Introduction
Snoring and sleep apnoea can be very debilitating for patients and/or their partners. Poor sleep at night can significantly affect one’s mood and concentration. It can prevent people performing optimally, be that in the workforce, on the sports field or simply interacting with family and friends.
It can be challenging to treat in adults as it may be multi-level and multifactorial (many causes). Snoring and sleep apnoea in children is often more straightforward.
Causes
There are anatomical causes which can contribute to sleep apnoea. The upper airway extends all the way from the nose to larynx (voice box). A narrowing at any point here can cause symptoms. Obesity or simply being overweight is strongly implicated in sleep disordered breathing. Alcohol and the use of sleeping tablets may help one fall asleep more quickly but can be associated with poor quality sleep. More rarely, craniofacial (bone structure in the head and face) or neurological problems are the cause of sleep apnoea.
Symptoms
Snoring at night, witnessed apneas (pauses in breathing) daytime somnolence (excessive sleepiness, poor concentration and morning headaches are all symptoms of sleep disordered breathing.
Complications of untreated sleep apnoea include heart disease, high blood pressure, diabetes, stroke, reflux, depression, certain cancers and increased risk of motor vehicle accidents.
Diagnosis
Nasendoscopy or transnasal laryngoscopy (looking at the upper airway with a small camera inserted in the nose) allows a very good assessment of the upper airway. Sometimes sleep endoscopy (assessing the upper airway as above, when asleep) can provide useful information as the areas of narrowing are not always apparent when awake. A sleep study is commonly requested if the diagnosis or recommended treatment is not obvious.
Treatment
CPAP (continuous positive airway pressure with a mask) has a very high success rate in treating sleep apnoea if it is used all night, each night. Oral splints to keep the lower jaw forward may be beneficial in certain patients. Unfortunately, many patients don't tolerate these devices and take off their masks or splints during the night (or refuse to wear them) and then suffer the symptoms and complications of sleep apnoea.
Weight loss for patients who are overweight or obese almost always improves sleep. Targeted surgery to address specific anatomical abnormalities can be successful. Some patients require more than one operation to address the different sites contributing to their sleep apnoea.
Treating sleep apnoea is complex. Dr Levin will be able to perform an upper airway assessment with high quality nasendoscopes and monitors, and then recommend the most appropriate investigations or treatment for you.
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