Obstructive sleep apnoea 

Introduction 

Snoring and sleep apnoea

An expert explains the difference between snoring and sleep apnoea, and people talk about the methods they've used to get a good night's sleep.

Media last reviewed: 18/03/2013

Next review due: 18/03/2015

Obstructive sleep apnoea (OSA) is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing.

There are two types of breathing interruption characteristic of OSA:

  • apnoea – where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it is called an apnoea when the airflow is blocked for 10 seconds or more
  • hypopnoea – a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more

As many people with OSA experience episodes of both apnoea and hypopnoea, doctors sometimes refer to the condition as obstructive sleep apnoea-hypopnoea syndrome, or OSAHS.

The term "obstructive" distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain not sending signals to the breathing muscles during sleep.

What happens in OSA?

People with OSA may experience repeated episodes of apnoea and hypopnoea throughout the night.

During an episode, the lack of oxygen triggers your brain to pull you out of deep sleep – either to a lighter sleep or to wakefulness – so your airway reopens and you can breathe normally.

After falling back into deep sleep, further episodes of apnoea and hypopnoea can occur. These events may occur around once every one or two minutes throughout the night in severe cases.

Most people with OSA snore loudly. Their breathing may be noisy and laboured, and it is often interrupted by gasping and snorting with each episode of apnoea.

These repeated sleep interruptions can make you feel very tired during the day. You'll usually have no memory of your interrupted breathing, so you may be unaware you have a problem unless a partner, friend or family member notices the symptoms while you sleep.

Read more about the symptoms of OSA.

When to seek medical advice

You should see your GP if you think you might have OSA.

They can check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre.

Read more about diagnosing OSA.

What causes OSA?

It's normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping.

For most people this doesn't cause breathing problems, but in people with OSA the airway has narrowed as the result of a number of factors, including:

  • being overweight or obese
  • having a large neck
  • taking medicines that have a sedative effect, such as sleeping tablets
  • having an unusual structure in the neck, such as an narrow airway, large tonsils, adenoids or tongue, or a small lower jaw
  • smoking or drinking alcohol, particularly before going to sleep

Read more about the causes of OSA.

Who is affected?

OSA is a relatively common condition that affects more men than women.

Most cases of OSA develop in people aged 30 to 60 years old, although it can affect people of all ages, including children. 

In the UK, it is estimated around 4% of middle-aged men and 2% of middle-aged women have OSA.

As someone with OSA may not notice they have the condition themselves, it is likely that OSA often goes undiagnosed.

How OSA is treated

OSA is a treatable condition, and there are a variety of treatment options that can reduce the symptoms.

Treatment options for OSA include:

  • lifestyle changes – such as losing excess weight, cutting down on alcohol and sleeping on your side
  • using a continuous positive airway pressure (CPAP) device – these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask
  • wearing a mandibular advancement device (MAD) – this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep

Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure.

However, for most people surgery is not appropriate and may only be considered as a last resort if other treatments have not helped.

Read more about treating OSA.

Outlook

The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases.

If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such as poor performance at work and school, and placing a strain on your relationships with others.

Poorly controlled OSA can also increase your risk of developing high blood pressure, having a serious accident caused by tiredness (such as a car crash), having a stroke or heart attack, and developing an irregular heartbeat (such as atrial fibrillation).

Read more about the complications of OSA.

Can OSA be prevented?

It is not always possible to prevent OSA, but making certain lifestyle changes may reduce your risk of developing the condition. These include:

  • losing weight if you are overweight or obese
  • limiting your alcohol consumption and avoiding alcohol during the evening
  • stopping smoking if you smoke
  • avoiding the use of sleeping tablets and tranquillisers

Page last reviewed: 01/07/2014

Next review due: 01/07/2016

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Comments

The 13 comments posted are personal views. Any information they give has not been checked and may not be accurate.

AnneBS said on 30 July 2014

OSA is a condition which affects many children and not just adults - as parents of a two year old boy whose OSA was life threatening and required emergency surgery, the advice on this site does not reflect the severity and urgency which this condition can pose, in particular to children. OSA in children can be caused by prolonged infections and conditons which enlarge the adenoids and tonsils, not simply the range of contributory factors which are listed above, such as obesity and alcohol, which affect adults. It is extremely common for GPs to overlook or misdiagnose OSA in children, only ENT specialists provide the expertise to properly diagnose this. As parents who had to battle within the NHS to have their son diagnosed and treated properly, we would strongly encourage other parents to trust their instincts when they observe their child struggling to breathe at night, and demand specialist help.

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kehena said on 08 December 2013

My friend who lives in Paris was diagnosed with this. He breathes for only 4 out of the 8 hours he is asleep apparently. He tried unsuccessfully the CPAP machine. but what has worked for him is an orthosis, which he only has to wear in bed. It pushes his jaw into a position that somehow stops the problem. He was monitored only this week and is now breathing completely normally.

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Staggie90 said on 08 September 2013

My boyfriend has this. And he is a typical candidate, overweight, double chin, 37, male, night sweats (which we've only realised was a symptom from this site), stops breathing at night, heavy snorer, can fall asleep standing up, while eating, while changing the babys bum, and never woke up feeling refreshed.
During his sleep test he was told he stops breathing from anywhere between 25-46 times and hour, for around 10-15 seconds every night (he was observed over 4 nights). Its in the severe category obviously.
He's been diagnosed for a couple of months now but still falls asleep during the day even when he's used the machine. So another trip back to the sleep clinic and he's found out that he needs a more intense machine because of the size of the back of his throat and the size of his tongue (apparenty this can cause sleep apneoa even if you're not overweight which I found interesting).
He's also been told smoking makes OSA worse so for those smokers it might be worth investing in some patches.
There was a young lady on here who said she thinks she has this but isn't in the usual criteria, my mum also suffers from what you decribed and she has been diagnosed with night panic attacks eventhough she doesn't get them during the day, it might be worth speaking to your doctor again.
Hope I've helped.

