Sleep Apnoea

In my experience as a ENT specialist in practice for 26 years there are no medical or surgical conditions which when adequately treated get the most gratifying satisfaction from my patients with Obstructive Sleep Apnoea (OSA) which has been properly managed.

It is my belief that it remains one of the most untreated, treatable, conditions in medicine. Most GPs, and surprisingly specialists, wait until a significant medical event occurs, eg Stroke, Heart attack, Severe depression, Car accident, before the penny drops and they think about this condition..

Could this person heave sleep apnoea?

I believe doctors who miss this condition are negligent. Who would not treat a diabetic with insulin or a hypertensive with adequate medication? It’s the same scenario.

This oversight needs to change and doctors need to be more pro-active. Identifying these patients should be a priority in all practices simply because there is excellent treatment available and it makes such a difference to our physiology. We cannot live without adequate sleep and oxygen and that toxic combination is what is lacking in sleep apnoea.

What is Sleep Apnoea? 

‘Apnoea’ literally means ‘the absence of breathing’ and this is in fact what happens when one sleeps and has this medical condition. When we are awake there is tone in our upper airways and we have no problem breathing the oxygen rich Hermanus air. The problem arises when we are in a relaxed sleeping state. Our upper airways may collapse and we have apnoea events (no air flow if measured at the nose or mouth)  which can last minutes! Try holding your breath for 2 minutes whilst awake?  Also, because of the obstruction we tend to repeatedly wake up for a few seconds depriving our bodies of the deep dreaming sleep which is essential for normal functioning. The net effect is therefore poor quality sleep and reduced oxygen supply to all our vital (and non-vital) organs.

Could this be me?

The symptoms are sometimes obvious with daytime somnolence and even falling asleep whilst driving reported. More subtle symptoms are morning headaches, depression, malaise and forgetfulness

More subtle symptoms are morning headaches, depression, malaise and forgetfulness

What are the dangers of Sleep Apnoea?

Sleep apnoea will have adverse effects on the brain, heart, lungs and hormone systems. 

People most at risk for this problem are usually overweight (but not always so) with the weight distribution especially in the neck area. Sometimes snoring may be also prevalent but one may have severe apnoea without snoring at all. One may also snore without the presence of sleep apnoea. Sleep apnoea incidence increases with advancing age and is less related to obesity.

How is Sleep Apnoea diagnosed?

The diagnosis is made by means of a sleep study(polysomnogram) which gives information on the number of apnoea events per hour and the degree to which the level of oxygen in the blood falls while this breath-holding occurs.

So if this is my problem all I have to do is lose weight you may think? This is however not so easy. There is a vicious cycle working against all good intentions here, with weight gain, poor motivation, increased nibbling and decreased physical activity an all too common phenomenon. A good night’s sleep with decent oxygen levels in the blood is a better diet than any which can be prescribed. Importantly, treatment of sleep apnoea is mandatory in anyone with Type 2 diabetes.

How is Sleep Apnoea managed?

A thorough history and examination of your upper airways are required to exclude a surgically correctable cause of the obstruction. The management of the condition has evolved over the last 10 years with the recognition that any surgical options should be more carefully selected because of the advancement in technology of continuous positive airway (CPAP) machines. There are also dental devices which may. be helpful. Whatever the treatment prescribed it is important to re-evaluate the resultant apnoea post this device/ procedure. Is the apnoea adequately treated?

The mainstay of medical treatment is a continuous positive pressure machine.(CPAP). This is a highly specialized machine which is attached to a mask which fits snugly over the nose and occasionally also the mouth. The machine detects when the airflow is obstructed and increases the pressure of the air flowing through the nose which in effect opens up the airways. This sounds like it could be a bit of a passion killer and that you might think you are waking up next to Darth Vader but it’s a small price to pay for an optimal functioning body on the way to better health.

Sleep apnoea will adversely affect the brain, heart, lungs and hormone systems