although OSA can occur at any age, its more common in people who are over 40 having a large neck men with a collar size greater than around 43cm (17 inches) have an increased risk of developing OSA taking medicineswith a sedative effect such as sleeping tablets or tranquillisers having an unusual inner neck structure  such as a narrow airway, large tonsils, adenoidsor tongue, or a small lower jaw alcohol drinking alcohol, particularly before goingto sleep,can make snoring and sleep apnoea worse smoking youre more likely to develop sleep apnoea if you smoke the menopause (in women) the changes in hormone levels during the menopause may cause the throat muscles to relax more than usual having a family history of OSA there may be genes inherited from your parents that can make you more susceptible to OSA nasal congestion OSA occurs more often in people with nasal congestion, such as a deviated septum, where the tissue in the nose that divides the two nostrils is bent to one side, or nasal polyps, which may bea result of the airways being narrowed Treating OSA OSA is a treatable condition, and thereare a variety of treatment options that canreduce the symptoms. Treatment optionsfor OSA include: lifestyle changes such aslosing excess weight, cutting down on alcohol and sleeping on your side usingacontinuouspositive airway pressure (CPAP) device  these devicesprevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask wearing amandibular advancement device (MAD) this gum shield-like device fits around your teeth, holdingyour jaw and tongue forward to increase the space at the back of your throat while you sleep Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure. However, for most people surgery isnt appropriate and may only be considered as a last resort if other treatments havent helped. Read more about treating OSA . Complications of OSA The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases. If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such aspoor performance at work and school, and placing a strain on your relationships with others. Poorly controlled OSAmay alsoincrease your risk of: developing high blood pressure (hypertension) having a stroke or heart attack developing an irregular heartbeat such as atrial fibrillation developing type 2 diabetes  although its unclear if this is the result of an underlying cause, such as obesity Research hasshown someone who has been deprived of sleep because of OSA may be up to 12 times more likely to be involved in a car accident. If youre diagnosed with OSA, itmay mean your ability to drive is affected. Its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. Once a diagnosis of OSA has been made, you shouldnt drive untilyour symptoms are well controlled. The GOV.UK website has advice about how to tell the DVLA about a medical condition . Preventing OSA Its not always possible to prevent OSA, but making certain lifestyle changesmay reduce your risk of developing the condition. These include: losing weight if youre overweight or obese limitinghow much alcohol you drink and avoiding alcoholin the evening stopping smoking if you smoke avoiding the use of sleeping tablets and tranquillisers Diagnosing obstructive sleep apnoea Obstructive sleep apnoea (OSA) can usually be diagnosed after youve been observed sleeping at a sleep clinic, or by using a testing device worn overnight at home. If you think you have OSA, its important to visit your GP in case you need to be referred to a sleep specialist for further tests and treatment. Before seeing your GP it may be helpful toask a partner, friend or relative to observe you while youre asleep, if possible. If you have OSA, they may be able to spot episodes of breathlessness. It may also help to fill out an Epworth Sleepiness Scale questionnaire. Thisaskshow likely youll be todoze off in a number of different situations, such as watching TV orsitting in a meeting. The final score will help your doctordetermine whether you may have a sleep disorder. For example,a score of 16-24 means youre excessively sleepy and should consider seeking medical attention. A score of eight to nine is considered average during the daytime. An online version of the Epworth Sleepiness Scale can be found on the British Lung Foundation website. Seeing your GP When you see your GP, theyll usuallyask a number of questions about your symptoms, such as whether you regularly fall asleep during the day against your will. Your blood pressure will be measured and a blood sample probably sent off to help rule out other conditions that could explain your tiredness, such asan underactive thyroid gland ( hypothyroidism ). The next step is to observe you while youre asleep at a local sleep centre. Your GP can refer you to specialist clinics or hospital departments that help treat people with sleep disorders. The Sleep Apnoea Trust Association has a list of NHS sleep clinics in Scotland . Observing your sleep The sleep specialists at the sleep centre may ask you about your symptoms and medical history, and carry out a physical examination. This may include measuring your height and weight to work out your body mass index (BMI) , as well as measuringyour neck circumference. This is because being overweight and having a large neck can increase your risk of OSA. The sleep specialists will then arrange foryour sleep tobe assessed overnight, either by spending the night at the clinic or taking some monitoring equipment home with you and bringing it back the next day for them to analyse. Testing at home In many cases the sleep centre will teach you how to use portable recording equipment while you sleep at home. The equipment you are given may include: a breathing sensor sensors to monitor your heart rate bands that are placed around your chest oxygen sensors that are puton your finger The equipment records oxygenlevels, breathing movements, heart rate and snoring through the night. If more information about sleep quality is required, a more detailed investigation calledpolysomnographywill be required, which will be carried out at the sleep centre. Testing at a sleep centre The main test carried out to analyse your sleep at a sleep centre is known aspolysomnography. During the night, several different parts of your body will be carefully monitored while you sleep. Bands and small metallic discs called electrodesare placed on the surface of your skin anddifferent parts of your body. Sensors are also placed on your legs and an oxygen sensor will be attached to your finger. A number of different tests will be carried out during polysomnography, including: electroencephalography (EEG) this monitors brain waves electromyography (EMG)  this monitors muscle tone recordings of movements in your chest and abdomen recordings of airflow through your mouth and nose pulse oximetry  this measures your heart rate and blood oxygen levels electrocardiography (ECG)  this monitors your heart Sound recording and video equipment may also be used. If OSA is