Sleep Apnoea – Q & A
What is sleep apnoea?
Sleep apnoea is a breathing disorder. It occurs when your breathing stops for 10 seconds or more. It produces breathing-disordered sleep. It usually happens when you are asleep but can also occur when awake. A forceful intake of air ends the apnoea. The word comes from the Greek word apnoia which, in turn, comes from apnous meaning breathless.
Obstructive sleep apnea(OSA) is a breathing disorder characterized by the disappearance or significant attenuation of oronasal airflow during sleep. It has been estimated that 936 million adults aged 30–69 years have OSA, and nearly half of them suffer from moderate to severe OSA globally. (see Benjafield AV, Ayas NT, Eastwood PR., et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–698. doi:10.1016/S2213-2600(19)30198-5 )
How do I know that I have sleep apnoea?
Usually, there are some tell-tale signs such as waking in the morning feeling exhausted and accompanied by a headache and a dry mouth and waking several times during the night to urinate. Another indicator is being told by your partner that you have been snoring during the night.
Medically your condition can be confirmed after you have undertaken a polysomnography or sleep study. During the sleep study, a number of aspects of the architecture of your sleep are measured.
These aspects include the airflow in and out of your lungs, blood oxygen levels, body position, snoring level, brain waves (EEG), eye movement during REM, heart rate, the electrical activity of muscles, breathing effort, rate of breathing and arousal levels.
Why does it occur?
Sleep apnoea occurs because we over breathe or hyperventilate. The volume of air we breathe (often through our mouth) is excessive to our needs. In doing so we lower the level of carbon dioxide (“CO₂”) in our blood beyond the level required to enable the efficient transfer of oxygen to our essential organs.
A deficiency of CO2 causes the oxygen to bind with the blood haemoglobin. When this occurs, our essential organs, such as the brain, heart and kidneys, are not being adequately oxygenated.
What are its effects on your health?
I suffered from the following effects: low energy levels, persistent headaches, breathlessness and a feeling that I could not obtain enough air, depression, impotence, weight gain, and poor memory. My mother suffered a stroke and lost a kidney to cancer. Whilst I am certain that there were other causes of these illnesses I am also certain that her sleep apnoea played a significant role in her poor health.
Sleep apnoea has been medically linked with depression in that people with depression are 5 times more likely to have a breathing-related sleep disorder than non-depressed people. See the Stanford University Report, 5 November 2003 at http://news.stanford.edu/news/2003/november5/depression.html
Those people with moderate to severe obstructive sleep apnoea are 3 to 4 times more likely to suffer a stroke within the next 4 years than those people without sleep apnoea. See the report in the Science Daily, 23 May 2005 at: http://www.sciencedaily.com/releases/2005/05/050523153827.htm
Stroke and Sleep Apnoea
And those people who have suffered a stroke and who have obstructive sleep apnoea (OSA), will die sooner than stroke victims who do not have OSA or who have central sleep apnoea. See the report in the Science Daily, 20 May 2008 at: http://www.sciencedaily.com/releases/2008/05/080518182655.htm
People with moderate to severe sleep apnoea have an increased risk of death from any cause in middle-aged adults, especially men. Men between the ages of 40 to 70 with severe sleep apnoea were twice as likely to die compared to their peers who did not have the condition. See the report of the National Heart, Lung and Blood Institute in the Science Daily, 20 August 2009 at: http://www.sciencedaily.com/releases/2009/08/090817190646.htm
Results of a 20-year follow-up study show that people with moderate to severe OSA were three times more likely to die from cancer and two and a half times more likely to develop cancer. See the report of the issue of the Journal of Clinical Sleep Medicine in the Science Daily, 14 April 2014 at: http://www.sciencedaily.com/releases/2014/04/140414154456.htm
In a study of 775 people with various degrees of OSA (from light to severe hypoxia), conducted at the Sleep Disorders Unit, Tianjin Medical University General Hospital during 2016-2-19 it was found that the risk of hypertension in patients with severe OSA increased according to the severity categories of T90, that is, the percentage of cumulative time with oxygen saturation below 90% in total sleep time. T90 is an objective parameter which can easily be obtained using polysomnography (or sleep study).
T90 was significantly and positively associated with hypertension in patients with severe OSA. See the report at https://doi.org/10.2147/NSS.S388238
What are the treatments available for sleep apnoea?
For mild to moderate sleep apnoea, a mandibular splint or mouthguard may be prescribed. It has an upper and lower section which is a replica mould of your teeth and gums. It is made by a specialist dentist known as a prosthodontist. Metal clips or hooks connect both sections of the mouthguard. Its purpose in setting your jaw forward is to prevent your tongue from falling back and blocking your airways.
For severe sleep apnoea, a CPAP machine is prescribed. It provides continuous positive air pressure as humidified air is fed through a hose connected to a face mask. Its purpose is to pump pressurised air directly into your mouth and through your respiratory tract to your lungs. In doing so the pressure produced by CPAP tends to prevent your throat from collapsing. When an obstructive sleep apnoea occurs the walls of your throat are said to collapse and block the air.
