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Snoring and sleep apnoea

By MIKE DIKES health@the-resident.com

Mr Mike Dilkes MS FRCS is a Consultant ENT Surgeon.

MANY READERS will have, probably literally, heard of snoring.

However, most of you won’t know what sleep apnoea is. Apnoea means ‘no breathing’, therefore sleep apnoea is when you stop breathing at night, while asleep.

Snoring, when left untreated, may progress to sleep apnoea over the passage of time. Approximately 40 per cent of males over the age of 35 snore regularly, of these two per cent have sleep apnoea. At the age of 65, 70 per cent of males snore regularly – 10 per cent have sleep apnoea. When you have proper sleep apnoea, your blood oxygen concentration can regularly drop to below 70 per cent – it usually runs at 99 per cent. This means your organs are deprived of oxygen for significant periods of time at night  and if their oxygen supply is already a bit precarious,  such as in patients with furring of the arteries (atherosclerosis), then this loss of oxygen can become critical.

Sleep apnoea is associated with all sorts of other medical problems, from heart attacks in the middle of the night, to impotence, lack of concentration, poor memory, diabetes, blood pressure and so on. Those people with sleep apnoea usually have an Epworth score above 10 – see table below. Sleep apnoea is diagnosed best by a multi-channel sleep study.

Snoring needs little real explanation, it is the noise produced by a partially blocked airway, when flow of air becomes turbulent, producing noise. This is often exacerbated by having a long soft palate, which then flaps in the turbulent airflow, causing even more sound to be produced.

Therefore, the treatment of snoring is to unblock the airway, as it is with apnoea, since one is just an extension of the other. This can mean having a small ventilator fitted over the nose at night, which forces air into the lungs, causing the airway to be stretched open – Nasal CPAP. It can also mean having a tooth splint fitted to the upper and lower jaw at night, holding the lower jaw in a forward position, which in turn pulls the tongue forward, and opens the airway at the back of the tongue – the most common site for airway obstruction at night.

Surgery

Otherwise, surgery can be performed to reduce back the tonsils (laser tonsillotomy), shrink back the soft palate (laser palatoplasty), or open up the nose (septoplasty). Perhaps the easiest, and best, way of treating this condition is to lose weight. Your BMI (body mass index) should be less than 30 – calculate it by taking your weight in kilogrammes, and divide it by your height in metres that has been squared (i.e. your height in metres x your height in metres). Losing weight both reduces the oxygen requirement of the body, meaning you breathe more lightly, and reduces the bulk of the neck, which means there is less pressure on the airway from this weight, so it obstructs less easily.

If you suffer from any of these conditions, or your doctor thinks you might have some of the associated problems, you need to be assessed by an ENT doctor who has a special interest in this area. You may need to be referred for a sleep study, and then need some treatment, as outlined above. Untreated sleep apnoea can seriously damage your health. Untreated snoring can seriously damage your wealth.

Mr Mike Dilkes MS FRCS is a Consultant ENT Surgeon. For an appointment or for further information please call FMC Quinta do Lago on (00351) 289 398 411.