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Thoracic Medicine

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Sleep Medicine

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Office workers with more light exposure at work had longer sleep duration, better sleep quality, more physical activity and better quality of life compared to office workers with less light exposure in the workplace.

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Can you be sleep deprived without knowing it? Sleep is not always prioritised however the implications can be devastating. Even one night sleep deprived can be impacting your body on a variety of different levels; physically and psychologically. The only way to know if you are getting consolidated sleep is to monitor with specialised equipment what is happening when you are asleep.

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In what may be the largest study of sleep problems among individuals with multiple sclerosis (MS), researchers at UC Davis have found that widely undiagnosed sleep disorders may be at the root of the most common and disabling symptom of the disease: fatigue. Study paticipant reports of sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population.

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A sleep-promoting circuit located deep in the primitive brainstem has revealed how we fall into deep sleep. Discovered by researchers at Harvard School of Medicine and the University of Buffalo School of Medicine and Biomedical Sciences, this is only the second "sleep node" identified in the mammalian brain whose activity appears to be both necessary and sufficient to produce deep sleep.  Using designer genes, researchers were able to 'turn on' specific neurons in the brainstem that result in deep sleep.

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Insomnia can cause chronic inflammation, which can lead to weight gain, hypertension, diabetes, heart disease, and earlier death. This study finds that curing the insomnia reduces the inflammation and hopefully reduces disease. It also found the best way to cure lack of sleep is through the use of a common psychotherapy treatment - cognitive behavioural therapy.

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Getting enough sleep is important to people of any age, but it is especially so for teenagers, with insufficient sleep possibly being linked to obesity as an adult.

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Obstructive Sleep Apnoea (OSA)

What is Obstructive Sleep Apnoea?

Obstructive Sleep Apnoea (OSA) is a common sleeping disorder, characterised by pauses in breathing during sleep. Each pause in breath is called an ‘apnoea’ and in more severe cases can occur hundreds of times a night. It is a problem which, if left untreated, can be fatal.

Obstructive Sleep Apnoea

Obstructive Sleep Apnoea is a condition in which the muscles of the back of your throat and your tongue relax during sleep, to the point where they collapse and block your airway. When this happens, you stop breathing.

After a period ranging from a few seconds to a minute, your brain registers that oxygen isn’t being drawn into the body through breathing. The brain then sends out signals to rouse you from sleep, forcing you to take a breath. This pattern can repeat itself many times during the night.

The severity of Obstructive Sleep Apnoea is determined by the frequency of this cycle of stop/start breathing. People with OSA often complain of daytime sleepiness, fatigue, poor concentration, having a poor memory, and irritability. Some people may even experience mood changes, including depression. Often, the partner of the person with OSA reports having observed the most common symptoms of OSA: snoring and characteristic periods of non-breathing, followed by the choking or coughing that signals the person has roused sufficiently to start breathing again.

Treatment options for Obstructive Sleep Apnoea

If you have had symptoms of, or have been diagnosed with Obstructive Sleep Apnoea Syndrome (OSAS), you know it can affect your health and lifestyle. Symptoms range from excessive daytime sleepiness to difficulty performing tasks at home and at work. OSAS can also lead to high blood pressure and other heart problems. Obstructive Sleep Apnoea is a common sleep disorder. It can have a severe effect on your health and lifestyle. Loud, frequent snoring is one of the most common signs of this problem. OSA often causes excessive daytime sleepiness. This can harm both your performance at work and your quality of life. Research shows that OSA also can lead to high blood pressure and other heart problems.

OSA involves the partial or complete collapse of the airway during sleep. It can occur hundreds of times in one night. The process that results in a blocked airway during sleep is rather complicated. It starts when the muscles in the throat relax as you sleep, making it more likely that the airway will collapse.

As you breathe in, the lungs create a negative pressure so they can pull air through the narrow airway. The pressure may cause the breathing passage to collapse. This is much like a straw that flattens and collapses if you pinch one end closed while sucking on the other end. With the airway blocked, no breathing occurs and oxygen levels drop. Your brain then wakes up your body to restore your breathing. These brief, repeated arousals cause your sleep to be unrefreshing.

Proper treatment can prevent the serious effects of OSA. There are a number of treatment options for you and your doctor to consider. Correcting OSA may involve one or more of the treatments outlined on this site.

