What is Obstructive Sleep Apnoea (OSA)?

OSA is a serious, potentially life threatening disease characterised by repetitive pauses in breathing during sleep due to the obstruction and/or collapse of the upper airway (throat), usually accompanied by a reduction in blood-oxygen saturation, and followed by an awakening to breathe.

Obstruction of the upper airway occurs when the muscles which control the tongue and soft palate relax, causing the airway to narrow. This leads to snoring and breathing difficulties. OSA occurs when these muscles become too relaxed, completely blocking the airway and preventing breathing.

Breathing can often stop from anything between ten seconds to two minutes. At this point the brain reacts to the oxygen deficiency and alerts the body to wake up. In most cases, the sufferer is unaware of this, as the arousal is slight. As this can happen several hundred times during the night, it is enough to fragment sleep, causing the sufferer to feel sleepy and lethargic the next day.

What Are the Warning Signs of OSA?

• Loud, repetitive snoring – OSA sufferers often follow a pattern of loud snoring followed by episodes of silence, and then gasps for breath
• Excessive daytime sleepiness – most people with OSA have difficulty staying awake during the day, regardless of how much sleep they have. This can occur whilst at work, watching TV, driving the car, or even sitting behind your desk at work.
• Erratic mood shifts – people with OSA are more susceptible to depression and increased irritability. OSA is often associated with impotence in men, and menstrual irregularities in women.

FIGURE 1A: Normal airway The soft palate and uvula are normal in length and total size. The tongue is normal in size and is angled forward. The upper airway at the level of the nasopharynx, oropharynx and hypopharynx is normal in size and contour.

FIGURE 1B: Abnormal airway during sleep Multiple sites of obstruction often occur in patients with obstructive sleep apnea. An elongated and enlarged soft palate impinges on the posterior airway at the level of the nasopharynx and oral pharynx. In addition, a retruding jaw pushes an enlarged tongue posteriorly to impinge on the hypopharyngeal space.

Can OSA Be Treated?

YES, IT CAN!
Effective treatments fall into several categories:

Continuous Positive Airway Pressure (CPAP) – this is the most common and effective method. By delivering air under slight pressure to the airway through a nasal mask, the upper airway can be kept open, creating a kind of “air splint,” which prevents apnoeas and snoring. Relief is immediate in the vast majority of users.

Oral Devices – that reposition the lower jaw and tongue are useful in reducing snoring in mild OSA cases. However, as OSA is generally a progressive condition which worsens with age, relief is often temporal.

Surgery – not to be taken lightly. It is almost never a “cure-all” and the risks often outweigh the benefits. Such procedures are effective in a small proportion of mild OSA sufferers only.

Frequently Asked Questions

Is there anything I can do myself?
While the techniques below will not “cure” your OSA, they will help alleviate it:

• Weight loss – obesity contributes to OSA in 2 ways: (1) fat deposits in the neck tissue compress the airway and make it more likely to collapse; and (2) excess weight in the abdomen makes the breathing muscles operate inefficiently, which contributes to breathing difficulty when sleeping.
• Smoking – as you probably are aware, smoking damages your lungs. By reducing your lung capacity, smoking can exacerbate your sleep apnoea.
• Alcohol – should not be taken in the evening as it depresses your breathing reflexes and significantly worsens sleep apnoea. Excessive drunkenness should be avoided as it’s possible that if you depress your reflexes enough, you might not wake up at all. This applies to sleeping pills, drugs, or anything else that might affect your breathing.

What happens if I ignore my OSA?
OSA left untreated is potentially life-threatening. The risks include heart attacks, strokes, irregular heartbeat, hypertension, loss of interest in sex/impotence and frequent night-time urination. Furthermore, OSA causes daytime sleepiness that can result in accidents, lost productivity and interpersonal relationship problems.

How long will I have to use a CPAP for?
No matter what you read or hear, there is no known cure for OSA. CPAP use is a long-term commitment. Without it, your symptoms will return.

Do I Need Help?

It is estimated in Australia that 17 percent of middle-aged men and 6 percent of middle-aged women suffer from OSA. Despite being as prevalent as diabetes and asthma, research has shown that fewer than 10 percent of sufferers have been treated for the disease. That means that a staggering 90 percent of sufferers aren’t even aware they have it!

To help those sufferers who live their lives with OSA untreated, we have devised a simple questionnaire to help you determine for yourself whether you require medical advice.

Sleep Questionnaire

If you answered ‘Yes’ to two or more of the above, it is quite likely you are amongst the 90 percent of unsuspecting OSA sufferers. GET HELP! See your family doctor NOW! You owe it to yourself to have a good night’s rest! Your future health and quality of life depends on it!