OSA is a condition in which people breathe shallowly or stop breathing for short periods while sleeping. This can occur many times at night, leading to frequent arousals and disturbed sleep. These in turn can cause excessive daytime sleepiness, impaired concentration and hypoxaemia.
The consequences of untreated OSA include impaired daytime mental functioning, personality changes and social impairment. Importantly, it can have serious consequences on activities requiring alertness. Thus, there is up to a 12 fold increase in road traffic accidents (RTAs) in patients with OSA [1]. Sleepiness at the wheel may cause up to 20% of motorway accidents, with each fatal accident estimated to cost £1.25 million to society.
Furthermore, there is now strong and emerging evidence that OSA is an independent risk factor for coronary heart disease, hypertension and Stroke (estimated 2-4x increased risk). Moreover, there is also evidence that successful treatment of OSA can reduce diastolic blood pressure by up to 5 mmHg in trials. Over time, this might have a profound impact on cardiovascular and cerebrovascular risk, as part of a collective risk reduction strategy.
OSA is emerging as a significant public health problem, with a large and increasing demand for sleep service facilities due to the high prevalence and growing public awareness of its existence.
SLEEP APNOEA
Sleep apnoea is a serious condition where breathing repeatedly stops and starts during sleep, leading to poor sleep quality and potential health risks. Treatment for sleep apnoea often includes lifestyle changes, such as weight loss and positional therapy, as well as medical interventions like continuous positive airway pressure (CPAP) therapy, which helps keep the airway open during sleep. In some cases, dental devices or surgery may be recommended. Proper treatment can significantly improve sleep, reduce daytime fatigue, and lower the risk of heart disease, stroke, and other related complications.
SLEEP APNOEA
Weight plays a significant role in sleep apnoea, especially obstructive sleep apnoea (OSA). Excess body weight, particularly around the neck and upper airway, can increase pressure on the airway during sleep, making it more likely to collapse and cause breathing interruptions. People who are overweight or obese are at a higher risk of developing sleep apnoea, and even a small reduction in weight can alleviate symptoms. Weight loss can reduce the severity of sleep apnoea, improve breathing, and enhance overall sleep quality, making it an important part of managing the condition.
SLEEP APNOEA
Central sleep apnoea (CSA) is a sleep disorder in which the brain temporarily fails to signal the muscles responsible for controlling breathing. Unlike obstructive sleep apnoea, where airflow is blocked due to a physical obstruction, CSA occurs due to a dysfunction in the brain's respiratory control centres. This leads to pauses in breathing during sleep, often without any physical obstruction. CSA is commonly associated with certain medical conditions, such as heart failure or stroke, and can result in poor sleep quality, fatigue, and other complications. Treatment typically involves addressing the underlying condition, as well as using devices like adaptive servo-ventilation (ASV) or continuous positive airway pressure (CPAP) to regulate breathing.
If a patient is referred for evaluation of possible sleep apnoea with sleep disturbance, excessive daytime sleepiness/tiredness, loud snoring or concerns about irregular night time breathing patterns, then a standard protocol is followed. An initial detailed medical consultation is arranged. During that visit, a full history and examination, preferably with an accompanying partner (although not essential), are performed with specific questionnaires, and if necessary a sleep diary for review.
The next stage is usually an overnight sleep study. This may be as an inpatient or at home. The results are analysed, and this report together with other investigations are discussed at a follow up appointment. At this stage, the diagnosis is usually available, and treatment with a device &/or other management strategies are discussed and arranged. Occasionally, sleep studies require repeating for reasons of technical quality assurance. Furthermore, certain other investigations that are important for health may be undertaken.
SLEEP DISTURBANCE
Symptoms of insomnia include difficulty falling asleep, waking up frequently during the night, or waking up too early and being unable to return to sleep. People with insomnia often feel tired upon waking and may experience daytime fatigue, irritability, difficulty concentrating, and reduced performance in daily activities. Chronic insomnia can also lead to anxiety about sleep, making the problem worse. Over time, insomnia can impact both mental and physical health, increasing the risk of conditions like depression, anxiety, and weakened immune function.
SLEEP DISTURBANCE
Treatments for insomnia typically involve a combination of lifestyle changes, behavioural therapies, and, in some cases, medication. Cognitive-behavioural therapy for insomnia (CBT-I) is considered the most effective treatment, focusing on improving sleep habits and addressing negative thoughts or behaviours related to sleep. Lifestyle modifications, such as maintaining a consistent sleep schedule, limiting caffeine and screen time, and creating a relaxing bedtime routine, can also help. In some cases, doctors may prescribe short-term use of sleep medications, but these are generally used as a last resort due to potential side effects and the risk of dependency.
SLEEP DISTURBANCE
There are two main types of insomnia: acute and chronic. Acute insomnia is short-term and often triggered by stressful events, illness, or major life changes. It usually resolves on its own once the stressor is addressed or over time. Chronic insomnia, on the other hand, lasts for at least three months and can occur several times a week. It may be caused by ongoing issues like anxiety, depression, poor sleep habits, or medical conditions. Insomnia can also be classified as primary (occurring on its own) or secondary (related to another health condition, medication, or substance use). Each type requires different approaches for effective management.
The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness. A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene and/or need to see a sleep specialist.
Prof. Suveer Singh is an experienced specialist in Respiratory Medicine, Sleep Apnoea and other Sleep Disorders (Insomnia), Respiratory Critical Care, Acute respiratory infection (including COVID) and post ITU recovery.
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