Surgical intervention has been prescribed, in particular, the removal of either part or all of the uvula (that is, the soft flap of tissue that hangs down at the rear of the mouth). If tonsils and adenoids are present they are also usually removed. The goal is to allow the airway to remain open by increasing the width of the airway.
Breathing less and through the nose (instead of the mouth) can assist in the efficient transfer of oxygen to the tissues and essential organs. By breathing only through the nose nitric oxide is produced in the paranasal cavity resulting in an increase of almost 10% arterial oxygen levels and an improved efficiency of CO2 secretion from the lungs. (see Bartley J and Wong C “Nasal Pulmonary Interactions” Nasal Physiology and Pathophysiology of Nasal Disorders 2013 at pp 560 and 564). By breathing less, the lungs have the opportunity to better accumulate carbon dioxide in the alveoli of the bronchial tree. Carbon dioxide works hand in hand with haemoglobin in transferring oxygen to the cells and tissues. Breathing correctly plays an important role in regulating the pH of the blood and the pH of the blood, in turn, regulates our breathing. This form of breathing is known as Buteyko (bew -tay -ko) breathing.
What are the pros and cons of the available treatments available?
The use of a mouthguard or mandibular splint can assist in opening your airways and preventing your tongue from blocking your airways. But it does not address the issue of over-breathing and does nothing to assist in the proper oxygenation of your tissues and organs. I found that it was initially uncomfortable and it resulted in large amounts of saliva accumulating in my mouth. It also required regular maintenance as it needed to be cleaned after using it.
Once I had overcome some of the many difficulties I encountered with using the CPAP machine there were definite benefits. The regulated rhythm of inhaling and exhaling certainly assisted in providing me with a better night’s sleep. I felt relief from the symptoms of my severe obstructive sleep apnoea.
But there were psychological and physical problems experienced through the use of CPAP. I used CPAP for approximately 2 months before I could tolerate it no longer. Physically it felt claustrophobic and at times I felt that I was almost drowning as the humidity in the face mask increased. Often I was not ready to inhale the next airstream which was being pumped through the hose and into my gaping mouth. I had to sleep on my back with the face mask and hose. I couldn’t sleep on my side with CPAP. I could only manage it in a partial sense.
Psychologically I rebelled against feeling like a semi-invalid. I found my mind, exhausted as it was, playing games with the contrived rhythm of air which sought entry into my lungs. I found myself still in the process of exhaling when a gush of air was being pushed into my mouth. In trying to accommodate the airflow imposed by CPAP my heart rate increased and I suspect so did my blood pressure. I also felt that my eyes were more watery after using CPAP.
I know of no reason why surgical intervention should be contemplated by anyone. In fact, I know of a man who was a regular snorer. At the request of his wife, he scheduled an operation with a surgeon who removed his uvula. Sadly the operation made no difference to his snoring.
The most compelling advantage of Mindful Buteyko Breathing is that it is completely natural and does not rely upon the assistance of medical instruments or drugs. It does not involve any surgery.
One of the most difficult aspects of Mindful Buteyko Breathing is that it requires strong determination and willpower to adhere to the breathing exercises. I initially found it very difficult to adjust to slowing my breathing and reducing the amount of air I breathed. My brain and my lungs were not used to receiving more carbon dioxide. This took time to adjust. But with persistence, I was able to readjust my breathing habits.
Who was Professor Buteyko?
Professor Konstantin Pavlovich Buteyko was born in 1923 near Kiev in Ukraine. He commenced his medical training in Russia in 1946. One of his practical assignments as a medical student involved monitoring the breathing of terminally ill patients prior to death. He observed a consistent increase in the depth of their breathing as they approached death. He pondered whether there was a link between carbon dioxide levels and the depth and rate of breathing. Professor Buteyko suffered from malignant hypertension. He experimented on himself and found that by reducing the volume and rate of his breathing he reduced his headache and rapid heartbeat. His laboratory conducted extensive scientific tests on the basic functions of the human organism – whether healthy or diseased.
Buteyko’s method of breathing relies on the physiological fact that for oxygen in our blood to be transferred efficiently to our tissues we need a certain amount of carbon dioxide. If we over breathe or breathe too much we deplete our carbon dioxide level and we actually obtain less oxygen.
For over 5o years the Professor researched the breathing retraining method, taught individuals and trained practitioners. Despite receiving Government approval by Moscow in 1983 his method did not reach the western world until 1990 when one of his students Alexander Stalmatski arrived in Australia.
On 3 May 2003, Professor Buteyko passed away.
Why should I learn Mindful Buteyko breathing?
There are several reasons why you should learn Mindful Buteyko breathing:
- It is completely natural
- It is relatively inexpensive (compared with other treatments)
- It results in a greater oxygen saturation being received by your tissues and vital organs
- It enables you to obtain quality sleep
- It gives you greater energy
- It causes you to lose weight – in my case – up to 10kg
- It improves the overall quality of your life and of your health
- It will restore calm and assist you in dealing with anxiety as your condition improves
Any further questions?
Should you have any further questions which are not covered by the above questions please contact me at firstname.lastname@example.org