Whether it is loud rattling or mild snorting sound, snoring can be irritating for both snorers and bed partners. According to international studies, up to 40% of adults snore and this is a common experience for many in Singapore. Many people may brush it off as nothing more than just a nuisance or inconvenience. However, sometimes snoring may be the tip of the iceberg of more serious health concerns such as sleep apnoea.
It is crucial to consult a Sleep Specialist in Singapore as soon as possible if you suspect that you or your partner is suffering from sleep apnoea. Your Sleep Specialist in Singapore may send you to a sleep clinic for further examination to provide you with optimal treatment options, relieving symptoms such as snoring.
Snoring is the rattling or snorting noise made by a person during breathing while sleeping.
Obstructive sleep apnoea (OSA) is a potentially serious sleep disorder. Under normal circumstances, the air flows smoothly from the mouth and nose into the lungs at all times throughout sleep. However, people with OSA often stop breathing involuntarily for brief periods of time during sleep. The flow of air stops because the space in the throat is too narrow. Snoring ends up as a characteristic of sleep apnoea and is often caused by airflow squeezing through the narrowed space.
If left untreated, sleep apnoea can cause serious health problems such as:
Thus, proper diagnosis and treatment at a sleep clinic are essential in preventing complications.
Sleep apnoea can be categorised into three types:
OSA is the most common type of sleep apnoea, and it tends to occur in older people as well as those who are overweight. Some lifestyle changes such as weight loss can significantly improve OSA symptoms. Besides weight management, patients suffering from sleep apnoea should try to not sleep on their back to prevent further aggravation.
Anyone can be at risk of developing OSA, however certain factors can increase your susceptibility to it:
Since airflow is obstructed, OSA causes episodes of decreased oxygen supply to the brain and other parts of the body. As a result, OSA patients have poor sleep quality, leading to daytime drowsiness. Furthermore, patients with OSA may also experience the following:
Daytime drowsiness puts people at risk for motor vehicle crashes as well as industrial accidents. Thus snoring and sleep apnoea treatments are good for helping them relieve OSA symptoms.
Patients who experience chronic or recurrent tonsillitis may also experience obstructive sleep apnoea (OSA). This is a result of swollen airways, preventing the patient from sleeping well and leading to other serious medical issues.
It is best to consult your doctor on how you can be evaluated for the presence of OSA. Usually, it involves a consultation with your ENT specialist who will make a thorough check of your clinical history and conduct a physical examination. It is likely that a flexible nasoendoscopy (the passage of a small lighted tube with a camera into the nose and throat – Figure 1) will be performed in the clinic to evaluate the possible sites of narrowing in the upper airway.
An overnight sleep study (Figure 2), also known as polysomnography (PSG), is required to diagnose OSA. A sleep study is conducted in a sleep laboratory or at home. It records the body’s activity during sleep which may include brain waves, the oxygen level in the blood, heart rate and breathing as well as eyes and leg movements. A reliable and less complicated alternative to a full sleep study would be the use of a WatchPAT sleep study. It does not monitor as much information as a full sleep study but has been shown to be a reliable alternative for patients with symptoms suggestive of OSA and for patients who are not be able to sleep well with many wires and sensors attached to them. The advantage of a WatchPAT sleep study is its simplicity and patients can often sleep better with it (Figure 3).
The sleep study records the number of events known as apnoeas (when there is > 90% decrease in airflow to the lungs for >10 seconds) or hypopnoeas (when one has >30% decrease in airflow to the lungs for > 10 seconds and >3% drop in oxygen saturation or arousal) during sleep.
The goal for sleep apnoea treatment is to ensure airflow is not obstructed during sleep. Some treatment methods include:
The type of surgery performed to treat OSA depends on the level of blockage or narrowing in the upper airway. These may include:
In the nose:
In the mouth and throat:
Know of anyone who snores and is looking to seek treatment for their sleep apnoea? Let us help you improve your health and quality of life, make an appointment at our specialist ENT and sleep clinic today.
Snoring is the rattling or snorting noise made by a person during breathing while sleeping.
Socially
A snorer may cause sleepless nights for his or her bed partner or roommates. This can lead to fatigue and frustration from the bed partner or roommates due to insufficient or disrupted sleep. A loud snorer may also be a subject of ridicule by his or her friends and family, resulting in psychological consequences.
