What is Sleep Apnoea?

Sleep Apnoea (also spelled Sleep Apnea) is a sleeping disorder characterised by severely disrupted and inconsistent breathing during sleep.

During a period of disrupted breathing, the lack of oxygen causes the brain to either wake you up or fall into a lighter sleep. The airway then reopens, and normal breathing resumes.

Many people don’t realise they have Sleep Apnoea, as they may sleep through the disrupted breathing episodes and will have no memory of them when they wake up. However, Sleep Apnoea can have a significant impact on health and quality of life.

Inconsistent breathing during sleep can result in:

Waking up not feeling refreshed
Constant fatigue
Emotional dysregulation

All of these concerns can have a negative effect on various areas of life including reducing productivity at work, placing strain on personal relationships and impacting mental health. Additionally, disrupted sleep can affect health, increasing the risk of conditions such as Type II Diabetes and high blood pressure, and reducing immune function.

There are a range of treatments for Sleep Apnoea, although surgical options may offer the most effective and longest-term solutions. Cadogan Clinic’s team of top Consultant ENT Surgeons in the UK can provide surgical treatments for Sleep Apnoea, resulting in improved comfort and quality of life.

Types of Sleep Apnoea

There are three types of Sleep Apnoea. Understanding the different types of Sleep Apnoea may help patients to establish the cause of the condition and seek the most suitable treatment.

Obstructive Sleep Apnoea

Abbreviated to OSA, Obstructive Sleep Apnoea is the most common form of the condition.

Obstructive Sleep Apnoea results from a functional obstruction in the mouth or throat, limiting airflow. This occurs for two primary reasons:

The tongue falling backwards against the roof of the mouth, pushing the uvula against the throat
The throat muscles relaxing
Nasal obstruction caused by a deviated septum, cartilage weakness or enlarged turbinates

The function of the lungs is not affected by OSA, and the body is still trying to breathe, but oxygen is not able to enter the body due to the physical blockage

Central Sleep Apnoea

Central Sleep Apnoea also affects breathing during sleep, but the cause is neurological rather than physical.

During an episode of Central Sleep Apnoea, the body stops trying to breathe because the brain and nervous system are not sending a consistent signal to the respiratory system.

In some cases of Central Sleep Apnoea, there is no apparent underlying cause; however, it sometimes results from:

Taking sedatives such as opiate painkillers
Sleeping at high altitudes
Congestive heart failure

Cheyne-Stokes breathing is a specific pattern of breathing which can occur in Central Sleep Apnoea, causing the breathing to switch from hyperventilating to not breathing at all. This is typically associated with congestive heart failure.

Complex Sleep Apnoea

Also known as Treatment-Emergent Central Sleep Apnoea, Complex Sleep Apnoea is described as a combination of Obstructive and Central Sleep Apnoea.

Complex Sleep Apnoea often appears in the same way as Obstructive Sleep Apnoea during diagnosis, but signs of Central Sleep Apnoea become apparent during treatment.

The causes of Complex Sleep Apnoea can be challenging to establish, and a combination of treatments may be required to find a solution.

How Common is Sleep Apnoea?

Sleep Apnoea is a common sleep disorder, affecting around 1 billion people worldwide.

In the UK, it is believed that around 10 million people have Sleep Apnoea, with 13% of men and 6% of women aged 30-75 being affected by the condition.

However, it is difficult to establish accurate figures for the number of people affected by Sleep Apnoea, as up to 85% of people who have Sleep Apnoea may not be aware.

Considering Sleep Apnoea is very common and often goes undiagnosed, although it is associated with some significant health consequences, it is seen as a serious public health concern.

What are the Symptoms of Sleep Apnoea?

