Main
- Sleep apnoea — repeated stops in breathing during sleep that fragment rest and deprive the body of the deep recovery phase.
- Signs at night: loud snoring with pauses in breathing, waking up from lack of air, dry mouth and headache in the morning.
- During the day drowsiness, fatigue, reduced attention and memory, irritability and mood swings appear.
- Diagnosis includes history-taking and examination by an ENT doctor, a sleep study, respiratory monitoring and assessment of daytime sleepiness using questionnaires.
- Care is managed by an ENT doctor; if necessary, a pulmonologist and a neurologist are involved; if no specialist is available, start with a general practitioner.
What is sleep apnoea
Sleep apnoea is pauses in breathing during sleep that recur and prevent the body from resting. Let us look at what lies behind this condition, why it occurs and who is affected more often.
What happens in the body
During sleep, the muscles of the pharynx relax and block the airway, so breathing stops briefly or becomes very shallow. The brain detects the lack of oxygen and sends a signal to wake up in order to restore breathing. The person usually does not wake up fully and in the morning remembers nothing about the night-time episodes. Such pauses can repeat many times during the night and significantly fragment sleep. Because of this, the deep phase of rest is lost, and the body does not have time to recover. During the day this manifests as drowsiness, lethargy, difficulty concentrating and a headache after waking up. If night-time pauses in breathing recur regularly, it is worth discussing this with a doctor rather than putting it down to ordinary fatigue.
What causes it to develop
- Excess body weight: extra tissue in the neck area compresses the airways and narrows their lumen during sleep.
- A deviated nasal septum or nasal polyps: make it harder for air to pass, so breathing through the nose during sleep becomes more difficult.
- Enlarged tonsils or adenoids: take up space in the pharynx and block the flow of air when the muscles relax.
- Alcohol and sedative use: further relax the muscles of the pharynx and make pauses in breathing more pronounced.
- Certain endocrine and neurological diseases: alter the function of the muscles and the respiratory centre, affecting the stability of breathing at night.
- Age-related changes in the tone of the pharyngeal muscles: over time the muscles weaken, so the lumen of the airways narrows more easily than before.
Who is affected more often
Pauses in breathing during sleep are more common in people with excess body weight, especially when fat is deposited in the neck area. Men are more prone to this condition than women, although after the onset of menopause the difference between the sexes noticeably evens out. Age also matters: over the years the tone of the pharyngeal muscles decreases, so the lumen of the airways narrows more easily. In children, the cause is often enlarged tonsils and adenoids, which prevent free breathing through the nose. Features of the structure of the face and jaw, as well as a deviated nasal septum, also contribute. Drinking alcohol in the evening and taking certain remedies that affect breathing increase the risk even in people without other predisposing factors. If loved ones notice pauses in a person's breathing during sleep, it is sensible to discuss this with a doctor and not put the conversation off.
What symptoms can occur?
Sleep apnoea is recognised by signs that appear at night and during the day. It is important to understand when these symptoms require a routine visit to a doctor, and when you need to act immediately.
How it is noticed at the very beginning
Sleep apnoea in the early stages is more often noticed by close ones rather than by the person themselves. At night, those around hear loud snoring that is interrupted by pauses in breathing. The sleeper themselves is not aware of the brief stops in breathing and may deny the problem. In the morning they wake up exhausted, feel dry mouth and headache. During the day, severe drowsiness, reduced attention and irritability appear. These signs are often put down to fatigue, lack of sleep or a busy job. If this condition repeats regularly, it is worth booking a routine consultation with a doctor for an examination.
Signs that occur most often
- Loud snoring with pauses in breathing: the snoring is interrupted by stops in breathing that close ones notice, while the sleeper themselves is not aware of them.
- Waking up with a feeling of lack of air: the person suddenly wakes up from a lack of air, which is frightening and disrupts night rest.
- Morning headache and dry mouth: after sleep there is exhaustion, the head hurts, the mouth is dry, and this repeats day after day.
- Daytime drowsiness and fatigue: the person falls asleep at work, at school or on transport, and by the evening feels completely exhausted.
- Reduced attention and memory: it becomes difficult to concentrate, details are forgotten, which affects work and studies.
- Irritability and mood swings: hot temper appears, which over time affects relationships with close ones and colleagues.
When to seek help urgently
Examinations and tests
Examination for suspected sleep apnoea is carried out in stages: first the doctor talks to the patient, then prescribes instrumental methods. Each test answers its own question and helps assess the severity of the breathing disorder during sleep.
How the examination begins
The examination begins with a detailed conversation with the doctor, who collects the patient's complaints and studies the history of their illnesses. At the appointment it is important to ask relatives about the nature of sleep and noticed breathing pauses, because the sleeper does not remember them. The doctor clarifies how long ago the episodes appeared, how the person sleeps, whether they snore and whether they wake up at night. Separately, it is established whether there is daytime sleepiness, morning headaches and reduced attention during the day. Then an examination is performed, including assessment of the structure of the upper respiratory tract, nasal breathing and the condition of the ENT organs. Such questioning and examination by an ENT doctor make it possible to suspect the cause of the obstruction and outline further steps. Without this conversation it is impossible to correctly choose the method of sleep testing and correctly interpret its results.
What is prescribed and what it shows
What is worth preparing for the appointment
- Extracts from medical records: they show the doctor how the condition developed and what examinations have already been carried out before.
- Results of previous sleep studies: recordings of breathing and blood saturation help compare the picture and assess changes over the past time.
- Relatives' notes about sleep: a description of snoring, pauses in breathing and awakenings provides information that the patient themselves cannot notice.
- List of medications taken: a list of what the person takes regularly is needed by the doctor for a correct assessment of the general condition.
