Sleep Apnoea - The Fatigue Of Sleep

What is Sleep Apnoea?

Sleep apnoea is a sleep disorder characterised by repetitive pauses in breathing during sleep. Whilst sleeping, the muscles of the throat relax to the point of blocking the airways above the voice box. Breathing stops, for between a few seconds and up to one minute, until the brain registers the lack of breathing (or a drop in oxygen levels) and sends a small wake-up call. The sleeper rouses slightly, typically snorts and gasps, then drifts back to sleep almost immediately. In most cases, the person doesn’t even realise they are waking up. This pattern can repeat itself hundreds of times over every night, leaving the person dogged by sleepiness and fatigue.

The most common type of sleep apnoea is Obstructive Sleep Apnoea. There are different degrees of sleep apnoea, with the severity of this disorder depending on how often the breathing is interrupted. The following averages can be used as a guide:

• Normal - less than five interruptions an hour
• Borderline - 5 to 15 interruptions an hour
• Mild sleep apnoea - between 15 and 30 interruptions an hour
• Moderate sleep apnoea - between 30 and 50 interruptions an hour
• Severe sleep apnoea - over 50 interruptions an hour

What causes Sleep Apnoea?

Obesity is one of the most common causes of sleep apnoea. A loss of around 5 to 10 kilograms is often enough to dramatically reduce the severity of the disorder.

Other causes of sleep apnoea include:

• Alcohol, especially in the evening, which relaxes the throat muscles and hampers the brain’s reaction to sleep disordered breathing
• Certain illnesses such as hypo thyroidism or the presence of a very large goitre
• Large tonsils
• Medications, such as sleeping tablets and sedatives
• Nasal congestion

What are the warning signs of Sleep Apnoea?

• Loud, repetitive snoring – sleep apnoea sufferers follow a pattern of loud snoring followed by episodes of silence and then a loud snort or choking sound
• Excessive daytime sleepiness – this can occur whilst at work, watching TV or even driving the car
• Erratic mood shifts – people with sleep apnoea are more susceptible to depression and increased irritability
• Morning headaches
• Memory or learning problems
• Poor concentration
• Dry throat upon waking in the morning

How common is Sleep Apnoea?

It is estimated in Australia that 17% of middle-aged men and 6% or middle-aged women suffer from Obstructive Sleep Apnoea. Anyone can have sleep apnoea, however the more risk factors you have, as well as a family history of sleep apnoea, increases the risk of this disorder.

How is Sleep Apnoea diagnosed?

Your doctor will do a physical exam and check your mouth, nose and throat for large or extra tissue. Your doctor may order a sleep study which is performed in a hospital or sleep centre.
The most common sleep recording to diagnose sleep apnoea is called a polysomnogram or PSG. This test records:

• Brain and muscle activity
• Eye movement
• Breathing and heart rate
• Air movement into your lungs
• Oxygen in your blood

Can Sleep Apnoea be Treated?

Yes It Can!

Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness. The following methods may be used:

• Continuous Positive Airway Pressure (CPAP) is the most common treatment for sleep apnoea. This involves wearing a mask while you sleep which blows air into your throat at a pressure level which is right for you. The increased pressure keeps the throat open while you sleep
• Oral Devices such as custom-made mouthpieces can be helpful in some people with mild sleep apnoea. The mouthpiece will adjust your lower jaw and your tongue to help keep the airway in your throat open while you are sleeping
• Surgery may be an option only if the above alternatives do not work. Such procedures are effective only in a small proportion of mild obstructive sleep apnoea sufferers

Preventing Sleep Apnoea

Prevention for sleep apnoea relies on changes to lifestyle. It is recommended to:

• Lose weight
• Reduce night time alcohol
• Quit smoking — smoking damages the smaller airways of your lungs which reduces your total lung capacity. Smoking can exacerbate your sleep apnoea

Do I need Help?

To help determine whether you need medical treatment, answer the following questions.

• Do you gasp, choke or stop breathing during sleeping?
• Do you snore loudly at night?
• Do you feel tired and un-refreshed during the day?
• Are you overweight?
• Do you have a neck girth over 42cm?
• Do you have high blood pressure?