Alongside the impact on quality of life, there are several signs and symptoms of Sleep Apnoea which are important to investigate further if they are occurring on a regular basis:

Breathing stopping and starting
Loud snoring
Gasping, snorting or choking noises
Waking up regularly throughout the night
Insomnia
Feeling panicked or confused on waking
Frequent headaches
Dry mouth when waking up

Sleep Apnoea symptoms can vary depending on the type of Sleep Apnoea an individual has.

Disrupted breathing, snoring and gasping are typically prevalent in Obstructive Sleep Apnoea as the airway is restricted, but the body is still attempting to breathe
Insomnia, feeling panicked and confusion are usually associated with Central Sleep Apnoea as the body stops breathing entirely
Complex Sleep Apnoea usually involves a combination of symptoms although Obstructive Sleep Apnoea symptoms may initially be more obvious

Many Sleep Apnoea symptoms are first noticed by family or partners, as the affected individual may not be aware of, or remember, the disruptions in their sleep.

What Causes Sleep Apnoea?

Sleep Apnoea can occur for a variety of reasons, and Sleep Apnoea causes are typically linked to the type of Sleep Apnoea a person has.

Generally, Sleep Apnoea is caused by the restriction of breathing during sleep. This can be physical (as in Obstructive Sleep Apnoea), neurological (as in Central Sleep Apnoea) or a combination (Complex Sleep Apnoea).

Although anyone can be affected by Sleep Apnoea, there are several risk factors which increase the chance of it developing:

Obesity – Being overweight may increase the risk of Sleep Apnoea as excess weight around the neck can put pressure on the throat narrowing the airway
Age – The risk of Sleep Apnoea increases with age, although young people can also develop the condition
Gender – Men are more likely to develop Sleep Apnoea than women
Genetics – Family history of Sleep Apnoea may increase an individual’s risk of developing Sleep Apnoea
Lifestyle – Smoking and drinking alcohol are linked to Sleep Apnoea
Nasal Congestion – Nasal obstruction may cause or worsen Sleep Apnoea
Sleeping Position – Sleeping on your back can cause the jaw or tongue to fall backwards, leading to Sleep Apnoea

How to Diagnose Sleep Apnoea

If you are concerned about Sleep Apnoea, the first person to speak with is your GP. They will discuss your concerns and may refer you to a specialist sleep clinic for further testing.

Sleep Apnoea diagnosis testing involves wearing a variety of medical devices overnight to monitor certain signs:

Breathing
Heart rate
Oxygen levels

Initially, you will be asked to complete these tests at home. However, if this testing is inconclusive or more information is required, you may be asked to undergo a more comprehensive sleep study at a specialist clinic.

As well as measuring your key health variables, this more detailed testing will monitor:

Brain activity
Eye movement
Muscle movement
Snoring
Sounds you make
Body position

The information from the testing is taken and translated into a Sleep Apnoea AHI (Apnoea-Hypopnea Index) score.

The Sleep Apnoea AHI score measures the number of pauses in breathing per hour of sleep. The score then guides diagnosis and treatment options.

There are two types of breathing interruption, which are considered in Sleep Apnoea diagnosis:

Apnoea – A complete blockage of the airway for at least 10 seconds
Hypopnoea – A partial blockage of the airway which reduces airflow by more than 50% for at least 10 seconds

A higher Sleep Apnoea AHI score indicates more severe Sleep Apnoea:

Normal (no Sleep Apnoea) – 0-5 breathing disruptions per hour
Mild – 5-14 breathing disruptions per hour
Moderate – 15-29 breathing disruptions per hour
Severe – 30 or more breathing disruptions per hour

The Sleep Apnoea AHI score is measured differently for children, who have lower thresholds due to their smaller lung capacity and faster metabolic rate.

Once you have an AHI score, your doctor will discuss Sleep Apnoea treatment options with you.

Treatment for Sleep Apnoea

Depending on the type, cause and severity of your Sleep Apnoea, there are a range of non-surgical and surgical treatment options available.

Your doctor will likely suggest trying several non-surgical Sleep Apnoea treatments before considering surgery.