- Sleepiness diary: notes on when and how strongly one feels sleepy help assess the effect of the disorder on daily life.
- Questions for the doctor: clarifications written down in advance about the course of the examination allow nothing to be forgotten during the conversation at the appointment.
Which doctor should I see?
This section explains which specialist to consult if sleep apnoea is suspected, what happens at the first appointment and what areas of care the treatment consists of.
Which specialist manages this condition
Sleep apnoea is managed by an ENT doctor, and if there are accompanying conditions, a pulmonologist and a neurologist are also involved. The ENT doctor examines the upper respiratory tract and assesses whether there are anatomical obstacles to breathing during sleep. The pulmonologist deals with the respiratory system and the selection of CPAP therapy, if it is indicated. The neurologist looks at the connection between breathing pauses and the functioning of the nervous system and sleep disorders. If there is no relevant specialist nearby, start with a general practitioner: they will listen to your complaints and refer you to the right doctor. At the first appointment, the doctor clarifies the complaints, takes a history, examines the respiratory tract and decides which examinations are needed. Then they explain the possible areas of care and agree with you on the next step.
What the treatment consists of
- Weight loss: if you are overweight, this reduces pressure on the respiratory tract and makes breathing during sleep easier.
- Giving up alcohol and sedatives: they relax the muscles of the pharynx and increase breathing pauses, so their effect is important to take into account.
- Intraoral devices: they are made individually to hold the lower jaw and tongue in a position in which breathing remains free.
- CPAP therapy: the device creates continuous positive pressure in the respiratory tract and prevents it from collapsing during sleep.
- Surgical treatment: it is considered when there are anatomical obstacles that impede the passage of air and do not respond to other methods.
- Treatment of accompanying diseases: it is important because untreated apnoea increases the risk of cardiovascular complications.
What depends on the patient themselves
Regular follow-up with the doctor determines how stable the result will be in sleep apnoea. Even with selected therapy, the condition changes over time, so infrequent visits do not allow these changes to be noticed in time. If you postpone the appointment, the doctor does not see how you are sleeping now and cannot adjust the care to the changed circumstances. Adherence to the recommendations, including using the prescribed devices every night, affects the course of the condition more than one-off efforts. Records of how sleep goes and how you feel during the day help the doctor more accurately assess the dynamics at the appointment. Giving up alcohol and sedatives in the evening remains your area of responsibility, and this noticeably affects night-time breathing. The practical conclusion is simple: choose a regular doctor and come to them according to an agreed schedule, and not only when things get worse.
What helps prevent an exacerbation?
Preventing the worsening of sleep apnoea is largely helped by the person themselves, by changing everyday habits and carefully monitoring their condition. Below is what exactly should be put in order and why regular monitoring is important even when you feel well.
What is changed in habits
Maintaining a healthy weight directly affects the course of sleep apnoea, since extra kilograms increase the narrowing of the airways when lying down. Limiting alcohol and sedatives reduces the relaxation of the muscles of the pharynx, which causes breathing pauses. Sleeping on the side often reduces the falling back of soft tissues and makes breathing more even throughout the night. Giving up smoking reduces irritation of the nasal and pharyngeal mucosa, and this noticeably eases the passage of air. Regular physical activity strengthens the respiratory muscles and helps keep weight within the necessary limits. Following sleep hygiene — a constant time of going to bed, a quiet and cool bedroom — reduces night awakenings and daytime sleepiness. If snoring and pauses in breathing persist despite these steps, it is worth discussing further tactics with a doctor.
What should be kept under control
- Body weight: it is measured regularly, because even a small weight gain increases snoring and breathing pauses during sleep.
- Alcohol and sedatives: their intake in the evening should be limited, as they relax the muscles of the pharynx and lengthen pauses in breathing.
- The condition of the nose and pharynx: congestion and difficulty with nasal breathing require treatment by an ENT doctor, otherwise breathing during sleep worsens.
- Position during sleep: the habit of sleeping on the back is useful to change to sleeping on the side, since in this way soft tissues less often block the airflow.
- Daytime well-being: the level of alertness and sleepiness is important to track, because their changes are the first to indicate a worsening of the course of apnoea.
How often to see a doctor
Regular visits to a doctor are needed even when your well-being seems quite satisfactory, since sleep apnoea can change imperceptibly over time. The specialist assesses how the person sleeps, how they cope with daytime loads and whether there is a return of previous signs. With weight gain, the resumption of snoring or increased daytime sleepiness, the visit should not be postponed, because these shifts indicate a possible worsening. The doctor also checks whether problems with nasal breathing have appeared that require separate attention. If the person uses the prescribed therapy, monitoring helps to notice in time that it has stopped helping. The frequency of examinations is determined by the doctor taking into account the condition and accompanying circumstances. Planned observation allows lifestyle to be adjusted before the condition noticeably worsens.
What is worth remembering
The discussion of sleep apnoea should end with what remains with the reader after becoming familiar with the signs, examinations and doctors. Below are brief conclusions that help make a decision without haste and unnecessary doubts.
Main conclusions
Sleep apnoea is a condition in which breathing during sleep is repeatedly interrupted, and the person is often unaware of it. It is usually noticed by indirect signs: loud snoring, breathing pauses reported by loved ones, daytime sleepiness and morning exhaustion. Such a condition does not go away on its own and may worsen over time, affecting the work of the heart and blood vessels. The danger is that people get used to it and consider it a variant of the norm, postponing a visit to a specialist. Meanwhile, a timely visit allows the cause to be clarified and a suitable approach to be selected. One should not try to correct sleep apnoea on one's own or wait until it becomes really severe. If loved ones speak of breathing pauses during sleep, this is already sufficient reason for a consultation.
