Phone (02) 6190 8722 | sleep@athomelseeptest.com.au
Sleep Breathing Disorders
Sleep Apnea
What is Sleep Breathing Disorder?
Sleep Breathing Disorder is any breathing issue during your sleep that affects your bodies normal function.
Types of Sleep Breathing Disorders are:
- Obstructive Sleep Apnea (OSA)
- Central Sleep Apnea (CSA)
- Hypopnea
- Respiratory Effort Related Arousal (RERA)
- Flow Limitation (FL)
- Cheyne Stoke Respirations (CSR)
- Catathrenia
- Sleep-Related Hypoxemia Disorder
- Sleep-Related Hypoventilation Disorder
Obstructive sleep apnea (OSA) is where repeated episodes of partial or complete obstruction of the throat (also known as the "pharynx" or "upper airway") during sleep.
A narrow floppy throat is also more likely to vibrate during sleep, which causes snoring. If partial or complete obstructions occur breathing is reduced or stops for a short time
– from 10 seconds up to a minute or more; and
– blood oxygen levels fall as a result.
A brief interruption to sleep (an arousal) that lasts for as little as 3 seconds then occurs, allowing breathing to start again but your sleep is disrupted as a result.
These episodes of obstruction may happen many times (even hundreds of times) overnight. Some people know that their breathing is not normal at night, but may be unaware that this is a medical problem that is causing them harm. Fortunately, good treatments are available.
What are the symptoms of Sleep Apnea?
Sign and symptoms of sleep apnea could be any of the following:
- Loud or frequent snoring (however not everyone who snores has sleep apnea)
- Silent pauses in breathing
- Choking or gasping sounds
- Daytime sleepiness or fatigue
- frequent bathroom trips during the night
- Unrefreshing sleep
- Daytime naps
- Insomnia
- Morning headaches
- Weight Gain
- Mood swings, depression and irritability
- Loss of libido
- Memory loss
- Uncontrolled High Blood Pressure
- Unstable Diabetes
- Heart Conditions (e.g. A.F.)
Other Types of Sleep Breathing Disorders
Central Sleep Apnea
In central sleep apnea (CSA), lapses in respiration during sleep occur because of a lack of effort to breathe. This happens when either the brain does not properly send signals to the respiratory muscles or the respiratory muscles don’t activate in response to the brain’s signals.
In this way, central sleep apnea is distinct from obstructive sleep apnea, but the two conditions can occur together, which is known as mixed sleep apnea7. In addition, sometimes the treatment for OSA triggers CSA, which is called treatment-emergent central sleep apnea8.
CSA is much less common than OSA, affecting just under 1% of people over the age of 409. It is more common in males and in people who are over 65.
There are different types of CSA based on the nature of the underlying problem preventing proper respiration. Some established risk factors include cardiovascular problems, use of narcotics, and high altitude, but not all cases are tied to these issues. A key focus of treatment for central sleep apnea is addressing its underlying cause.
Sleep-Related Hypoventilation Disorders
Sleep-related hypoventilation disorders involve elevated blood levels of carbon dioxide during sleep that result from a lack of air moving in and out of the lungs.
This insufficient breathing is commonly tied to other health problems. Often, people with sleep-related hypoventilation disorders have lung conditions like chronic obstructive pulmonary disease (COPD) or pulmonary hypertension. Disorders that affect the nervous system and some types of medications can also affect breathing and trigger hypoventilation.
A specific type of sleep-related hypoventilation disorder is called obesity hypoventilation syndrome (OHS). This condition can occur in obese patients and normally co-occurs with obstructive sleep apnea. It is frequently associated with poor sleep and can lead to detrimental effects on the cardiovascular system.
Many people with sleep-related hypoventilation disorders struggle to breathe properly when they are awake, but the problem normally intensifies during sleep. As with central sleep apnea, treatment for sleep-related hypoventilation disorders is often directed at managing an underlying illness contributing to breathing problems.
Sleep-Related Hypoxemia Disorder
Add an anHypoxemia is a low level of oxygen in the blood. Sleep-related hypoxemia disorder is when oxygen concentrations drop, but the levels of carbon dioxide don’t rise high enough to cross the threshold for diagnosis as a sleep-related hypoventilation disorder.
Sleep-related hypoxemia disorder occurs mostly as the result of another health problem that affects breathing, including a number of types of lung conditions, and addressing hypoxemia frequently involves a focus on that underlying issue.swer to this item.
