Daytime sleepiness, loud snoring and restless sleep are all hallmarks of the disorder known as sleep apnoea. “Sleep apnoea is a condition where breathing during sleep is disturbed,” says Professor Seamus Linnane, who is deputy medical director of the Beacon Hospital and a consultant in respiratory and general internal medicine.
“The affected individual will have an interruption to their breathing with a drop in their oxygen levels occurring at least five times per hour on average during sleep,” he says.
The most common cause is obesity and excess weight but there are several risk factors for sleep apnoea, he explains.
“Sleep apnoea happens if your airways (walls of the throat) become too narrow while you sleep and obstructs the flow of air into your lungs.
“Risk factors include obesity, having a large neck (17.5” shirt size is the average size), ageing and smoking. Drinking alcohol or taking sedatives at night also worsen the severity and there can also be a genetic link.”
He elaborates on what happens.
“As the breathing is obstructed and as the oxygen level drops the body’s response is to struggle to take the next breath.
“The person’s heart rate and blood pressure also go up and the depth of sleep that the person is in becomes lighter. The person may not wake up at all during that event, however, so they may not be aware that they are struggling to breathe,” he says.
It’s often the spouse or partner that alerts the person to the problem.
“Very often it will be the bed partner who notices that the person beside them is breathing erratically or gasping for breath,” he says.
“They will report lying beside their partner at night and waiting for the next breath to come or giving a nudge to encourage the person to take the next breath, so it does have an impact on the sleep quality of the bed partner as well.”
Sleep apnoea is quite common, he says.
“Some surveys say that 5% of middle-aged men will suffer from sleep apnoea. It’s usually considered that we know about half the people who have this so half of it is undiagnosed. If we extrapolate out in the Irish population it equates to over 100,000 people. While it is more common in men it can affect women as well.”
Impact on daily life
Having sleep apnoea can mean that the person feels exhausted even though they have just spent eight hours in bed. This sleep deprivation can have a major impact on their daily life.
“These mini sleep interruptions can occur many times an hour so the quality of the person’s sleep is severely degraded,” Professor Linnane says.
Five to 15 obstructions per hour is considered mild, 15-30 is moderate and >30 obstructions per hour is considered severe.
“What you have then is chronic sleep deprivation, so it’s the sense of waking up feeling exhausted, it’s the tendency to have or to require naps or experience an overwhelming urge to sleep during the day.”
Mental acuity is affected by this lack of sleep, too.
“It can impact the ability to make decisions or undertake complex tasks. That’s where machinery and driving and the very high increase in accidents with sleep apnoea occurs.”
There are biological consequences to sleep deprivation also.
“There is a tendency to have further weight gain and the increased risk of high blood pressure, strokes and heart attacks.”
Road accident increase
The danger of sleep apnoea for those who drive has been proven in accident statistics, he says.
“There is data showing that those with sleep apnoea are seven times more likely to be involved in major road traffic accidents (because of falling asleep or having ‘micro sleeps’ at the wheel).
“The road traffic accidents tend to happen on motorways when driving is boring or repetitive, when people are at high speed and have been driving for a while. They are then high-velocity, high-impact accidents. The Road Safety Authority (RSA) has therefore listed sleep apnoea as a notifiable medical condition along with others like epilepsy and diabetes.”
He points out that there is a self-declaration as part of the driving licence form.
“There is a box that asks ‘Do you have sleep apnoea?’ then there is the decision to be made by the doctor as to whether somebody is able to continue to drive. He or she has to certify that the person’s sleep apnoea is effectively treated and is not affecting the person’s ability to drive.
“For category 1 licences, as long as the sleep apnoea can be documented as treated ie it’s mild or not affecting daytime alertness, the person can drive unrestricted. With effective treatment you can have people back on the road without any difficulty.”
So how is sleep apnoea diagnosed? It involves an overnight stay in hospital during which the person’s sleep is monitored, he says.
“Oxygen levels and breathing are monitored, also brain waves and heart levels in order to make a diagnosis.”
The first treatment approach involves lifestyle change.
“Weight reduction can significantly improve the oxygen levels and breathing. Avoidance of alcohol at night is also helpful because it will reduce the number of low oxygen level incidents that can lead to sleep apnoea.”
Such approaches can take time, however, and have variable success. If these changes don’t help sufficiently, a continuous positive airway pressure (CPAP) machine is prescribed.
“The person wears a mask either on the nose or under the nose or over the mouth and nose. The machine applies regular room air under a slight increase in pressure. That pressure increases the pressure inside the upper airway so that it can’t collapse and therefore can’t occlude and obstruct. The CPAP machine is worn for the entire night’s sleep, seven nights a week.”
Using this machine can often transform the person’s life.
“For those with moderate or severe sleep apnoea, when everything works well, people report that their lives are completely different within a couple of days. They have energy, they can think straight, they are waking up refreshed,” he says.
“There are all these knock-on benefits in terms of their work, their relationships, their quality of life and their sense of wellbeing. While it can take a while to get used to, if they are feeling much better within a couple of days, they are enormously incentivised to keep using the machine.”
But what if the CPAP machine doesn’t work for an individual?
“For some people who have mild sleep apnoea or a simple snoring issue or if they struggle with the CPAP there is a technology called a mandibular advancement device,” he says.
“This is essentially an oral appliance. It’s like two tailor-made gum shields, one on the upper teeth and one on the lower teeth that help reposition the lower jaw during sleep thereby allowing air to flow freely into the lungs.”
While Professor Linnane doesn’t know if farmers are more affected by sleep apnoea than other groups in society, sleep disruption coupled with sleep apnoea could make farmers more vulnerable to accidents, he believes.
“I see many farmers and am aware of issues with what’s called sleep hygiene and sleep maintenance. In terms of my assessment of them, they have disrupted sleep from getting up (for example to tend stock) during the night or they have too little sleep, going to bed late and getting up very early. All this has an impact on the person’s quality of life.
“We’re talking about the ideal where someone should be getting eight hours sleep a night but if someone isn’t getting enough sleep (because of their occupation) and then if the sleep they do get is ineffective (because of a medical problem like sleep apnoea), that adds greatly to the complexity.”
He points out the need for tackling the sleep hygiene issue.
“You sometimes have to work with people and say ‘Look, we’ve fixed your sleep apnoea but we also have to look at your sleep volume and your sleep opportunity and how your occupation is impacting on the quality of your sleep’.
“Sleep apnoea is a very severe example of how sleep deprivation can have very negative impacts in terms of quality of life and health and so forth,” he says, “and farmers’ sleep is disrupted perhaps more than other occupations.
“Certainly the incidence of accidents among farmers seems to be higher than in other occupations. Sleep deprivation coupled with sleep apnoea would leave farmers in a vulnerable position.”
Cystic Fibrosis Ireland (CFI) is calling on people to support 65 Roses Day, taking place on Friday 8 April, by taking part in a 65 Roses Challenge, donating online at 65Roses.ie, or by purchasing a purple rose in participating Dunnes Stores, shopping centres and other outlets nationwide.
This year, the annual fundraising day – which derives its name from the way in which young children often first say the words “cystic fibrosis” – is seeking to raise €350,000 to provide support and services for people with cystic fibrosis including funding for the CFI Fertility Grant scheme.