What is sleep apnoea and what are the signs to watch out for?

Loud, persistent snoring may indicate obstructive sleep apnoea — here are the red flags to watch out for

Snoring and disrupted sleep are symptoms of sleep apnoea. Pictures: iStock 

Screening for obstructive sleep apnoea (OSA) should be introduced in workplaces, researchers say, after findings from a new study, published in the journal Thorax, suggested the condition may cost businesses due to absenteeism and reduced productivity.

With sleep apnoea, breathing repeatedly stops and starts during sleep, and loud snoring is a key symptom, according to the HSE website.

We spoke to two sleep specialists about the key signs that might indicate your snoring could point to a more serious underlying problem.

What causes snoring?

Anatomy, lifestyle, and physiology are the three main factors that can cause snoring, says Dr Ryan Chin Taw Cheong, a British-based consultant ENT (ear, nose, and throat) and specialist sleep surgeon.

Cheong says: “If you have a structural narrowing of your nose or the back of your throat or the back of the tongue, that can actually increase the resistance of air flow when you breathe at night, which results in snoring sounds.”

Also, if you’re particularly overweight or you drink a lot of alcohol, the upper airway muscles can become more relaxed, and that can also increase the resistance of air flow, resulting in snoring.

How your muscles relax at night can also have an impact.

“In some patients, the way that the muscles of the tongue or the palate or the throat relax is excessive to the point of obstruction or narrowing, and that can also cause snoring,” says Cheong.

What red flags might indicate your snoring is something more serious, like sleep apnoea?

Choking episodes, gasping of air, and/or pauses of breath: “If you witness any choking episodes or gasping of breath, or pause of breath by your bed partner, or if you’ve experienced it yourself, that’s a potential red flag of sleep apnoea,” says Cheong.

The issue with sleep apnoea is that it causes fragmented, poor-quality sleep, “so you can’t get in to these deep states of sleep that help you feel refreshed in the morning”, says David Garley, a GP with a special interest in sleep. “So, if you wake up feeling unrefreshed, are sleepy throughout the day, and often struggle with concentration, memory, and low mood, then you might want to consider talking to a professional.”

What are the risks of untreated sleep apnoea?

“The immediate effects are significant daytime sleepiness and disruption to your bed partner with snoring,” says Cheong.

This consistent disruption of sleep can also have negative impacts on your mental health. 'If you think how bad you feel after one night of [poor] sleep, then you can see how years of bad sleep can have a really major impact on your health.'

However, there can also be significant health consequences. “Untreated sleep apnoea has been associated with an increased risk of strokes and heart attacks, increased risk of diabetes, high blood pressure, and there’s also been evidence to suggest that it can increase the risk of neurocognitive decline.”

This consistent disruption of sleep can also have negative impacts on your mental health.

“If you think how bad you feel after one night of [poor] sleep, then you can see how years of bad sleep can have a really major impact on your health,” says Garley. “Some evidence suggests that around 20% of patients with sleep apnoea have depression.”

How is sleep apnoea diagnosed?

“There’s a risk assessment that you can do called the STOP-Bang questionnaire, but the diagnosis generally is carried out with a home sleep test,” says Garley.

“This usually involves wearing a medical watch-like device on your wrist, which has a chest and a finger sensor, which takes really detailed measurements on how you sleep.

“They’ll pick up the pauses in breathing, the drop in your oxygen levels, and also the activity of your fight-or-flight nervous system, which gets activated by the pauses in breathing.”

How is sleep apnoea treated?

Reducing your alcohol consumption can help reduce your risk of sleep apnoea, says Cheong. “Making sure that your weight is within optimal range can also help.”

CPAP (continuous positive airway pressure) therapy is also a common treatment option.

“It’s a small box that sits on your bedside table that blows low-pressure air through a tube that leads to a mask, which sits either over your nose or over your mouth and nose,” says Garley.

“That gentle pressure holds your airway open from the inside, so that when you fall asleep and your airway narrows, the air pressure just keeps it open, so you keep breathing freely and get to these deep states of sleep.”

Surgery or more advanced technologies are also available.

“More advanced technologies include hypoglossal nerve implants, such as the Genio Nyxoah device, which goes underneath the patient’s chin and stimulates the hypoglossal nerve to pulse the tongue forward to open up the airway at night,” says Cheong. “You can also have an operation on the palate at the back of the throat to open up the airway as well.”