diagnosed during the early part of the night, you may be given continuous positive airway pressure (CPAP) treatment. CPAP involves using a mask that delivers constant compressed air to the airway and stops it closing, which prevents OSA. Read about treating OSA for more information about CPAP. Once the tests have been completed, staff at the sleep centre should have a good idea about whether or not you have OSA. If you do, they can determine how much it is interrupting your sleep and recommend appropriate treatment. Determining the severity of OSA The severity of OSA is determined by howoften your breathing is affected over the course of an hour. These episodes are measured using the apnoea-hypopnoea index (AHI). Severity is measured using the following criteria: mild an AHI reading of 5 to 14 episodes an hour moderate an AHI reading of 15 to 30 episodes an hour severe an AHI reading of more than 30 episodes an hour Current evidence suggests treatment is most likely to be beneficial in people with moderate or severe OSA. However, some research has suggested treatment may also help some people with mild OSA. Treating obstructive sleep apnoea Treatment for obstructive sleep apnoea (OSA) may include making lifestyle changes and using breathing apparatus while you sleep. OSA is a long-term condition and many cases require lifelong treatment. Lifestyle changes Inmost cases ofOSA youll be advised to make healthy lifestyle changes,suchas: losing weight if youre overweight or obese stopping smoking if you smoke limiting your alcohol consumption, particularly before going to bed the NHS recommends not regularly drinking more than 14 units of alcohol a week; if you drink as much as 14 units a week, its best to spread this evenly over three or more days avoidingsedative medications and sleeping tablets Losing weight, reducing the amount of alcohol you drink and avoiding sedativeshave allbeen shown tohelp improve the symptoms of OSA. Although itsless clear whether stopping smoking can improve the condition,youll probablybe advised to stop for general health reasons. Sleeping on your side, rather than on your back, may also help relieve the symptoms of OSA. Continuous positive airway pressure (CPAP) As well asthe lifestyle changes mentioned above, people with moderate to severe OSAusuallyneed touse a continuous positive airway pressure (CPAP) device. This is a small pumpthatdelivers a continuous supply of compressed air through a mask thateither covers your nose or your nose and mouth. The compressed air prevents your throat closing. CPAP can feel peculiar to start with andyou may be tempted to stop using it.But people who persevereusually soonget used toit and their symptoms improve significantly. CPAP is available on the NHS and is the most effective therapy for treating severe cases of OSA. As well as reducing symptoms such as snoring and tiredness, it can also reduce the risk ofcomplications of OSA, such as high blood pressure . Possible side effects of using a CPAP device can include: mask discomfort nasal congestion, runny nose or irritation difficulty breathing through your nose headaches and ear pain stomach pain and flatulence (wind) Earlier versions of CPAP also often caused problems such as nasal dryness and a sore throat. However, modern versions tend to include humidifiers, a device that increases moisture, which helps reduce these side effects. If CPAP causes you discomfort, inform your treatment staffas the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep. Mandibular advancement device (MAD) A mandibular advancement device (MAD) is a dental appliance, similar to a gum shield, sometimes used to treat mild OSA. Theyre not generally recommended for more severe OSA, although they may be an option if youre unable to tolerate using a CPAP device. An MAD is worn over your teeth when youre asleep. Its designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring. Off-the-shelf MADs are available from specialist websites, but most experts dont recommend them, as poor-fitting MADs can make symptoms worse. Its recommended you have an MAD made for you by a dentist with training and experience in treating sleep apnoea. MADs arent always available on the NHS, so you may need to pay for the device privately through a dentist or orthodontist. An MAD may not be suitable treatment for you if you dont have many or anyteeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure they wont be stressed or damaged by an MAD. Surgery for OSA Surgery to treat OSA isnt routinely recommended because evidence shows its not as effective as CPAP at controlling the symptoms of the condition. It also carriesthe risk of more serious complications. Surgery is usually only considered as a last resort when all other treatment options have failed, and also if the conditionis severely affecting your quality of life. Arange of surgical treatmentshave been used to treat OSA. These include: tonsillectomy  where the tonsils are removed if theyre enlarged and blocking your airway when you sleep adenoidectomy where the adenoids, small lumps of tissueat the back of the throat above the tonsils, are removed if theyre enlarged and are blocking the airway during sleep tracheostomy where a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked weight loss (bariatric) surgery where the size of the stomach is reduced if youre severely obese andthis is making your sleep apnoeaworse Surgery toremove excess tissue in the throat to widen your airway (uvulopalatopharyngoplasty) used to be a common surgical treatment for OSA, but its performed less often nowadays. This isbecause more effective treatments are available, such as CPAP. This type of surgery can mean youre unable to use a CPAP device properly in the future if you need to. Soft palate implants Soft palate implants make the soft palate, part of the roof of the mouth, stiffer and less likely to vibrate and cause an obstruction. The implants are inserted into the soft palate under local anaesthetic . The National Institutefor Health and Care Excellence (NICE) has said soft palate implants are safe, but theyre not currently recommended for treating OSAas theres a lack of evidence about their effectiveness. However, this form of treatment is recommended for treating snoring associated with OSA in exceptional cases. Support groups OSA can have a significant impact on the quality of life for someone with the condition, as well as their friends and families. As well as causing physical problems such as tiredness and headaches, the condition can have a significant emotional impact and affect your relationships with others. For support and advice about living with OSA, you may find it helpful to contact a support group, such as: British Lung Foundation Sleep Apnoea Trust Source: NHS 24 - Opens in new browser window Last updated: 17 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites British Lung Foundation: Obstructive sleep apnoea NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852