Sleep apnoea - How can it be treated?

Sleep apnoea: Disturbed sleep affects the whole family!

When sleep is disturbed, it can no longer be restful. This applies both to the person causing the snoring and to those who are awakened or kept awake by the snoring. So it is often not just one person who is affected, but a whole household.

Sleep apnoea: the symptoms

The leading symptoms are more or less regular snoring at any volume and pauses in breathing of varying length. Dangerously, the volume of snoring is not linearly related to the severity of the disease.

Breathing pauses during sleep are an indication of sleep apnoea

Many of those affected come to the consultation and do not feel ill themselves. In these cases, they are only driven by the concern of their bed partner, who urges medical clarification in the case of recurring nocturnal respiratory arrests. These breathing stops do not necessarily always have to be accompanied by loud snoring. They can also occur without snoring. However, they are almost always characterised by gasping for air, where the affected person then struggles for air "like a fish on land". Some report that they are literally torn out of their sleep. Others have no memory of it.

When sleep apnoea becomes dangerous

The consequences for those affected are fatigue, exhaustion, reduced performance, microsleep and finally the development of chronic diseases. First and foremost are cardiovascular diseases, possibly resulting in a heart attack or stroke, which occur due to oxygen desaturation in blocked airways and the resulting respiratory standstills.
Metabolic disorders such as diabetes and mental illnesses such as burn-out and depression with loss of drive and libido can also occur.

What are the causes of sleep apnoea?

In obstructive sleep apnoea syndrome (OSAS), a narrowing of the throat repeatedly causes a reduction or complete cessation of breathing during sleep. Therefore, sleep apnoea is a serious sleep-related breathing disorder!

Which examinations are necessary?

The diagnosis of sleep-related breathing disorders includes the clinical ORL specialist examination as well as the apparative diagnostics to clarify the anatomical situation and assess the pathophysiological processes and thus determine the severity of the apnoeas. Questionnaires that provide information about performance and attention are used. Apparative diagnostics can initially be carried out with a polygraphy that can be performed on an outpatient basis, in which the measuring apparatus is taken home. The advantage of this is that the measurement takes place in the patient's own bed and familiar surroundings, i.e. it also reflects the circumstances under which the patient normally sleeps at home.

Sleep apnoea meter for home use

There is currently a new development for this, which does without annoying tube sensors that are usually pulled under the nose to record the respiratory flow and then behind the ear. Many patients felt uncomfortable because of the plastic tubes, which often slipped out of the measuring position when turning over in bed, or simply because of the annoying tangle of cables. This then led to a sleeping situation that was already perceived as extremely disturbing by the presence of the measuring apparatus.

With this measuring method, only a wristwatch-sized measuring probe is worn on the non-dominant arm. This probe is connected to a finger sensor and an adhesive electrode that is stuck to the neck between the collarbones. Data is collected here during the night, which is stored by the measuring device and can be read out by the treating doctor the next morning.

Measurement of sleep apnoea in corona times

This apparatus has recently been further developed. It is now a measuring device that can only be used once. In times of corona and other infectious diseases, this is particularly important from a hygienic point of view, because no contamination can take place, since it is a single-use device that can be disposed of properly in the household waste or sent back to the company after use. The device, which is easy to use via a smartphone app and at the same time innovative, can also be sent by post, so that a visit to the practice is only necessary to discuss the findings and plan the further procedure. This eliminates the need to collect the device and return it to the doctor to have the data read out. Inconspicuous findings can also be explained by means of a telemedical discussion, taking into account the individual circumstances.

Sleep apnoea therapy with CPAP (Continuous Positive Airway Pressure)

In the case of conspicuous findings, measured respiratory arrest of up to 2 minutes and occasionally longer, or oxygen desaturations of up to 70% are not uncommon. Special attention is paid to the apnoea-hypopnoea index, which helps to classify the severity of the disease.
If abnormal values are measured in this examination, a second measurement is usually carried out, but then in the sleep laboratory, the so-called polysomnography (PSG). Here, positive pressure ventilation can be used to prevent the airways from collapsing. This involves fitting a nasal or face mask, which is connected to the CPAP machine next to the bed via a tube.

Alternative to CPAP therapy

Not all patients tolerate the mask because either the ventilation pressure is too high and is perceived as uncomfortable or the mask does not fit because of the individual shape of the midface and the airflow from the mask is blown into the eye. This can lead to inflammation of the eyes. Other patients simply feel disturbed by the appliance design and do not use the CPAP machine. A frequent feedback is that especially the younger patients do not want to be perceived like "Darth Vader from Star Wars" and they also feel stigmatised by this.

In any case, not using the CPAP machine means that the apnoea phases continue and continue to have their pathogenic effect.

Sleep apnoea surgery: Minimally invasive surgical measures

This is where surgical therapy to improve upper airway patency comes in. Endoscopic diagnostics such as "drug induced sleep endoscopy" (DISE) makes it possible, for example, to determine the type and extent as well as the height localisation of the airway collapse for the patient concerned. In this way, for example, surgical treatment of the problem can be carried out in the anaesthesia that immediately follows, tailored to the individual needs.

Depending on the individual anatomical situation contributing to the sleep apnoea, these constrictions can be corrected by minimally invasive measures.

We are happy to advise you, because every person is different and therefore it is also important to address the individual characteristics.