Sleep Apnea

Sleep apnoea refers to stopping breathing events in sleep. The cause is a narrowing or collapse of the upper airway (breathing tube in the neck) during sleep. When you go to sleep, your muscles relax, including those in your throat. In some people, this causes the airways to narrow.

When the airway narrows, the flow of air ceases and this causes the oxygen level in your blood to fall. The brain is very sensitive to lower oxygen levels and so it wakes you from sleep, activating the muscles in the neck which open the airway, allowing the airflow to start again, so that oxygen levels in the blood are corrected.

Once this has happened, the brain is happy and lets you go back to sleep again. The whole process then repeats. This all happens in a matter of seconds, but stopping breathing can occur 30 or more times an hour, meaning sleep is very disturbed and you feel groggy in the morning and sleepy in the daytime. Nighttime symptoms include snoring, waking up choking or gasping for air and irregular breathing patterns with pauses in breathing during sleep.

You will not die from an apnoea in sleep, but untreated sleep apnoea syndrome is associated with an increased risk of high blood pressure and cardiovascular disease (strokes and heart attacks), as well as an increased risk of fatal driving accidents. 

Sleep apnoea is treated with a device called CPAP (Continuous Positive Airways Pressure) which is a mask-based therapy, worn at night-time, which blows air into the upper airway, holding it open, like blowing into the neck of a balloon. It is highly effective for snoring and sleep apnoea. More mild conditions can sometimes be treated with a mouthguard, called a mandibular advancement splint. If you are overweight, losing weight will also help, as will stopping smoking and avoiding alcohol and sedative drugs.

If sleep apnoea is largely due to being overweight, significant weight loss can help to reduce the severity of sleep apnoea and, in some cases, can eliminate sleep apnoea entirely. 

There is no evidence that using a different mattress or pillow can improve sleep apnoea. If your apnoeas occur predominantly when you lie on your back, sometimes a special wedge can be used to prevent you from rolling onto your back. This is not as effective as CPAP and is only suitable for some individuals.

The bedroom should be cool, dark and quiet. Earplugs or white or pink noise apps can help if you live in a particularly noisy area, or shared residence, but should otherwise not be necessary. Similarly, eye masks or blackout blinds can help if you cannot keep the room dark, particularly in the summer months. A comfortable, supportive mattress and pillow will help you remain comfortable through the night, particularly if you have pain or joint issues. 

I keep things as simple as possible: a supportive mattress which is turned and replaced regularly, clean, breathable cotton bedding to help regulate my body temperature overnight and an “all seasons” duvet so that I can reduce the thickness (tog) in the summer months and increase it for additional warmth in the summer. 

Dr Alanna Hare is a consultant in respiratory medicine at Royal Brompton Hospital, where she treats private and NHS patients.