If you answer ‘YES’ to two or more of the above questions, you may have sleep apnoea and you should see your GP.

SLEEP More, WEIGH Less

Did you know that under-sleeping can lead to poor performance and impaired judgement and has also been linked to depression, obesity, diabetes and hypertension. A new study of 1,200 people showed that the average Australian adult gets less than seven hours sleep a night, below the seven to eight hours recommended by sleep experts.

A study by Columbia University, found people who slept four hours or less per night were 73% more likely to be overweight or obese. Also, people who habitually slept for five hours had 15% more ghrelin, a hormone which increases feelings of hunger, than those who slept for eight hours. Those who slept for less time were also found to have 15% less leptin, a hormone which suppresses appetite. "These differences are likely to increase appetite, and therefore contribute to obesity" Dr Taheri states. The subjects in the study also tended to eat more sweet and starchy foods when sleep was cut short.

While research continues, sleep still remains one of the body's most mysterious processes. We do know that sleep is absolutely necessary for survival and even occasional sleeping problems can make daily life feel more stressful or cause you to be less productive. Sleep loss also affects growth hormone secretion that is linked to obesity and impairs the body's ability to use insulin, which can lead to the onset of diabetes. It is paramount that we discover more about this activity where we spend a third of our lives - sleeping.

There are prescriptions and non-prescription drugs, herbs, remedies, technologies, etc that may help you get a good night's sleep. Some work for some and not for others.

Here are some tips you can try at home tonight. These tips are intended for the average adult, but not necessarily for children or persons experiencing medical problems:

• Imagining - Think of a hammock - you're up off the ground, wrapped in a cocoon of comfort, swaying gently in the open air. The sun is warm on your face and there's a cool breeze blowing you back and forth. This visualisation helps you "see" what the reward for sleeping will be, getting you more in the mood to sleep. Visualisation has proved helpful in developing the appropriate brain wave patterns for sleep.
• Magnesium - Has a calming effect on the nervous system. It is part of bones and cells, especially the smooth cells of arteries, and assists in the absorption of calcium and potassium. Over 300 enzymes in our body need magnesium to function properly. It is so important, that the brain stores a "safety supply" to have in the event of a drop in the magnesium reserves.
• Nutmeg - Grind fresh nutmeg and serve it with warm low fat milk and a touch of honey. Milk is naturally high in calcium and rich in tryptophan; together they can be a powerful tranquilizer (and very delicious).
• Hot foot baths - In the Eastern World, a hot foot bath is a traditional remedy; it draws blood from the brain to calm a racing mind. Try soaking your feet in a hot bath with a cupful of Epsom salts and a few drops of lavender essential oil, which will soothe you. Your feet absorb the magnesium from the Epsom salts and relax you further.
• Stomach rub - Soothes down the digestive system and helps bring about deeper relaxation. Lie on your back and place your hand on your belly button. Begin to make small circles in a clockwise direction as you gently glide your hand over your stomach. Let your circles gradually become bigger and bigger. When your circles reach the outside of your stomach, gradually reduce their size until you are back at your belly button again. Reverse the direction; repeat the whole series with your other hand and do this several times. Doing this with lavender oil can create an even more relaxing experience.
• Listening to an audio book - The brain works like a tape player - with one main auditory loop that processes words. If you fill that loop with an interesting book, there's no room for your own worrisome internal narrative. Especially helpful for those who have continuous thoughts running through their heads.
• Deep breathing - Take a deep breath in then slowly release out - focussing on your breathing causes your mind to get distracted from your worries and focussed on your breathing. Doing this for a few minutes can relax your mind and help you get a more peaceful sleep.
• Turn it off - Sleep experts suggest refraining from doing work, watching television, or being on the computer at least an hour before bed time. This allows your brain to start to 'wind down'.

Gangwisch. D, Malaspina. D, Boden-Albala. B, (2005) Inadequate Sleep as a Risk Factor for Obesity: Analyses of the NHANES I; COlumbia University, College of Physicians and Surgeons, New York, NY.

Taheri. S, Lin. L, Austin. D, Young. T, Mignot. E, (2004) Short Sleep Duration is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLos Med 1(3): e62. doi:10.1371/journal.pmed.0010062.