Lifestyle changes

Some behaviours or habits can make OSA worse. For some people, changing these behaviours can reduce or end sleep apnoea. Talk with your sleep specialist or another qualified healthcare professional. See if one of these options might work for you.

Losing Weight and Exercising Regularly

Weight loss may be the most helpful treatment for overweight people who suffer from OSA. Consult your doctor before trying to lose weight. He or she can make sure that your weight-loss programme is both safe and effective. Your programme should combine a healthy diet with regular exercise.

A doctor should confirm that you no long have OSA once you reach your desired weight. Then it is important to maintain that weight. Otherwise, snoring and breathing problems are likely to return when you gain weight again.

Quitting Smoking

Smoking irritates your mouth and throat. Recent evidence suggests that this might make snoring and sleep apnoea problems occur during sleep. Talk with your doctor to find a safe and effective way to quit smoking.

Avoiding Alcohol and Sedatives

Even one glass of wine just before bed can worsen your snoring and sleep apnoea. You should avoid drinking alcohol for at least four hours before bed. Alcohol and sedative medications can cause the muscles in your throat to relax more than usual. This can cause sleep apnoea to occur. Alcohol and sedative drugs also make it harder for the brain to “wake up”. This means that episodes of sleep apnoea will last longer and will be more dangerous. These are some examples of sedative drugs:

  • Sleeping pills
  • Muscle relaxants
  • Some anxiety medications
  • Some pain medications

Your sleep specialist can help you modify your use of sedatives and alcohol.

Sleeping on your side or stomach

Sleeping on your back allows gravity to pull on the soft tissues at the back of your throat and neck. This causes the airway to narrow or collapse completely. Sleeping on your side or stomach might improve your breathing. This change in behaviour is called “sleep-position training”.

Sleep-position training can occur in several ways. The simplest approach is called the “tennis ball technique”. It involves sewing a pocket into the back of your pyjama top. You then insert a tennis ball into it. They help when you start to roll onto your back during sleep. The pressure from the balls will cause you to roll back to your side. Strapping a foam wedge to your back can produce the same result. You can also buy a device with an alarm that alerts you when you roll onto your back. Sleep-position training may not help all people with OSA. It is best to consult with your sleep specialist to see if it might work for you.

Medical Therapy

Positive Airway Pressure Devices

Positive Airway Pressure (PAP) is the standard method of treating moderate to severe Obstructive Sleep Apnoea. It keeps the airway open by providing a steady stream of air through a mask that you wear as you sleep. PAP machines work by pumping air through a hose to the mask. Masks either fit over the nose or over the nose and mouth. This mask is held in place with straps. Your sleep specialist determines the right level of air pressure for you during an overnight sleep study. To determine the correct pressure for you a sleep study will need to be conducted in a sleep laboratory.

Some people prefer using nasal pillows instead of a traditional mask. These are soft pieces of plastic that are placed directly into the nostrils. A nasal pillows system covers less of your face and may give you more freedom in your choice of sleeping positions.

Several brands of PAP devices are available. Your sleep specialists can recommend for you the best combination of mask and PAP model.

Most people do well with PAP therapy. Others may experience dryness in the nose or feelings of claustrophobia. You can overcome these problems with a few adjustments.

Using a heated humidifier is one of your best options. Some PAP models come with humidifier. Others give you the option of connecting a humidifier to it. You may also be able to overcome nasal dryness by using a saline nasal spray. This solution is a mixture of salt and water. Taking a nasal decongestant or using a chin strap can also reduce nasal symptoms.

A few people have feelings of claustrophobia from PAP treatment. This can be corrected by relaxation techniques given to you by your CPAP consultant. You can also try using a mask that covers less of the face, which should allow you to overcome feeling claustrophobic. Your sleep specialist can help you overcome these feelings.

Oral Appliances

These devices look much like sports mouth guards. They keep the airway open by holding the tongue or jaw forward. This increases the airway space behind the tongue. They can be effective for people who have mild to moderate Obstructive Sleep Apnoea. A licensed dentist who is trained in dental sleep medicine can custom fit the oral appliance. This will give you the best results.

Surgery

An operation may be an option if there is a physical cause for your Obstructive Sleep Apnoea that surgery can correct. You may also want to consider surgery if more conservative treatments fail to control your sleep apnoea. Make sure you have a realistic understanding of the expected success rate for any surgery you consider. Your sleep specialist should also inform you of all possible risks and side effects. An operation can be an effective treatment for some people. But it is not the right choice for everyone.

