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Primary Care Information
What is sleep apnoea
Sleep apnoea known as (OSA) is a sleep breathing disorder characterised by breathing pauses during sleep, with the most common type being obstructive sleep apnoea (OSA). Symptoms include breathing that stops and starts, gasping or choking noises, frequent arousals from sleep, loud snoring, daytime tiredness, difficulty concentrating, mood swings, and morning headaches. OSA can contribute to other health conditions such as high blood pressure, stroke, heart disease, type 2 diabetes, depression, workplace accidents and road traffic accidents due to tiredness.
How is sleep apnoea diagnosed
Sleep apnea diagnosis involves an evaluation of symptoms and a sleep history. Patients are usually referred to a specialist sleep clinic where tests like an in-lab polysomnography test may be conducted to monitor various sleep parameters, such as breathing patterns, sleep stages and oxygen saturation. A Home sleep apnoea test (HSAT) may also be used to diagnose OSA, measuring parameters like heart rate, blood oxygen level, airflow, and breathing patterns. Other less invasive Sleep tests that can be carried out at home are the Watch Pat, Acupebble and the Sunrise Screening device. More information regarding diagnostic tests can be found at this link.
How is sleep apnoea treated
Treatment options for OSA are diverse and tailored to individual needs. Lifestyle changes, such as weight management and avoiding alcohol and smoking, are recommended. The primary treatment for OSA is Continuous Positive Airway Pressure (CPAP) therapy, involving a machine and mask worn during sleep to keep airways open. For those who struggle with CPAP, an oral mandibular advancement device (MAD) can be an alternative to help maintain open airways. Surgical interventions like tonsil removal may also be beneficial in certain cases. Hypoglossal nerve stimulation is a newer therapy for individuals who cannot tolerate CPAP or MAD. Positional therapy can be effective for position related OSA. Personalised medicine is emerging as a novel approach in OSA management, aiming to provide tailored treatments based on genetic, environmental, and lifestyle factors. Research into new drug therapies targeting specific subtypes of sleep apnea is ongoing for more effective and personalised treatment strategies.
Risk factors for OSA
Obesity significantly raises the risk of OSA due to fat accumulation around the upper airway, which can lead to breathing obstructions. Individuals with thicker necks or narrow throats are more prone to airway collapse during sleep, increasing the likelihood of OSA. Men face a higher risk of OSA compared to women, with men being 2 to 3 times more likely to develop OSA. Other risk factors include anatomical features like a narrowed throat, enlarged tonsils or adenoids, and certain medical conditions such as heart issues and lung disorders. Lifestyle risk factors also contribute to OSA, like alcohol consumption, smoking, and the use of sedative medications can contribute to the development of OSA. Family history can also be a risk factor for OSA.
Lifestyle modifications in OSA
Maintaining a consistent sleep schedule by going to bed and waking up at the same time daily can regulate your body's internal clock and enhance sleep quality. Elevating your head during sleep using adjustable beds or wedge pillows can help keep your airways open, reducing obstructions. A healthy diet rich in fruits, vegetables, lean proteins, and whole grains aids in weight management, crucial for OSA. Regular exercise, at least 30 minutes most days, can assist in weight management and improve overall sleep quality. Limiting alcohol and smoking is beneficial as both can exacerbate sleep apnea symptoms. Creating a sleep-friendly environment involves keeping the bedroom cool, dark, and quiet, investing in a comfortable mattress and pillows, and promoting relaxation. Avoiding sedatives and sleeping pills is recommended as they can relax throat muscles excessively, worsening symptoms of sleep apnea. Consistency with Continuous Positive Airway Pressure (CPAP) therapy is vital for improving sleep quality in moderate to severe cases of sleep apnea.
Follow up for OSA
Regular follow-up for individuals with OSA is crucial to monitor treatment effectiveness, address any concerns, and ensure optimal management of the condition. The frequency of follow-up visits varies based on individual needs and treatment response. Guidelines suggest monitoring at 1-2 weeks, 1 month, and 3 months after starting CPAP therapy, with subsequent visits tailored to factors like patient characteristics, co morbidities, side effects, compliance, and residual symptoms. Telemonitoring is essential for real-time oversight of sleep patterns and treatment adjustments. Teleconsultation provides remote access to healthcare providers for consultations and support, enhancing patient guidance and treatment plan adjustments without frequent in-person visits. Combining regular follow-up appointments with telemonitoring and teleconsultation can optimise OSA management by ensuring continuous support and personalized treatment strategies.
OSA and driving Issues
To notify the DVLA about sleep apnoea, individuals must follow specific steps outlined in the guidelines. Here is the process for notifying the DVLA about sleep apnoea:
Diagnosis Confirmation: Individuals should not drive until their Sleep Clinic confirms that their OSA is under control, excessive sleepiness has improved, and symptoms are managed satisfactorily.
Consultation with GP: If individuals suspect they have symptoms of OSA, particularly excessive sleepiness, they should refrain from driving and seek an appointment with their GP. The GP can then refer them to a Sleep Clinic for further evaluation and investigation.
Completing Forms: Once diagnosed with OSA, individuals may need to complete forms such as SL1 or SL1V for the DVLA. These forms require accurate information about the diagnosis, treatment adherence, and control of symptoms. It is crucial to follow the guidelines carefully when completing these forms. Online completion is also an option.
Regular Reviews: The DVLA guidelines require regular reviews of with OSA, with a minimum of annual reviews for Group 2 drivers (bus and lorry) and every three years for Group 1 drivers (car and motorcycle). These reviews ensure that symptoms are under control and treatment is effective.
By following these steps and guidelines, individuals can ensure compliance with DVLA regulations regarding OSA and driving safety.
Living with Sleep Apnoea
Are you or someone you care about suffering from sleep apnoea?
Do you have questions about OSA, or are looking for information or practical advice?
Do you want to exchange with other patients?
You can visit dedicated sleep and OSA websites :
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Shop - Hope2Sleep Charity
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OSA Alliance | Facilitating clinical excellence with all in OSA
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Scottish Association for Sleep Apnoea (scottishsleepapnoea.co.uk)
