Oman wellness: Obstructive sleep apnoea

When you have sleep apnoea, your breath can become very shallow or you may even stop breathing briefly while you are sleeping. It can happen many times at night in some people. Obstructive sleep apnoea happens when something partly or completely blocks your upper airway during sleep. That makes your diaphragm and chest muscles work harder to open the obstructed airway and pull air into the lungs. Breathing usually resumes with a loud gasp, snort, or body jerk. You may not sleep well, but you probably won’t be aware that this is happening. The condition can also reduce the flow of oxygen to vital organs and cause irregular heart rhythms.

Symptoms
The most common obstructive sleep apnoea warning signs include
• Daytime sleepiness or fatigue
• Dry mouth or sore throat when you wake up
• Headaches in the morning
• Trouble concentrating, forgetfulness, depression, or irritability
• Night sweats
• Restlessness during sleep
• Snoring
• Waking up suddenly and feeling like you’re gasping or choking
• Trouble getting up in the mornings.
If you share a bed with someone, they’ll probably notice it before you do.

Symptoms in children may not be as obvious. They may include
• Bedwetting
• Choking or drooling
• Sweating a lot at night
• Ribcage moves inward when they exhale
• Learning and behaviour
disorders
• Problems at school
• Sluggishness or sleepiness (often misinterpreted as laziness in the classroom)
• Snoring
• Teeth grinding
• Restlessness in bed
• Pauses or absence of breathing
• Unusual sleeping positions, such as sleeping on the hands and knees, or with the neck hyper-extended

It’s more likely if you’re overweight or obese, have a thick or large neck, or have smaller airways in your nose, throat, or mouth.
It can also happen if you have enlarged tonsils or too much tissue at the back of the throat — the uvula and soft palate — that hangs down and blocks the windpipe. A larger-than-average tongue can also block the airway in many people as well as a deviated septum in the nose. The condition is more common among men than women, and it becomes more likely as you get older. But it’s not a normal part of ageing. Other risk factors include: Smoking, diabetes, high blood pressure, and being at risk for heart failure or stroke.

Diagnosis
Your doctor will give you a checkup and ask about your sleep. He may also want to ask people who live with you about your sleeping habits. You may need to spend a night in a sleep lab or have a sleep study done at your house. You’ll wear monitors to measure things such as:
•Air flow
•Blood oxygen levels
•Breathing patterns
•Electrical activity of the brain
•Eye movements
•Heart rate
•Muscle activity
The study will track how many times your breathing was impaired during sleep.
You may also need to undergo certain blood test, a cardiology opinion, and a ct scan or Mri
Your otolaryngologist may also do some endoscopic examinations before suggesting the treatment options.

Treatment
The possible options include:
Weight loss, if needed. Losing even 10% of your weight can make a difference. Avoid alcohol and sleeping pills, which make the airway more likely to collapse during sleep and lengthen the times when you’re not breathing properly. Sleeping on your side, if you only get mild sleep apnoea when you sleep on your back. Nasal sprays, if sinus problems or nasal congestion make it harder to breathe while you sleep.

CPAP Machine
This device includes a mask that you wear over your nose or mouth, or both. An air blower forces constant and continuous air through the nose or mouth. The air pressure is just enough to keep the upper airway tissues from collapsing during sleep.
Other types of positive airway pressure devices are also available, including the BPAP, which has two levels of air flow that vary with breathing in and out.
Oral devices. For people with mild sleep apnoea, dental appliances or oral “mandibular advancement” devices that prevent the tongue from blocking the throat or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A dental expert who is trained in oral health, TMJ, and dental occlusion can check on which type of device may be best for you.
Surgery is for people who have extra or misshapen tissue that blocks airflow through the nose or throat. For example, a person with a deviated nasal septum, enlarged tonsils and adenoids, or a small lower jaw that causes the throat to be too narrow might benefit from surgery. Doctors usually try other treatments first.

Type of Surgeries
Upper Airway Stimulator
This device, called Inspire, has a small pulse generator that the surgeon places under the skin in your upper chest. A wire leading to the lung detects your natural breathing pattern. Another wire, leading up to the neck, delivers mild stimulation to nerves that control airway muscles, keeping them open. A doctor can programme the device from an external remote.

Somnoplasty
Doctors use radiofrequency energy to tighten the soft palate at the back of the throat.

UPPP, or UP3
This is a procedure that removes soft tissue in the back of the throat and palate, increasing the width of the airway at the throat opening. (UPPP stands for uvulopalatopharyngoplasty.)

Mandibular/Maxillary
Advancement Surgery
The surgeon moves the jaw bone and face bones forward to make more room in the back of the throat. It’s an intricate procedure that doctors only do for people who have severe sleep apnoea.

Nasal surgery
These operations correct obstructions in the nose, such as a deviated septum.
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(Dr Benaifer Bilimoria is ENT Specialist at NMC Healthcare LLC)