Nasal Operations

Nasal surgery removes blockages in the nose. It can also repair a deviated septum. The septum is the bony divider between the two nostrils. A bent septum can block the flow of air through your nose. These operations may be one part of an overall plan to treat sleep apnoea. They tend to be used along with other forms of treatment or other operations. Nasal surgery by itself rarely cures OSA.

Laser-assisted uvulopalatoplasty (LAUP)

This procedure is used mainly for the treatment of snoring. The surgeon uses a laser to remove part of the soft palate and uvula. The uvula is the soft lump of tissue that hangs down in the back of the throat. The surgery takes place during several sessions in a doctor’s office. This technique may be helpful for snoring. You need to be aware that it rarely succeeds in treating OSA.

Uvulopalatopharyngoplasty (UPPP)

This operation involves removing the uvula, the tonsils and part of the soft palate. It is helpful for less than 50% of people who undergo the operation. But not all of them are cured. Side effects may include:

  • Severe throat pain
  • Nasal-sounding speech
  • Liquids backing up into the nose when you swallow

Maxillomandibular Advancement (MMO)

This surgery involves cutting the upper and lower bones of the jaws. This moves them both forward. General anaesthesia is used for the operation. The surgery requires a hospital stay of a few days. After the operation the jaw is wired shut to hold it in place for about four weeks. A liquid diet is required and weight loss often results. Once the wires are removed you may need orthodontic work to realign the teeth so they fit together properly.

This treatment is time-consuming and expensive, but its results are positive for many people. It works best for people who are born with a jaw that is either smaller than normal or that is set too far back.

Tracheostomy

This surgery is rarely used to treat sleep apnoea. It is performed only in severe cases of OSA when all other options have failed. It involves the recreation of a small surgical opening in the throat. The opening is located in the windpipe below the larynx. The tracheostomy bypasses any obstructions in the throat. This allows air to flow freely into the lungs while you are sleeping. The opening is covered during the day and normal breathing and speech resume.

Medications and Alternative Treatments

Using only medications to treat snoring and OSA has limited benefits. They may be most useful for treating mild sleep apnoea. They may also be one part of an overall treatment programme.

Nasal Sprays

Over the counter nasal sprays that help clear the nasal passages can be habit forming. They should be used for only a few days. Prescription anti-allergy nasal sprays might improve Obstructive Sleep Apnoea by helping to unblock the nose. You should be aware that it takes days or weeks for the spray to work. By themselves, nasal sprays do not fully control OSA. Nasal sprays tend to be ineffective if there is a permanent nasal blockage. This may be caused by a deviated septum or other abnormality.

Decongestants

Oral medication to relieve nasal congestion may help you breathe better through your nose. But they are rarely a successful treatment for sleep apnoea. They also can make it hard for you to fall asleep and stay asleep.

Oxygen

This treatment can help correct the low oxygen levels in the blood that sleep apnoea causes. But oxygen treatment rarely prevents sleep apnoea from occurring. It is sometimes used along with PAP therapy.

Alertness promoting medications

Modafinil is a medication that stimulates the brain to help you stay awake. It is used to treat some causes of excessive daytime sleepiness. Some people with OSA may remain sleepy during the day even if their PAP treatment is successful. If there is no other identifiable cause of this sleepiness, then taking modafinil is an option to improve alertness. Some people with OSA have mild elevations in their blood pressure when taking modafinil. It is important to monitor your blood pressure while you are taking the medication.

Follow up care

A sleep specialist in an accredited sleep centre can help you achieve long-term success with your OSA treatment. This will improve your health and overall quality of life. It is important for you to have regular follow up appointments with your sleep physician. This will allow him or her to confirm the ongoing success of your treatment.

Obstructive Sleep Apnoea may become more severe as you age. A change in your weight can also affect your sleep apnoea. Even if surgery has initially corrected OSA, the problem may return later. Snoring or struggling with daytime sleepiness again may indicate that your sleep apnoea has returned.

If you are using Positive Airway Pressure devices to treat your Obstructive Sleep Apnoea, your first follow up appointment should be shortly after you start using PAP at home. This will ensure that you get off to a good start. Ongoing follow up will then help you maintain this success.

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