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Sleep Medicine Library

Obstructive Sleep Apnoea (OSA)

What is Obstructive Sleep Apnoea?

Obstructive Sleep Apnoea (OSA) is a condition that makes you stop breathing for short periods while you are asleep. It is a highly prevalent condition. 40% of adult men and 30% of women have the condition.

Muscles that control the airway for speaking, swallowing, and breathing surround the throat. During sleep, these muscles are less active. This causes the throat to narrow In most people, this narrowing does not affect breathing. In others, it can cause snoring, sometimes with reduced or completely blocked airflow.

People with obstructive sleep apnoea often do not know that they stop breathing when they are asleep.

OSA causes oxygen levels to fall. Because the airway is blocked, breathing faster or harder does not help to improve oxygen levels until the airway is reopened. Typically, the obstruction requires the person to rouse to activate the upper airway muscles.

Many people with sleep apnea are unaware of their abnormal breathing in sleep, and patients often underestimate how often their sleep is interrupted.

Consequences of untreated OSA

This diagram shows the potential medical consequences of untreated OSA.

What are the symptoms of OSA?
  • Snoring
  • Choking or gasping during sleep
  • Pauses in breathing
  • Morning headaches, dry mouth, or sore throat
  • Tiredness, fatigue and daytime sleepiness
  • Restless sleep
  • Insomnia
  • Waking up feeling unrefreshed or groggy
  • Trouble concentrating
  • Depression, irritability
  • Drowsiness particularly when driving
What are the risk factors for OSA?
  • Snoring
  • Feeling tired and unrefreshed
  • Observed stopping breathing
  • Excess weight: BMI>25
  • Large neck size (>43cm for men, >40cm for women)
  • Older age (>40 for men, >50 for women)
  • Male
  • Smoker
  • Hypertensive
  • Family History
Do I have OSA?

The STOP-BANG questionnaire is sometimes helpful in determining if you might have OSA.

If you answer “YES” to 3 or more of the statements in the STOP-BANG questionnaire you have a moderate to high risk of having OSA. Please see your doctor regarding the results of this questionnaire.

Download and print the document below to fill out the questionnaire.

Is there a test for OSA?

Yes. If your doctor suspects you have sleep apnoea, he or she might send you for a sleep apnoea test or sleep sleep study. Sleep studies can be done at home or in a sleep laboratory.

Click the button below to view our services page, then open the Sleep Apnoea Tests tab.

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Is there anything I can do on my own to help my OSA?
  • Lifestyle modifications
  • Lose weight, if you are overweight
  • Avoid sedatives including alcohol, because these can make sleep apnoea worse
  • Avoiding sleeping on your back can occasionally help in some cases
  • Avoid smoking
  • Relaxation techniques
  • Regular exercise
  • Good sleep hygiene
How is sleep apnoea treated?

There are several modalities of treatment available and your Sleep Physician will recommend the most effective therapy for you. Continuous Positive Airway Pressure (CPAP), is considered the gold standard.

Click the button below to view our services page, then open the CPAP Therapy tab.

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Is OSA dangerous?

People with OSA do not get good-quality sleep, so they are often tired and not alert. This puts them at risk for car accidents. OSA can increase the risk of developing high blood pressure, strokes, heart disease and diabetes.

OSA also increases the risk of developing or worsening of mental health illness including depression.

Treatment of OSA may reduce the risk of some of these complications or conditions.

Click here for the Obstructive Sleep Apnoea Fact Sheet from the Sleep Health Foundation (Australia).

Snoring

Risks of Snoring

Snoring commonly leads to the following risks:

  • Disturbed sleep
  • Inefficiency, mental irritability and unsociability
  • Can be a sign of obstructive sleep apnoea

Download and print the STOP-BANG Questionnaire using the link below to better understand your risk of obstructive sleep apnoea.

If you answer “YES” to 3 or more of the statements in the STOP-BANG questionnaire you have a moderate to high risk of having OSA. Please see your doctor regarding the results of this questionnaire.

