Sleep occurs in stages, with the deepest stages characterized by paralysis of voluntary muscles and rapid eye movements. Sleep apnea is a disorder where breathing stops briefly during sleep, often due to airway obstruction, which interrupts sleep quality. The main types are obstructive sleep apnea, caused by relaxation of throat muscles blocking the airway, and central sleep apnea, caused by failure of the brain to signal breathing muscles. Risk factors include obesity, large neck size, and family history. Treatment options include devices that use air pressure to keep the airway open as well as surgery in severe cases. Untreated sleep apnea can increase health risks like hypertension, heart disease, and diabetes.

2. SLEEP (11)
Sleep is a routine of the daily life. In sleep, there is reduced or lack of conscious state. Voluntary muscles do not work
during sleep.
There are 5 stages of sleep. Stage 1 to stage 4 are classified as NON RAPID EYE MOVEMENT (N-REM) stage of sleep. As the
stages increase, the sleep gets deeper and consciousness decrease.
The last stage of sleep is the RAPID EYE MOVEMENT (REM) stage where there is paralysis (complete inactivation) of
voluntary muscles. However, the eye muscles are still working and the eyes are moving (rolling) rapidly. The obstructive
sleep apnoea mainly occurs in this stage when the paralysed muscles collapse onto the airways and cause blockage.

3. WHAT IS SLEEP APNOEA? (12)
Sleep apnoea is a disorder of sleep. The underlying cause is mostly stopping of breathing during the sleep, especially in
the deep sleep.
When there is not enough oxygen in the body, it wakes up to re-initiate breathing. This results in interruptions to sleep
and leads to lack of quality sleep. These episodes of awakening are very short moments and the patient may or may
not even realise it.

4. SLEEP
STOP
BREATHING
WAKE UP
RESTORE
BREATHING

5. For managing sleep apnoea, it is very important to find the condition that triggers
breathing to stop.
This lack of quality sleep causes SLEEPLESSNESS and TIREDNESS during the day.

6. TYPES OF SLEEP APNOEA (2)
Obstructive Sleep Apnoea (OSA):
During sleep, mainly in the REM stage, the muscles of upper airway relax and BLOCK the airways. There can be complete
blockage (apnoea) which stops breathing or half blockage (hypopnoea) which causes poorer breathing. The blocking can
last for more than 10 seconds.
Central Sleep Apnoea (CSA):
There is a respiratory centre in the brain which controls breathing during day and night. Central sleep apnoea occurs
when this centre does not send appropriate signals to the muscles that facilitate breathing.
Complex Sleep Apnoea:
Complex sleep apnoea is the condition when both obstructive sleep apnoea and central sleep apnoea are present.

7. OSA - CAUSES(2) (3)
Palate shape and micrognathism (small jaw)
Large tonsils or tongue
Large neck
Being overweight
Narrow upper airway

8. OSA - RISK FACTORS(2) (3)
Male gender
Old age
Family history
Smoking
Alcohol or addictive drug consumption
High blood pressure
Obesity

9. SIGNS
AND
SYMPTOMS
SNORING
GASPS IN
SLEEP
FEELING OF
SLEEPLESSNESS AND
FALLING ASLEEP DURING
DAYTIME
DRY MOUTH IN
THE MORNING
SUSPENSION OF
BREATHING
WAKING UP
FREQUENTLY
IN THE NIGHT
FORGETFULLNESS
HEADACHE
OSA - SIGNS AND SYMPTOMS(3)

10. CLINICAL EXAMINATION
OVERNIGHT PULSEOXIMETER
ELECTROENCEPHALOGRAM
ELECTROMYOGRAM ELECTRO-OCULOGRAM
ELECTROCARDIOGRAM
NASAL AIRFLOW
SENSOR/SNORE MICROPHONE
Pulseoximeter: record pulse and oxygen
saturation during sleep
Electroencephalogram: Measure brain activity
Electromyogram: Measure muscle activity
Electro-occulogram: Measure eye movements
Electrocardiogram: Measure heart rhythm
OSA - DIAGNOSING CRITERIA(4)

11. OSA - TREATMENT OPTIONS (4) (6) (8)
OSA is a condition which can be treated very successfully. If the symptoms are mild, simple lifestyle
changes can help. However, if the condition remains, a sleep specialist must be seen.

12. 1. Continuous Positive Airflow Pressure (CPAP):
The main treatment for obstructive sleep apnoea is the CPAP treatment. A mask is positioned on the face and
secured in a way that it is not very loose to move or it is not very tight to give pain. The mask is connected to a
small machine which blows out air with a steady force. This prevents the obstruction of airways and ensures the
inflation of lungs with air is satisfactory during inhalation phase of breathing.

13. 2. Oral Appliance Therapy (OAT):
OAT ARE specially designed mouthpieces such as mandibular repositioning device, mandibular responding
splint or tongue retaining device, which are commended by dental specialists. The aim is to bring the jaw
(chin) or tongue to front and prevent airway blockage.

14. 3. Surgery:
Surgery is the last choice of OSA treatment and it is mainly performed in the presence of tonsiliar enlargement,
small jaw, or nose injury.
Tonsillectomy: Removal of tonsils
Adenoidectomy: Removal of adenoids
Uvulopalatopharyngoplasty: Removal of surplus neck tissue
Soft palate implants: Adding a tool into the mouth to prevent airway obstruction

15. OSA - LIFESTYLE CHANGES (6)
Certain lifestyle changes are beneficial in treatment of OSA. Little changes to daily routines and habits can
noticeably improve the quality of life. These changes can result in the prevention of airway blockage, and help to
restore normal breathing in due course.

16. SMOKING CESSATION
WEIGHT LOSS
NO ALCOHOL BEFORE BEDTIME
NO ADDICTIVE DRUG USE
DECREASED CAFFEINE BEFORE BEDTIME
MAINTAINING REGULAR SLEEP ROUTINE
AVOID SLEEPING ON THE BACK
USING A PILLOW IN BED - KEEP HEAD ELEVATED
* AFTER BEING DIAGNOSED WITH SLEEP * APNOEA, DVLA NEEDS TO BE INFORMED

17. OSA - OUTCOME(9)
OSA is mainly seen in middle aged and elderly people.
Middle
Aged Men
4 in 100
Elderly
Over 65
6 in 10
Middle
Aged
Women
2 in 100
OSA is a treatable condition with good prognosis. With appropriate treatment, patients can continue their daily lives
with no obvious problems. However, untreated OSA can lead to serious complications.

18. OSA - COMPLICATIONS (9)
Complications are mainly caused by the increase of CO2 and decrease of O2 during apnoea.
UNTREATED
OBSTRUCTIVE
SLEEP
APNOEA
HYPERTENSION
HEART ATTACK/
STROKE
HEART FAILURE
TYPE 2 DIABETES
Hypertension: Blood pressure above 140/90
Heart failure: Condition when heart cannot pump
enough blood
Heart attack: Damaging of a vessel in heart
Stroke: Damaging of a vessel in brain
Type 2 diabetes: Condition when body cannot produce
enough insulin

19. OSA - RESEARCH & FUTURE MANAGEMENT(10)
-There are various research programs going on in order to improve diagnosis and treatment of OSA.
-Exercises for throat and tongue to decrease OSA are developed.
-A study in New York is working on developing new technology chips to be placed in the chest for OSA treatment.
-American thoracic society is working on portable monitor testing.
-Da Vinci Surgical System is being implanted into medicine for robotic surgery operations. It will also be used in surgeries for OSA.
-Cognitive behavioural therapy for psychologically accepting CPAP usage is in clinical trials.

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