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Mary Summerley said on 20 May 2013

I've just been diagnosed with severe obstructive sleep apnoea and told I will have to use a CPAP machine. I'm quite apprehensive at the thought of having to have a mask strapped onto my head all night and every night. Any advice on how to adapt to it more easily?

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freedomlass said on 23 April 2013

I was diagnosed with Sleep Apneoa about 4 years ago I was always tired and my other half complained madly about my snoring, after an op on my nose and throat as things didn't really improve I was given a CPAP machine, it took some getting used to and being called Darth Vadar I use it constantly, I don't however generally feel much different I still feel tired a lot of the time and do not wake feeling refreshed as I was told I would do, my consultant does feel after further overnight tests that it is working as I do not snore no where near as much, yes I do still snore sometimes even with the mask on, I am slowly loosing weight too. I do not like the mask much as I can't get into a sleep position that I like as it gets in the way, it wakes me up with the air leaks into my eyes or sides of cheeks, even after adjustments it still happens, they say it fits me well but find the straps at the back of the head slide up and have to put my hair in a pony tail to stop it sliding off, when it happens the bar on the forehead also moves up, I get indents on my forhead and over my nose, as for the breathing I even find myself occasionally holding my breath even when awake, does it really work?

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Andy W Leeds said on 02 March 2013

O.S.A.

Before diagnosis
Chronic fatigue
Thunderous snorer
Breathing stopped
Wife apprehensive!

Dozed everywhere:
Mid sentence
At work
Or pub
Awoken frequently!

Driving risk
For family
Strangers, friends
Eventually expecting
Airbag ending!

Finally treated
Thanks doctors
CPAP dependence
Love, hate
Life resurrected!

Sleeping quality
Never snoring
Or stopping
Wife calmed
Feeling energised!

Driving safely
DVLC approved
Obese drivers
Very concerning
Carnage diagnosed?

Nasal mask
Forehead imprinted
Whirling fan
Hissing, leaking
Snotty masks!

Fifteen years
Loving CPAP
Thanks NHS
Marathon runner
Life's fantastic!


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Emilycharlotteh said on 10 February 2013

Hiya,

I am 17 and believe I may have sleep apnea.
I have spoken to doctors about my experiences and they have given me little help, simply telling me that I must be stressed and to go away or go to see a councillor..

I do not snore and I am actually under weight. However I suffer with sleep paralysis at least twice a week, feeling as if someone is sat on my chest, I struggle to breathe and move even though I am aware of what is happening to me. I also wake up every day with a very dry mouth. I also suffer with daily morning migraines and things have got so bad that I cannot go at least 7 hours without having a nap, I am physically drained and worn out and I don't really know what can be done about it as it is really affecting my life daily.

If anyone has any advice or information please let me know as I need to get through to a doctor and get them to take me seriously, as they have not done the last 4 times I have been to them.

Best,
Emily.

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AndrewD said on 17 July 2012

I was diagniosed with apnea a little more than a year ago. In the run-up I had been catching lots of colds, was constantly exhausted and falling asleep all over the place.

After being given a cpap machine I lay down to try it out with a nap and slept 10 hours awaking incredibly refreshed.

Its a nuisance but does the job with no need for drugs.

Having lived with apnea for a while now I realise that I have a heavy double chin that presses down on my throat and is likely the cause of the problem, but you need to be getting good rest to have the energy to lose the necessary weight,.

Cpap is an effective remedy while you work on the weight.

I got a very small mask that is effectively just a bulb that sits under the nose. I wodul recommend this to anyone as an alternative to the face or nose mask, if you find it uncomfortable.

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David McC said on 27 June 2012

I am a world-class snorer....or, I was until I was provided with a CPAP machine a week ago - snoring has been stopped in its' tracks. That's the (very!!) good news.....

I have had no problems whatsoever adapting to the full-face mask - but, I do awake feeling decidedly fuzzy-headed. It's a feeling that does not fully disappear for several hours after what would appear to have been a good night's sleep.

Do you have experience of this? Is this something caused by the CPAP machine possibly - or, just a coincidence? If it isn't a coincidence, how did you overcome the problem, and after how ,long?

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David McC said on 26 June 2012

I am a world-class snorer who has very recently been given a CPAP machine ( a week ago) as OSA was causing my blood oxygen levels to be described as being "dangerously low" and I was waking as many as 12 times per hour each night.....it has stopped my snoring in its' tracks (much to my wife's great relief!!). However - and, this may not be associated in any way whatsoever - I awake feeling very fuzzy-headed and somewhat weary. I am having no difficulties whatsoever adapting to the full-face mask, or to the CPAP machine, and appear to be getting a good nights' sleep. Is this a disassociated coincidence - or, has anyone else experienced these symptoms? If you have, what did you do about it - or, did they simply disappear in time?

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Suzidog said on 27 October 2011

How do I get tested for this. I wake up during the night choking. Only happens once during the night but it appears to be getting more common. I'm starting to worry about what could be causing it. The morning after my throat is sore but usually clears by midday. Reading the internet suggests this as a possible cause. I am a 31 year old male, over weight but not obese.

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southway1 said on 31 May 2011

i am getting treated for this condition from my local hospital, and have been having the utmost care from them i could not wish for any better treatment they are a 100%

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Sleep Apnea said on 05 November 2010

It would be interesting to read about central and complex sleep apnea. I know that CPAP can worsen the symptoms of sleep apnea. However, Adaptive Servo-Ventilation was designed to help the patient with central apnea events.

Remy

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