Medically
Snoring may be a sign of Obstructive Sleep Apnoea (OSA), a medical condition with potentially severe consequences if left untreated.
OSA is a medical condition where a person stops breathing repeatedly during his or her sleep due to collapse of the upper airway. In each episode of apnoea, the person stops breathing completely for a duration of greater than 10 seconds. As a result, less oxygen gets carried in the blood to the heart and brain (Figure 1).
Excessive bulkiness of throat tissues
The throat can be congested and narrow if one has:
Excessive bulkiness of nose tissues
A blocked nose will often result in mouth breathing. Mouth breathing may result in excessive breathing effort. This excessive effort creates a vacuum that causes soft tissues in the throat to collapse, leading to snoring. The nose can be obstructed from:
Floppy soft tissues in the throat and poor muscle tone in the tongue
In people with these conditions, their tongue may fall backwards into the airway and their throat tissues at the side may be drawn in during sleep. These results in a partially obstructed airway, vibration of the tissues and snoring
The most common symptom of OSA is snoring. OSA patients are often loud snorers with choking episodes during sleep, excessive restlessness at night and they may feel tired during the day. Other associated symptoms include morning headaches, frequent urination at night, depression and decreased sex drive.
It is best to consult your doctor on how you can be evaluated for the presence of OSA. Usually, it involves a consultation with your ENT Specialist who will take a thorough clinical history and conduct a physical examination. It is likely that a flexible nasoendoscopy (the passage of a small lighted tube with a camera into the nose and throat – Figure 1) will be performed in the clinic to evaluate the possible sites of narrowing in the upper airway.
An overnight sleep study (Figure 2), also known as polysomnography (PSG), is required to diagnose OSA. A sleep study is conducted in a sleep laboratory or at home. It records the body’s activity during sleep which may include brain waves, the oxygen level in the blood, heart rate and breathing as well as eyes and leg movements. A reliable and less complicated alternative to a full sleep study would be the use of a WatchPAT sleep study. It does not monitor as much information as a full sleep study but has been shown to be a reliable alternative for patients with symptoms suggestive of OSA and for patients who are not be able to sleep well with many wires and sensors attached to them. The advantage of a WatchPAT sleep study is its simplicity and patients can often sleep better with it (Figure 3).
The sleep study records the number of events known as apnoeas (when there is > 90% decrease in airflow to the lungs for >10 seconds) or hypopnoeas (when one has >30% decrease in airflow to the lungs for > 10 seconds and >3% drop in oxygen saturation or arousal) during sleep.
In adults, a diagnosis of OSA is made when one has an AHI (Apnoea-Hypopnoea Index – average number of apnoeas and hypopnoeas in an hour) of more than 5 in an hour. The severity of OSA in adults is based on the AHI as follows:
The scoring of AHI is different in children. Your ENT Specialist will discuss this differences with you.
When ignored and untreated, sleep apnea can cause serious health problems. These problems include high blood pressure, heart disease, Type 2 diabetes, stroke and depression.
Is there cure for OSA? The management of snoring and OSA can be complex. The list below are common treatment options available in Singapore but are not meant to be exhaustive. It is recommended to consult your doctor for your snoring and OSA issues on the best treatment options for you.
Medical treatment
Weight reduction (for overweight or obese patients) and sleeping on the side are effective in both primary snorers and patients with OSA. The gold standard for the management of OSA is the use of Continuous Positive Airway Pressure (CPAP) therapy* (Figure 1). In CPAP therapy, a machine pumps air through a mask that the patient wears during sleep. This “positive pressure” or column of air passes through the patient’s upper airway will keep the upper airway splinted open during sleep. It has been shown to be very effective. However, some patients may not tolerate this and may want to consider other treatment options that can a more effective cure for OSA.
Dental devices
Customized oral appliances can be used to reposition the lower jaw and tongue forward during sleep
Surgical treatment
The type of surgery performed to treat OSA depends on the level of blockage or narrowing in the upper airway. These may include:
In the nose:
In the mouth and throat:
*In children, the most common cause of OSA are enlarged tonsils and adenoids as well as obesity. If enlarged tonsils and adenoids are the likely reasons for OSA in your child, surgical removal of the tonsils and adenoids will be the first line treatment.
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