Lifestyle Factors causing Snoring

Snoring is often the result of overindulgence in some of life’s pleasures. The following are the causes of snoring and by controlling them, you can become quiet at night.

  • Overeating and/or lack of exercise: Overeating and/or lack of exercise leads to an increase in fat around the throat. Being overweight by just a few kilograms can be the cause of your snoring.
  • Alcohol and Sleeping Pills: Alcohol travels to all areas of the body and slows the brain’s responses, causing the muscles to relax even more than during a normal night’s sleep. The added relaxation of the muscles causes the airway to collapse more readily causing further snoring. Additionally alcohol can induce obstructive sleep apnea (where breathing stops for short periods during sleep) in individuals who are otherwise just snorers.
  • Smoking: Cigarette smoke irritates the lining of the nasal cavity and throat causing swelling. If the nasal passages become congested it is difficult to breathe through your nose because the airflow is decreased.
  • Sleeping Position: When sleeping on your back, gravity increases the tendency for the tongue and soft palate to fall back into the throat. This creates a narrowing of the airway and the likelihood of airway obstruction that leads to a number of breathing abnormalities.
Lifestyle Changes for Treatment of Snoring

Snoring is something that cannot be stopped at will, neither is it something that can be ‘cured’. It can however, be successfully controlled.

  • If you cannot stop drinking or smoking you can modify the effects by having your last drink or smoke at least 4 hours before you go to bed. This will give your body sufficient time to reduce the effects of the alcohol and smoke and help you to sleep without snoring.
  • Weight loss with accompanying fat reduction will certainly help to alleviate snoring.
  • It would seem desirable to prevent snorers from sleeping on their back.
Physical Factors causing Snoring

Snoring may be caused by physical abnormalities that need to be identified before a control can be found:

  • Fat deposits around the neck – double chin
  • Obstruction at the back of the tongue caused by a ‘weak chin’
  • Small or collapsing nostrils
  • Deviated septum
  • Nasal congestion
  • Enlarged nasal turbinates and nasal polyps
  • Large soft palate or uvula

Click here for the Snoring Fact Sheet from the Sleep Health Foundation (Australia).

Sleep and Mental Health

We have a particular interest in managing sleep disorders in people with mental health issues, particularly PTSD, depression and other conditions.

We understand that sleep disorders are commonly associated with these conditions and treatment leads to alleviation of symptoms of the mental health issue.

Depression

65% to 90% of adults with major depression experience insomnia and obstructive sleep apnoea (OSA) is also very common.

Common symptoms of sleep apnoea are also seen in depression and include restless sleep; daytime symptoms include feeling sleepy, tired or fatigued, as well as poor attention and concentration. Therefore, patients with sleep apnoea and depression can have overlapping or similar symptoms.

OSA & Depression Venn Diagram

Treatment of obstructive sleep apnoea and insomnia may result improvement in mood of people with depression.

Light therapy has also been shown to be as effective as antidepressants in some cases or as useful adjuncts to medication.

Anxiety Disorders and Post-Traumatic Stress Disorder

More than 50% of adult patients with generalized anxiety disorder and 90% of those with post-traumatic stress disorder (PTSD) report insomnia. Insomnia may also be a risk factor for developing an anxiety disorder and major depression.

At Sleep Australia, we work with your primary mental health caregiver, sleep psychologists and other physicians to provide a holistic solution to your condition, including:

  • Investigations for relevant conditions including OSA, insomnia and delayed sleep phase syndrome
  • Cognitive behavioural therapy for insomnia
  • Appropriate referral for therapies, for example image rehearsal therapy
  • Medications
  • Regular follow up by our team (Sleep Physician, Sleep Scientists)

We liaise with your GP and other care providers to ensure the best outcome for our patients.

For more information, click the following articles:

Sleep Related Movement Disorders (RLS & PLMS)

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is an uncontrollable urge to move one’s legs, usually worse at rest and at night. This is usually associated with sleep disturbance including resultant insomnia. Restless legs symptoms can be due medications, low iron levels are also associated with worse symptoms. The goals of therapy are to improve sleep, daytime functioning and quality of life.