Are You Getting Enough Sleep to Lose Weight?

In the last 40 years, the average duration of nightly sleep has decreased by 1-2 hours (1), a time during which the number of people classified as overweight or obese has doubled. It's been hypothesised that there is a correlation between these two trends: and it's not just because more waking hours means more time to eat.

Research has found that sleep deprived rats eat more than rats that are allowed normal amounts of sleep (2,3) . And several studies with human subjects show that people who sleep less are more likely to be overweight (4).

The cause is believed to be two hormones that regulate appetite and energy expenditure: Ghrelin and Leptin. The level of Leptin, a hormone that suppresses appetite, is decreased with sleep deprivation; and the level of Ghrelin, a hormone that stimulates appetite, is increased with sleep deprivation. So if you are trying to lose weight it's important that you are getting enough sleep.

How Much Sleep is Enough?

There's no perfect level of sleep for everyone, but the following table identifies the 'rule-of-thumb' amounts most experts have agreed:

Age / Sleep Needs Per Night (hours)
1-2 months: 10.5 - 18
3-11 months: 9-12 + 1-4 x 0.5 - 2 hour naps
1-3 years: 12-14
3-5 years: 11-13 hours
5-12 years: 10-11 hours
11-17 years: 8.5-9.25 hours
Adults: 7-9 hours
Older adults: 7-9 hours

To determine your own sleep needs, assess how you feel with different amounts of sleep.

How Can I Get More Sleep?

1. Make sleep a priority - don't make it the thing you do when everything else is done. If you have a daily planner; schedule sleep into it.
2. Drink a glass of milk before going to bed. Milk contains the amino acid Tryptophan, which may facilitate sleep.
3. Don't eat in the 2-3 hours before going to bed and aim to go to bed feeling content (i.e. neither full nor hungry). Going to bed hungry can affect your sleep as much as going to bed on a full stomach.
4. Exercise on a regular basis; avoiding the three hours before your bedtime. Some people exercise close to bedtime in the hope it will exhaust them; but this tactic can backfire as exercise stimulates the body by increasing your heart rate and metabolism.
5. Reduce your alcohol consumption. Although alcohol may help you fall asleep, it can disrupt your normal sleep pattern during the second half of the night and leave you feeling tired.
6. Avoid caffeinated drinks and foods after midday. This includes coffee, tea, cola and chocolate. If you are having trouble sleeping; try avoiding caffeine entirely and see if your sleep patterns improve.
7. Avoid smoking in the six hours before your bedtime (nicotine is a stimulant).
8. Avoid drinking too many fluids before bedtime to minimise night time urination.

References:

1. National Sleep Foundation, 2002, 'Sleep in America'
2. Danguir J and Nicolaidis S. 1979, 'Dependence of Sleep on Nutrients' Availability' Journal of Physiology and Behaviour vol. 22, pp. 735-740.
3. Everson CA, Bergmann BM, Rechtschaffen A. 1989, 'Sleep Deprivation in the Rat: III. Total Sleep Deprivation' Sleep vol. 12 pp. 13-21.
4. Hasler G, Buysse D, Klaghofer R, Gamma A, Ajdacic V, et al. 2004, 'The Association Between Short Sleep Duration and Obesity in Young Adults: A 13-year Prospective Study' Sleep vol.27 pp. 661-666.

Sleep Apnoea

Did you know that obesity is one of the most common causes of Sleep Apnoea?

You need to see a Doctor for an official diagnosis, but if you are experiencing the following symptoms you may be suffering from sleep apnoea:

- Daytime sleepiness, fatigue and tiredness
- Poor concentration
- Irritability and mood changes
- Impotence and reduced sex drive.

People with sleep apnoea are at an increased risk of motor vehicle accidents and developing diseases such as hypertension, heart attack and stroke.

One of the first steps in treating sleep apnoea is weight loss, in fact by losing 5-10kg you can dramatically reduce the severity of the disorder. At the Wesley Weight Management Clinic we have seen many people reduce the symptoms of Sleep Apnoea by completing our weight loss program, so it's a great place to start.