Catatherina
Catathrenia is a pattern of abnormal breathing and vocalization that is often referred to as sleep-related groaning.
During episodes of catathrenia, a sleeper takes in a long inhaled breath and then exhales slowly while making a monotone, groan-like sound. As this occurs, the sleeper is not aware of the vocalizations.
Catathrenia is uncommon and does not pose any known health risks to the sleeper. However, it can be annoying or disruptive for bed partners or others within earshot. People with catathrenia may also be embarrassed about the sounds once they are made aware of the condition. When desired, treatments for obstructive sleep apnea, such as the use of a continuous positive airway pressure (CPAP) device, have achieved reductions in catathrenia episodes
Treatment Options for OSA
There are a range of treatment options to manage and treat Sleep Apnea. Depending on your severity, our Sleep Doctors and Therapists will provide you with the best options to help you.
Treatments do vary from one person to the next, and in some cases some patients use two or three different therapies to assist them.
CPAP (Continuous Positive Airway Pressure)
CPAP is the most common treatment for sleep apnea, and it is estimated to be 80% effective. CPAP is a machine that uses a steady stream of air to gently keep your airway open throughout your sleep to keep maintain normal oxygen levels in your body. You sleep with a mask that connects to the machine with a tube and kept the CPAP at the bedside. Masks and machines may vary depending on your treatment and comfort needs.
CPAP machines require a CPAP Therapist to adjust them to personalise the therapy to your airway needs and ensure the best out for you. This can take a few days to a week to get the settings right.
Patients who struggle with their CPAP therapy, struggle for some common reasons:
- Have another underlying sleep problem that needs to also be treated (e.g. restless legs, insomnia, etc.)
- Require adjustment to the settings.
- Require guidance by the CPAP Therapist on alternative devices to obtain the best comfort. As different brands of CPAP have different comfort settings (Contact our CPAP Team today for advice).
- Have a physical blockage that CPAP can not fix (e.g. enlarged tonsils, nasal polyps, deviated septum, etc.)
Oral Appliance Therapy
An oral appliance is also known as a Mandibular Advancement Splint (MAS) or Mandibular Advancement Device (MAD) and is a device that fits in your mouth over your teeth while you sleep. It may resemble a sports mouth guard or an orthodontic retainer.
The device prevents the airway from collapsing by holding the lower jaw and tounge in position or forward. Some patients prefer sleeping with a MAS compared to a CPAP machine.
Devices can be over the counter or personally customed fitted by a dentist trained in dental sleep medicine.
Weight Management
Weight loss can help improve or eliminate your Sleep Apnea symptoms if you are overweight or obese. Overweight people often have thick necks with extra tissue in the throat that may block the airway. As little as 3kg weight loss can reduce the number of Sleep Apnea episodes/events.
Laser Therapy
The Nightlase Laser Treatment can effectively reduces Snoring & Sleep Apnoea in most individuals safely & with no downtime.
The NightLase procedure involves shining a laser light on the soft palate, uvula, base of the tongue and back of the throat. This causes the collagen in the tissues to shrink and new firmer collagen is produced. The result is a tightening of the muscles in the mouth and throat, which opens up the airway.
No cutting, no bleeding, nothing scary. Most feel feel no pain during or after. Not to be confused with other types of laser procedures that involve cutting the soft palate.
You return to your normal routine straight after treatment. No anaesthesia required. Postoperative, a dry throat for a couple of days is the worst you’ll feel.
The Nightlase Laser Treatments are performed at specific clinics.
The treatment requires 3 to 4, 30 Minute sessions in the first 3 months. Then usually a revisit every 6 to 12 months.
Success rate of 60%-80% of patients. Some patients recognise results immediately and continue to improve with time in most patients.
Surgery
Surgical therapies are not as effective in treating Sleep Apnea as CPAP and oral appliances. There are a variety of surgical options you can elect to have if CPAP or oral appliance therapy does not work for you. The most common options reduce or eliminate the extra tissue in your throat that collapses and blocks your airway during sleep. More complex procedures can adjust your bone structures including the jaw, nose and facial bones.
Surgery is only recommended if you have physical aspects that is causing your Sleep Apnea. Such as: enlarged tonsils or enlarged tongue, nasal polyps, deviated septum.
An Ears, Nose & Throat (E.N.T. Specialist) will provide the most accurate assessment and solutions if surgery is required.