Non-Surgical Treatment for Sleep Apnoea

Sleep Apnoea Machine

Positive Airway Pressure (PAP) is the most common treatment offered for moderate to severe Obstructive Sleep Apnoea.

The treatment involves a PAP machine which is connected by a tube to a mask which the patient wears over the mouth, nose or both while they sleep. The Sleep Apnoea machine maintains an open airway by delivering air at high pressure into the nose and/or mouth.

There are different types of PAP Sleep Apnoea machine depending on a patient’s needs:

CPAP (Continuous Positive Airway Pressure) – delivers air at one constant pressure, calibrated at the average level a patient requires throughout the night
BiPAP (Bilevel Positive Airway Pressure) Machine – Air is released at a higher pressure during inhaling and a lower pressure during exhaling
APAP (Auto-Adjusting Positive Airway Pressure) Machine – The level of air pressure is automatically adjusted depending on the needs of the patient

PAP therapy is considered highly effective for treating Obstructive Sleep Apnoea when used consistently, usually on a nightly basis. However, it is less effective for treating Central Sleep Apnoea.

Sleep Apnoea machines are designed to be extremely quiet, but some patients may find wearing the mask uncomfortable during sleep.

Adaptive Servo-Ventilation

Adaptive Servo-Ventilation (ASV) is primarily used as a treatment for Central Sleep Apnoea. Similar to PAP Sleep Apnoea machines, pressurised air is delivered through a mask worn during sleep, however instead of the airflow being constant, the ASV machine can detect when breathing has stopped completely to restart airflow.

Although it can be an effective treatment for some patients, ASV may not be suitable for those with congestive heart failure, which is often associated with Central Sleep Apnoea.

Expiratory Positive Airway Pressure

Unlike other PAP treatments for Sleep Apnoea, Expiratory Positive Airway Pressure (EPAP) doesn’t involve a Sleep Apnoea machine.

Instead, EPAP treatment requires two small valves that are placed into the nostrils each night. This can be more convenient for some patients as it doesn’t require electricity, makes minimal noise and is lightweight and portable.

Nasal EPAP is effective for some cases of Obstructive Sleep Apnoea, with patients experiencing a 53% reduction in symptoms. However, this is still a relatively new treatment for Sleep Apnoea, and more research is required to determine its long-term effectiveness and suitability for treating Central Sleep Apnoea.

Oral Devices

For patients who do not tolerate Sleep Apnoea machine treatment there are devices which can be placed in the mouth to physically open the airway during sleep:

Mandibular Advanced Splints (MAS) – MAS involves wearing a custom-made dental device, which fits over the top and bottom teeth, keeping the lower jaw in a forward position. This prevents the tongue from falling backwards to keep the airway open. It is most suitable for patients who experience mild to moderate Obstructive Sleep Apnoea with disruptive snoring
Tongue Retaining Devices – Tongue Retaining Devices prevent the tongue from falling backwards by using suction. They are often recommended for short-term treatment of Obstructive Sleep Apnoea and are not as effective as PAP therapy

Medication

Sleep Apnoea medication is a less common treatment in the UK; however, it may be available in some circumstances.

There are two primary types of Sleep Apnoea medication:

Muscle Relaxers – These are offered for Obstructive Sleep Apnoea and work by relaxing the muscles involved in breathing. This allows the patient to take deeper, more consistent breaths, which results in more oxygen entering the body
Stimulants – These are offered for Central Sleep Apnoea and work by stimulating the nervous system to prevent disruptions in the messaging between the brain and respiratory system, resulting in improved breathing consistency

Sleep Apnoea medication may only be available in specific circumstances, and all other treatment options must have been exhausted.

