Sleep apnoea and microsleep

Overview

In sleep apnoea, breathing repeatedly stops and starts while you sleep, alternating with sudden snoring and waking up with a start. It is often caused by an obstruction of the airways in the throat. Because they sleep badly, patients suffer from chronic fatigue during the day and tend to experience episodes of microsleep, which can be quite dangerous. Preventive measures include losing weight, among others.

Symptoms

• Loud, irregular snoring with breathing pauses during the night
• Sleep is regularly interrupted by waking up abruptly and incompletely
• Sufferers feel tired and exhausted in the morning
• Lack of concentration, forgetfulness, reduced ability to function properly
• Sometimes an uncontrollable need for sleep, sleepiness during the day
• Microsleep (dangerous when driving a vehicle or working with a machine)
  • Promoting factors: long and monotonous driving sessions, driving at night, sleeping passenger
• Possible accompanying symptoms
  • Anxiety
  • Headaches
  • Depression
  • Potency disorders

Risk of secondary diseases (cardiovascular system)

• Hypertension (high blood pressure)
• Heart arrhythmia
• Myocardial insufficiency (cardiac insufficiency)
• Cerebral apoplexy (stroke)

Causes and treatment

Cause

Obstructive sleep apnoea

• Obstruction or narrowing of the airways in the throat
  • Anatomical causes: small jaw, enlarged tongue or adenoids
  • Muscular causes: severe muscular weakness
• Promoting factors:
  • Obesity
  • Alcohol, smoking
  • Tranquillisers and sleeping pills
• Waking up because of lack of oxygen
  • Breathing starts again, accompanied by snoring and gasping for air

Central sleep apnoea

• Brain doesn’t send the proper signals to the respiratory centre
  • Inflammatory: cerebral inflammation (encephalitis)
  • Degenerative: degradation processes in the brain stem
• Symptoms of an underlying disease
• Occurs more frequently with age
• Less often: apnoeic attacks in newborn babies
  • Probably caused by immaturity of the respiratory centre

Important: combination of central and obstructive apnoea can occur

Further treatment by your doctor / in hospital

Possible tests

• Standardised questionnaires
• Ask your partner if you snore and stop breathing (third-party anamnesis)
• 24-hour blood pressure measurement
• Examination in a sleep laboratory
  • Flow of breath, breathing pauses, oxygen saturation in the blood
  • Breathing movements, snoring sounds, heart rate
  • Phases and stages of sleep, eye movements, muscle activity

Possible therapies

• Treatment of an underlying disease
• Positive pressure ventilation (most effective treatment)
  • Patients wear a nasal mask providing a flow of air into the nasal passages
  • Airways remain open
  • Patients receive sufficient oxygen
• Sometimes: mouthguard
  • Inserted between the upper and lower jaws
  • Holds the airways open
• Operation
  • Enlarged tonsils, polyps are removed
  • Certain malformations are corrected

What can I do myself?

• Reduce overweight
• Avoid nicotine
• Don't drink alcohol at night (reduced quality of sleep, need to urinate)
• Take sleeping pills or tranquillisers by way of exception only
• Practice good sleep hygiene
  • Better to sleep on your side (more snoring and breathing pauses when sleeping on the back)
  • Regular and sufficient sleep
• Take signs that warn of a microsleep episode seriously:
  • Yawning, “heavy eyelids”, shivering, fatigue
  • Driving mistakes: wavy line, irregular speed, sudden braking
• React correctly to imminent episodes of microsleep:
  • Park the car, drink something
  • Move around outside, do some exercises
  • If possible, let the passenger take over the wheel

When to see a doctor?

• Very loud snoring
• Breathing pauses while sleeping (>10 sec)
• Constantly tired and fatigued in the morning in spite of sleeping long enough
• Urgent: uncontrollable urge to sleep while driving, working, etc.
• Regular snoring by children, in particular pre-school children

Further information

Selbsthilfe Schweiz (Self-Help Support Switzerland)
www.selbsthilfeschweiz.ch

Swiss Lung Association (Lungenliga Schweiz)
www.lungenliga.ch

Synonyms

sleep apnoea and microsleep, snoring, microsleep, sleep apnoea, OSA, obstructive sleep apnoea, sleep apnoea syndrome, central sleep apnoea syndrome, obesity hypoventilation syndrome, Pickwickian syndrome