Introduction

What is sleep related disordered breathing or sleep apnea?

If you snore, you may have sleep related disordered breathing which is also known as sleep apnea or obstructive sleep apnea (OSA). There are 2 terms when discussing sleep related disordered breathing. The first is apnea which refers to the complete airflow obstruction at the nose or mouth. The other is hypopnea which refers to the partial airflow obstruction during sleep.

Sleep Related Disordered Breathing can be categorized into 3 main groups.

1. Obstructive Sleep Apnea (OSA)
   The most common type of sleep apnea occurs when the upper airway occludes (either partially or fully) but efforts to breathe continue. The primary causes of upper airway obstruction are lack of muscle tone during sleep, excess tissue in the upper airway, and anatomic abnormalities in the upper airway and jaw.

1. Central sleep apnea (CSA)
   Affects only 5-10% of the sleep apnea population. Occurs when both airflow and respiratory effort cease. This cessation of breathing results from a decrease ventilator drive. Mixed apnea Is even less common than CSA. Occurs when there is both a central and obstructive component.

1. Mixed apnea
   This Is even less common than CSA. Occurs when there is both a central and obstructive component.
   If you snore, you might have a common sleeping disorder called sleep apnea, also known as Obstructive Sleep Apnea (OSA).
   If you have OSA, it means your upper airway temporarily closes while you sleep, causing you to stop breathing. These periods when your breathing stops (called apnea) last for at least ten seconds and may happen up to several hundred times a night.This puts a strain on your body, raising blood pressure and reducing your quality of sleep. These repeated apneas reduce your oxygen levels, and this alerts your brain to wake the body to begin breathing again.

Diagnosis

Clinicians have a variety of diagnostic procedures to choose from, ranging from at-home to in-hospital studies which include an evaluation of sleep breathing.

Regardless of which diagnostic test is used, a clinical history of sleep apnea and a consultation with a sleep specialist are integral to the diagnosis.

Symptoms

• Excessive daytime sleepiness (EDS)
• Witnessed apneas
• Snoring (generally associated with OSA, not CSA)
• Irregular breathing during sleep
• Unrefreshing sleep
• Poor concentration
• Poor memory
• High blood pressure
• Anatomical abnormalities
• Motor vehicle accidents as result of dozing off on the wheels
• Accidents at work place especially ones involving heavy machineries

Who are at risk to develop sleep apnoea?

These are :

• Overweight/Obese
• Male gender
• Increasing age  (up to 65)
• Smoking
• Alcohol  and sedatives intake
• Family history of OSA
• Abnormal structures over the upper respiratory tract
• Hypothyroidism and acromegaly

Your doctor may send you for a sleep study, to confirm the diagnosis of sleep apnea and start your treatment plan.

What questions might your doctor ask?

• Do you feel tired much of the time?
• Do you take naps during the day?
• Do you have trouble sleeping through the night?
• Do you have to go to the toilet in the middle of the night?
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

If you think you have sleep apnea, you’re likely to start by visiting your doctor, who may refer you to a sleep specialist. What can you do in the meantime?

What you can do in the meantime

• Try to sleep on your side. Most forms of sleep apnea are milder when you sleepyour side
• Avoid alcohol and sedatives as both worsens obstructive sleep apnoea
• If you’re drowsy, avoid driving. If you have sleep apnea you may be abnormal sleepy, which can put you at higher risk of motor vehicle accident

Getting Diagnosed

If your sleep physician refers you for a sleep test, they are basically interested in monitoring your breathing, body movements and responses during the night to see if you have a sleep disorder. Sleep tests can take place in a sleep clinic, hospital or in the convenience of your own home.

What happens during a clinic sleep test?

In a clinic or hospital, clinical staff will place sensors on your body to monitor your sleep.??Sensors are placed:

• on your chest to monitor your heart activity
• close to your eyelids to measure eye movements that help indicate the stage of sleep you are in
• on your head to measure electrical signals from the brain
• on your legs to assess muscle activity.

You’ll also be fitted with:

• a nasal cannula to monitor your breathing
• an oximeter on your finger to record your oxygen levels
• bands around your chest and stomach to measure breathing effort.

With your permission, the clinic may also film you as you sleep to gain more insights into your sleeping behaviour. You will be required to stay overnight at the clinic or hospital, so you should take everything you need for your usual sleeping routine, including pyjamas and toiletries.

What happens during home sleep tests?

The set-up is similar for home tests, with the added benefits of comfort, familiarity and convenience. Prior to your sleep test night, a sleep clinician will have shown you how to apply the sensors and monitors, and how to use the recording device during the night. Follow your normal evening routine and when you are ready for sleep, attach everything as you have been shown and start the recording. In the morning, remove everything as you have been shown and return the recording device to the clinic.

How will I get my results

After your test, make a follow-up appointment with your sleep physician to discussyour results. If the results show that you have a sleep disorder, your sleep physician will talk to you about its severity, its possible effects on your health and your treatment option

You will also be referred to the otorhinolaryngologist to look for any obstruction in the nose and upper respiratoray tract such as enlarged tonsils, polyps, or a deviated nasal septum.

Treatment

Treatment Options

• Continuous  Positive Airway Pressure (CPAP) therapy provided one constant air pressure throught the night.
• Automatic Positive Airway Pressure (APAP) therapy automatically varies the pressure throught the night .
• Bilevel therapy is used in the circumstance where a higher pressure is required for effective therapy and expiratory pressure is provided.

Treatment given will:

• Open airways which is blocked thus facilitates breathing
• Reduce of abolishes snoring
• Thus sleep quality improves for you and your partner
• You will get a good night’s rest and shall be able to function well during the day.

Very few patients requires surgery

How can your family help?

Most of the time, patient does not know that they have the disease. They also do not realize that they stop breathing many times during sleep. Family members or sleeping partner would be the first to notice this. There are a few measures the family or partner can help:

• Let patient know that they snore
• Ask patient to seek treatment
• Help patient find a doctor specializing in sleep medicine including use of CPAP
• Machines should be cleaned regularly
• Emotional and moral support is also important
• It is important that patients with sleep disorder seek treatment from early from a right  doctor.  Remember that treating sleep disorders not only treat you but also the whole family. Follow-up treatment is important, to ensure treatment is effective and without side-effects.

Prevention

• Practice healthy lifestyles which includes:
• Ideal body weight
• Balanced diet
• Exercise
• Avoid alcohol or sedatives
• Seek treatment if you have hypertension, hypothyroidism or acromegaly.