Positional Therapy
If your Sleep Apnea / Snoring is positional, meaning it only occurs when sleeping on your back, you may be able to improve or eliminate your symptoms by changing your sleep position. Your airway may open if you sleep on your side instead of your back. There many products that you can wear when you go to sleep that prevent you from sleeping on your back.
Contact our Sleep Team to find out what options there are.
Lifestyle Changes
There are a variety of lifestyle changes that you can make to help you reduce your snoring and improve your Sleep Apnea symptoms. Behavioural changes such as quitting smoking or not drinking alcohol may improve Sleep Apnea symptoms. As patients with Sleep Apnea already have disrupted sleep, it is important that it is not made any worse. Therefore, it is important for patients with OSA to have regular bed times and rising times, preferably allowing 8 hours of sleep per night If you have difficulty staying with your treatment plan or cannot sleep even with treatment, our doctor will recommend alternatives for you.
Frequently Asked Questions
Please reach us at sleep@athomesleeptest.com.au if you cannot find an answer to your question.
There are a number of factors that increase the risk of developing sleep apnoea. These include:
- Having a smaller or narrowed airway
- Excessive weight
- Smoking and alcohol
- Ethnicity
- Diabetes
- Hypertension (high blood pressure)
One key indicator of sleep apnoea is the AHI (Apnoea Hypopnea Index) which is the number of apnea events/episodes recorded during the study per hour of sleep.
Another key indicator is your oxygen saturation levels which shows the level of oxygen in your blood while you are asleep.
Our Sleep team will go through all of this information with you so that you understand exactly what the sleep test results mean.
- Alcohol may worsen Sleep Apnea because it relaxes your muscles. A few drinks could cause Mild Sleep Apnea to become severe.
- Sleeping tablets can cause the airway to collapse more, reducing the drive to breathe.
- Smoking damages the upper airway and makes it more collapsible.
Facts & Figures about Sleep Apnea
An estimated 2.5 million Australians or roughly 10% of the population suffers from mild to moderate sleep apnea. These figures are comparable to the number of Australians suffering from diabetes.
An estimated 80% of people with sleep apnea remain undiagnosed. Because the signs of sleep apnea are not always apparent, it frequently goes unnoticed. Sleep apnea symptoms include snoring, gasping for air during sleep, and waking up feeling tired or unrefreshed.
Mild Obstructive sleep apnea (OSA) is the most common type of sleep apnea, accounting for 95% of all cases in Australia. Moderate and severe OSA is less common, accounting for the remaining cases.
Mild OSA is defined as having fewer than 15 apneas (pauses in breathing) per hour on the AHI scale. Moderate OSA is defined as having 15-30 apneas per hour. Severe OSA is defined as having more than 30 apneas per hour.
An estimated 1.25 million Australians suffer from moderate to severe OSA. The actual figures are likely to be higher as most OSA cases go undiagnosed.
Sleep apnea is two times more common in men than women. It is estimated that 13.0% of women and 25% of men in Australia have sleep apnea. This difference is not fully understood, but it is thought to be due to higher obesity rates in men and smaller airway sizes in women.
Obstructive sleep apnea affects 25% of males in the 30-40 years age group, 49% of males in the 40-69 years age group and 62% of males above 70 years age group.
It’s estimated that 58% of moderate-severe OSA is due to obesity. Obesity can lead to excess fat deposition around the neck and chest, narrowing the airway and leading to OSA.
Type II diabetes is a major risk factor for OSA due to the shared risk factors of obesity and age. It is estimated that 74% of people with Type II diabetes have sleep apnea.
Australians with sleep apnea pay an average of $2,450 in diagnosis and treatment annually. This includes the cost of CPAP machines, doctor’s visits, sleep study and other treatments.
The cost of sleep apnea to the Australian economy is estimated to be $5.1 billion annually. This includes $3.4 billion lost in productivity and reduced employment, $500 million in medical expenses and $1.1 billion in deadweight loss.
Additionally, in 2019-20, the government spent $547 million on OSA related healthcare services accounting for 58% of the total spending for sleep disorders.
CPAP is the most common treatment for sleep apnea, and it is estimated to be 80% effective. CPAP (Continuous Positive Airway Pressure) involves wearing a mask over the nose and mouth during sleep. The mask is connected to an oxygen concentrator that provides a steady stream of oxygenated air to prevent the air passage from collapsing.
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