The importance of sleep

What is obstructive sleep apnoea (OSA)?

• Obstructive sleep apnoea occurs when your upper airway (the part between your nose and Adam’s apple), narrows and shuts during sleep.

• This can result in apnoeas - when the airway closes completely, and hypopnoeas – when the airway partially closes.

• Apnoeas and hypopnoeas can last as long as 45 seconds at a time and happen many times during the night resulting in very disturbed sleep.

• People usually ask for medical help because of a partner’s concern or because they feel very sleepy at inappropriate times (for example when driving the car or during a meal).

• The DVLA has published a very helpful leaflet ‘Tiredness can kill’ and there is more information about when to contact the DVLA below. Please read this information very carefully.

What are the symptoms of OSA?

• Loud snoring.

• Pauses in breathing (confirmed by partner).

• Restless sleep.

• Feeling unrefreshed on awakening, headaches, loss of concentration.

• Excessive daytime sleepiness.

Could I have sleep apnoea?

Do an Epworth Sleepiness Scale test below.

What causes OSA?

• In approximately 50% (about half) of people with OSA weight is a factor.

• OSA is considered to be more common in men and in the over 50s.

• For women the risk increases after the menopause.

• Occasionally it may be due to a problem with the upper airway such as enlarged tonsils.

How do I get tested for Sleep Apnoea?

• There are a couple of options, either via Albyn or you can use a charity called Hope2sleep.com.

  OPTION 1 - ALBYN (£250)

• If you choose to get the test done at Albyn then the kit is provided via the nurses in our Treatment Room. You bring the kit home, wear it overnight and then return the kit the following day. This data is then analysed by a computer program and a report provided. I then see you with the report at clinic sometime thereafter. The sleep kit is a “2 channel study” and pretty basic. There is a risk of a ‘false negative’ result. Most insurers will cover the cost (around £250 currently). This fee is paid to Albyn.

• A video below shows the kit used at Albyn.

• Note if you do have sleep apnoea buying a CPAP machine can be very expensive, around £1000 and usually not covered by Insurers (see section on CPAP therapy below).

• Currently NHS colleagues at the Sleep Service in Aberdeen Royal Infirmary do not accept Albyn 2-channel studies. I therefore cannot refer you on for a NHS CPAP machine.

OPTION 2 - YOU SELF REFER TO ‘HOPE2SLEEP’ CHARITY (£125-250)

• I believe this is preferable for most patients, particularly if self-funding. You should check of course with your Insurer what is covered. This charity provides a much more detailed sleep study (4-channel), you can get 2 nights of data rather than 1, and the report is manually ‘scored’ by a Sleep Consultant. This is more accurate. A personalised report is also created and sent to you. More details can be found at this page on their website. They also, should you have sleep apnoea, provide a CPAP machine rental service for 3 months (as well as selling their own CPAP machines) which allows you to try out a machine before buying.

Can OSA be treated?

• Yes. Continuous Positive Airways Pressure (CPAP) which involves using an air pump and a mask is the most effective way to treat OSA.

• CPAP works by delivering pressure to your upper airway which pushes the airway open to prevent it collapsing.

• It’s the best treatment for moderate to severe sleep apnoea.

• For mild sleep apnoea devices which pull your lower jaw forward and take the tongue away from the back of your mouth can help. These are called mandibular repositioning devices are fitted over your teeth.

If I need treatment what happens next?

• If you choose an Albyn sleep study we contact a company called ResMed and CPAP therapy is provided by them directly to you. A machine is sent to you and training provided to you how to use it. Using technology they can remotely assess how well the treatment is working. They have an excellent website which you can link to here explaining more. It costs around £1000 for a full package including kit and teaching from ResMed.

• If you choose to self-refer to ‘Hope2sleep’ charity then you can choose to trial a CPAP machine via them for a few months (only £45 and allows you to test out kit!) OR buy a CPAP machine via them.

What does CPAP therapy feel like?

• When you use CPAP for the first time you will notice the pressure when breathing in and out and may feel you need to consciously push the air out. This is normal and as you get used to the therapy it will subside.

• Tip: When you are just starting CPAP, try using it when you are distracted by something such as a TV programme. In this way you will gradually become used to the feeling of having a mask on your face with some pressure.

• Modern CPAP machines are designed to adjust the pressure automatically so you get just the right amount to keep your airway open at any time.

• Ramp - This is used to keep the pressure at minimum for a short period after you turn the machine on to give you time to fall asleep.

• Humidification - Some people find CPAP makes their mouth and throat very dry. If it doesn’t settle down a humidifier can be added to the CPAP machine that puts some moisture into air before you breathe it in.

What are the guidelines around driving and the DVLA?

The latest DLVA guidelines discuss what to do - it is your legal responsibility to let them know if you have moderate or severe sleep apnoea (given the increased risk of road traffic accidents). Please also read their leaflet ‘Tiredness can kill’ which provides more useful information.