Periodic Limb Movements of Sleep

Involuntary, jerking movements of the arms or legs during sleep, is known as Periodic Limb Movements of Sleep (PLMS). A sleep study is required to diagnose PLMS. Treatment includes lifestyle changes such as moderate regular exercise, minimisation of caffeine, minimization of alcohol intake and smoking cessation. Hypothyroidism is corrected as well as iron deficiency. Magnesium supplementation often helps. In some cases medications such as Pramiprexole or Pregabalin are effective.

For more information, click the following articles:

Bruxism (Teeth Grinding)

Bruxism or sleep related teeth grinding is not uncommon and can disrupt sleep and also cause damage to the teeth. Patients often report clenching of the jaw and pain in the jaw.

OSA is a common cause and treatment is often needed in conjunction with possible protective splints. We work with specialist dentists to diagnose and manage this condition.

Click here for the Teeth Grinding/Bruxism Fact Sheet from the Sleep Health Foundation (Australia).

Insomnia

Insomnia and Fatigue Management is covered in our Services section. Click the button below then open the Insomnia and Fatigue Managment tab to learn more.

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Shiftwork Disorder

Individuals who work night shifts often experience difficulties with both sleep and alertness at desired times, and shift work is increasingly recognized as a risk factor for a variety of adverse health outcomes including heart disease, depression, type II diabetes and breast cancer.

We have experience in dealing with occupational sleep disorders and management of commonly seen shiftwork disorders. Shiftwork may lead to insomnia and increased propensity to sleepiness, decreased neurocognitive and psychomotor function, and emotional lability.

After a detailed assessment including history, sleep diary, sleep study, and actigraphy (if required), we will advise you on a specific treatment plan which may include sleep scheduling, circadian re-alignment strategies and medications (if required).

Click here for the Shiftwork Fact Sheet from the Sleep Health Foundation (Australia).

Narcolepsy

Narcolepsy is one of the less common sleep disorders. Patients with narcolepsy have excessive daytime sleepiness. Patients can have strong urges to nap. These naps can occur several times a day. They are typically refreshing, but only for a few hours.

Other symptoms include sleep paralysis and hallucinations. Patients with narcolepsy can also have disrupted sleep.

With the correct diagnosis and treatment, patients can achieve a good functional status with better daytime functioning and alertness levels.

For more information, click the following articles:

Parasomnias

Parasomnias are abnormal behaviours noticed in different stages of sleep. These include sleep terrors, sleep walking, confessional arousals that occur during NREM sleep. REM related parasomnias include sleep paralysis, nightmare disorder and REM sleep behaviour disorder.

A detailed sleep history and assessment is required, including looking for associated neurological conditions. Treatment includes lifestyle and environmental modification, identification and avoidance of triggers (e.g. medications, sleep apnoea, sleep deprivation etc.). In some cases medications may be required.

For more information, click the following articles:

Respiratory Medicine Library

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory condition characterized by airflow limitation and is the 5th leading cause of mortality in Australia.

If you have symptoms of shortness of breath, chronic cough, or chronic sputum production, especially if there is a history of exposure to tobacco smoke or occupational dust, a diagnosis of COPD should suspected. It is diagnosed with spirometry. Other lung conditions may require more comprehensive tests.

Treatment includes smoking cessation in the first instance (if appropriate), symptomatic management with inhalers that help open up the airways or decrease swelling in the airways. Pulmonary rehabilitation is often usual is the condition progresses.

Click here for COPD Information from the Lung Foundation Australia.

Asthma

The “classic” signs and symptoms of asthma are intermittent shortness of breath, cough, and wheezing and diagnosis is made when there is airflow limitation with bronchodilator reversibility.

Asthma attacks happen when the airways in the lungs become narrow and inflamed. Triggers include exercise, cold air, infection and exposure to inhaled allergens (eg pollen, animal hair).

Diagnosis is made after a complete history, examination and lung function tests.

Asthmatics are treated with two types of inhalers, one for preventative treatment and the other for quick relief of symptoms.

All patients with asthma must have an asthma management plan.

For more information, click the following articles: