What can make sleep apnoea worse?

By Sandip Banerjee Sleep Disorders 24 November 2023

Sleep apnoea, a pervasive sleep disorder characterised by interruptions in breathing during sleep, poses substantial challenges to both physical and mental health. Understanding the factors that can exacerbate sleep apnoea is crucial for effective management, and exploring potential treatments becomes imperative for those affected.

What is Sleep Apnoea?

Sleep apnoea is a sleep disorder characterised by interruptions in breathing during sleep. These interruptions, known as apnoea events, can last for seconds to minutes and may occur multiple times throughout the night. The most common type is obstructive sleep apnoea (OSA), where the muscles in the throat relax excessively, leading to complete blockage of the airway.

Complications

Before delving into the factors that worsen sleep apnoea, let’s briefly explore the potential complications of this sleep disorder. It has been linked to various health issues, including:

1. Cardiovascular Problems: Individuals with untreated sleep apnoea are at a higher risk of hypertension, heart disease, and stroke. The strain on the cardiovascular system due to intermittent oxygen deprivation during sleep contributes significantly to these risks.

2. Diabetes: Sleep apnoea has been associated with insulin resistance and an increased risk of developing type 2 diabetes. The disrupted sleep patterns and elevated stress response associated with sleep apnoea can contribute to the insulin resistance, and in turn glucose (sugar) dysregulation. Diabetes can often be difficult to manage and can lead to a wide array of complications, so it is vital for patients with sleep apnoea to take proactive measures to keep their blood sugar levels within the normal range.

3. Mental Health: The profound impact of consistent, quality sleep on mental and emotional well-being is well documented. Sleep apnoea has been linked to mood disorders, such as depression and anxiety. The chronic sleep fragmentation and deprivation can adversely affect neurotransmitter levels and contribute to emotional instability.

4. Daytime Fatigue: The interruptions in sleep can lead to excessive daytime sleepiness, impacting overall daily functioning. By treating sleep apnoea, we can improve the flow of oxygen to the brain, leading to enhanced mental clarity, concentration, and overall cognitive performance. This can be of particular importance to patients who need to be fully alert for work, such as heavy goods vehicle operators.

What makes sleep apnoea worse?

1. Obesity: Being overweight or obese is a significant risk factor for sleep apnoea. Obesity contributes to the accumulation of fatty deposits around the neck and throat, increasing the likelihood of airway obstruction during sleep. In England, 61% of adults are classified as overweight or obese. Sleep apnoea affects 40% of obese individuals (BMI between 30 and 40) and 77% of those classified as morbidly obese (BMI over 40). Obesity is also associated with a wide array of other health problems such as an increased risk of cardiovascular disease (heart disease, stroke etc), type 2 diabetes, joint problems, and certain cancers, impacting both physical and mental well-being. Addressing obesity through lifestyle changes, including a balanced diet and regular physical activity, is crucial for mitigating these health risks.

2. Dietary Factors: The role of diet in sleep apnoea deserves attention. Studies have shown that higher frequency intake of fruits is associated with a reduced risk of developing obstructive sleep apnoea. On the other hand, a diet with higher levels of animal innards, fried food, salted food, carbonated and non-carbonated beverages consumption may increase your risk of developing obstructive sleep apnoea. Exploring dietary interventions, such as a balanced and nutrient-rich diet, can help complement other lifestyle changes in managing sleep apnoea.

3. Hormonal Factors: Hormonal fluctuations, particularly in women, can influence sleep apnoea severity. Postmenopausal women are two to three times more likely to have sleep apnoea compared with premenopausal women. This is likely due to the loss of the protective effects of hormones such as oestrogen and progesterone which become depleted after menopause. Unfortunately, sleep apnoea in menopausal women can often go undiagnosed as many often attribute the symptoms and effects of sleep disorders, like daytime fatigue, to the menopause itself.

4. Positional Factors: Sleeping on your back can worsen sleep apnoea symptoms. The National Institute for Health and Care Excellence (NICE) recommends sleeping on your side to alleviate symptoms. The significance of sleep position in exacerbating sleep apnoea can be highlighted by monitoring tools, like sleep trackers and positional therapy devices. These devices provide valuable data on sleep positions and can aid in developing strategies to mitigate apnoea events. Investigating the real-time impact of different sleep positions on the frequency and severity of apnoea episodes can help professionals in providing enhanced treatment recommendations.

5. Nasal Congestion and Environmental Factors: Obstructive sleep apnoea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. Addressing the cause of any nasal congestion issues, such as allergies or anatomical issues, through appropriate medical interventions after seeking advice from a healthcare professional, can play a role in improving sleep quality. In addition, environmental factors such as air pollution can also result in an exacerbation of an individual’s sleep apnoea symptoms.

6. Alcohol and Sedative Use: Regular alcohol use and certain sedatives heighten the risk of developing sleep apnoea by 25% as they cause your throat muscles to relax, increasing resistance during breathing and slowing the body’s response to arousal. This can exacerbate sleep apnoea symptoms, leading to more prolonged and hazardous breathing interruptions. It is recommended to avoid alcohol within 4 hours of bedtime to allow the body sufficient time to metabolise it. Additionally, as alcohol is an appetite stimulant, being mindful of its calorie content is crucial for individuals with sleep apnoea, as weight loss can have significant benefits for managing this condition.

7. Smoking: Smoking, regardless of the form (vapes, cigars, or cigarettes), diminishes sleep quality and exacerbates difficulty falling asleep. It can inflame the upper airway, contributing to sleep apnoea symptoms, with more severe forms observed in those who smoke more. A particular study found that current smokers were 1.2 times more likely to have obstructive sleep apnoea than former and never-smokers combined and 1.49 times more likely to have obstructive sleep apnoea than never-smokers. The study indicated that men, especially those with cardiovascular issues, exhibited higher smoking rates, nicotine dependence, and more severe obstructive sleep apnoea. Additionally, smoking is linked to respiratory issues such as chronic obstructive pulmonary disease (COPD), various cancers, and heightened risks of conditions like diabetes and reproductive issues. Therefore, smoking cessation not only plays a role in managing sleep apnoea but also benefits overall health.

Potential treatments

Addressing sleep apnoea involves diverse treatment approaches aimed at alleviating symptoms, improving sleep quality, and reducing associated health risks. The two main primary treatments are Continuous Positive Airway Pressure (CPAP) therapy and Mandibular Advancement Devices (MAD). Other treatments, such as positional therapy, are also emerging to provide alternatives to the traditional treatment methods currently available.

1. CPAP Therapy: This non-invasive treatment involves wearing a mask during sleep, delivering a constant stream of air to prevent airway collapse. CPAP is highly effective and is considered the gold standard treatment for individuals with moderate – severe sleep apnoea, reducing apnoea severity and also improving overall sleep quality. Despite its proven efficacy, factors influencing long-term adherence, including mask comfort and noise levels, warrant further research to enhance patient compliance.

2. Mandibular Advancement Devices (MAD): Offering an alternative for those finding CPAP uncomfortable, MADs reposition the lower jaw to prevent airway collapse, and have proven to be particularly effective for those with moderate to severe sleep apnoea. MAD, with its unobstructive design and ease of use, presents a more favourable choice for those seeking comfort without compromising effectiveness. Whilst CPAP has shown to be more effective at reducing sleep apnoea, an increasing number of studies suggest fairly similar outcomes in terms of symptoms as a result of these treatments. These findings, coupled with the higher compliance seen with MAD, positions it as a viable and more tolerable alternative for those seeking effective yet user-friendly interventions.

3. Positional Therapy: Emerging as a viable option, positional therapy encourages sleeping positions that minimise airway collapse. Devices like positional pillows and wearables provide feedback to promote lateral sleeping positions. Whilst effective for positional sleep apnoea, individuals with other types of sleep apnoea may find these devices prove to be more of a hassle than of any significant benefit.

In summary, sleep apnoea can significantly impact health and well-being, but understanding the factors that worsen the condition is crucial for effective management. Addressing these factors, along with exploring tried and tested treatments like CPAP and MAD, can lead to improved sleep quality and overall health.

By implementing lifestyle changes and considering appropriate treatments, individuals with sleep apnoea can take proactive steps towards a more restful night’s sleep and enhanced well-being. As we continue to uncover the intricacies of sleep apnoea, it becomes evident that a holistic approach, encompassing both lifestyle modifications and targeted therapies, is key to managing and improving this sleep disorder.

Is your sleep apnoea getting worse?

Sleep apnoea can profoundly affect physical and mental well-being in many ways. It is important to contact your GP and the right specialists if you are struggling with your sleep or breathing. In severe cases, sleep apnoea can also lead to life-threatening conditions. It is important to ensure that the correct type is diagnosed as soon as possible to start the right treatment.

As a leading sleep and respiratory physician specialising in sleep apnoea and sleep-related breathing disorders, I offer consultations to diagnose and treat these conditions including providing CPAPs and MADs. Please contact me if you have any further queries about what can may sleep apnoea worse or want further advice on the potential treatments available.