Lifestyle Changes

Depending on the cause of the Sleep Apnoea, doctors may suggest certain lifestyle changes to improve the symptoms:

Weight loss – Where excess weight may be contributing to Obstructive Sleep Apnoea, weight loss may be recommended
Throat exercises – A series of tongue, palate and throat movements have been shown to reduce the severity of Obstructive Sleep Apnoea symptoms when performed regularly for three months
Changing sleep position – Sleeping on your back is associated with more severe Sleep Apnoea. By learning to sleep on your side, symptoms can be improved
Avoiding alcohol and quitting smoking – Both smoking and drinking alcohol can increase the risk of Obstructive Sleep Apnoea
Changing certain medications – If you are taking prescription medications which you feel are affecting your sleep, it is essential to speak with your doctor to see if an alternative may be more suitable.

Surgical Treatments for Sleep Apnoea

Tissue Removal

There are several tissue removal procedures which can address Obstructive Sleep Apnoea, by removing physical restrictions to breathing:

Uvulopalatopharyngoplasty – This surgery involves removing part of the uvula at the back of the mouth along with parts of the soft palate
Adenoidectomy – The adenoids are the glands found above the roof of the mouth. This procedure is most often performed in children with Obstructive Sleep Apnoea
Tonsillectomy – Tonsil removal is a common surgery for Obstructive Sleep Apnoea and may be combined with other procedures

Jaw Repositioning

Also known as Maxillomandibular Advancement, Jaw Repositioning surgery moves the jaw forward to keep the airway clear and prevent the tongue from falling backwards.

On average, repositioning the jaw reduces Obstructive Sleep Apnoea symptoms by 87% and is successful for around 85% of patients. However, it can change the physical appearance of the face, which some people may wish to avoid.

Rhinoplasty Surgery

Various functional concerns affecting the nose can contribute to Obstructive Sleep Apnoea.

Misaligned cartilage within the nose and enlarged turbinates can narrow the airways and limit airflow, causing Sleep Apnoea. There are several Rhinoplasty procedures which can help treat Sleep Apnoea:

Rhinoplasty – This procedure adjusts the shape and alignment of the nose
Septoplasty – A surgery which straightens the cartilage which separates the two nostrils (the septum)
Septorhinoplasty – This combines Rhinoplasty and Septoplasty to realign the nose and reposition the internal structures
Turbinectomy – This removes excess tissue from the turbinates (the small bones in the upper airways of the nose) when they become inflamed
Nasal Valve Surgery – This opens up the nostrils to improve airflow

Cadogan Clinic has a team of expert Consultant Rhinoplasty Surgeons, who are specialists in performing Functional Rhinoplasty procedures to address conditions such as Sleep Apnoea.

Words From Our Founder

Mr. Bryan Mayou

Sleep Apnoea is a common but often undiagnosed sleep disorder involving episodes of disrupted breathing. This has a significant impact on quality of life, affecting physical and mental health. In cases where a Rhinoplasty procedure can open the airways, this is often an effective and long-term solution for patients struggling with this draining condition.

Mr. Bryan Mayou

Frequently Asked Questions

Is Sleep Apnoea a disability?

In some cases, Sleep Apnoea may be considered a disability under the UK Equality Act 2010, if it is severe enough to impact your ability to undertake normal daily activities for over a year. This is due to the potential severity of Sleep Apnoea side effects, which can impair physical and mental health and may require certain support and protection.

Is Sleep Apnoea dangerous?

Undiagnosed and untreated Sleep Apnoea can be dangerous as it significantly increases the risk of serious health problems such as high blood pressure, heart conditions, and Type II Diabetes.

Due to the nature of Sleep Apnoea, up to 85% of affected individuals are not aware that they are suffering from the condition, leaving it untreated and associated concerns unmonitored.

Is Sleep Apnoea hereditary?

Sleep Apnoea may be hereditary for some patients. Family history is a risk factor for Sleep Apnoea as genes influence the structure of your skull and airways, which may play a part in whether you develop the condition. People with naturally narrow airways are more likely to have Sleep Apnoea, and they may inherit this trait from relatives.

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