Snoring happens when the tissues that line your upper respiratory tract vibrate, as a result of the airflow to your lungs being interrupted. Snoring is normal and tends to increase as you grow older. However, snoring can become a serious issue for people with Obstructive Sleep Apnea (OSA).
OSA is a condition in which breathing is disrupted multiple times throughout sleep, sometimes hundreds of times, due to obstruction in the airway. This obstruction causes the airway to narrow and eventually collapse. When your brain senses this, it jolts you awake temporarily to catch your breath and as you do so, you may snort, choke or gasp for air. This happens very briefly and you may not remember waking up. When this happens too many times night after night, it can affect your quality of sleep and the effects spill over to your daily routine.
It is estimated that 15% of the population in Singapore, suffered from OSA and this prevalence may have increased along with other health trends, such as increasing levels of obesity and sedentariness. The prevalence of OSA is also expected to rise in tandem with the ageing of our population, which is also a factor of OSA.
OSA can be caused by a person’s physical structure or existing medical conditions. Some common causes include:
In Singapore, overweight male individuals in the middle age group onwards are more likely to suffer from OSA. Cases are also more prevalent in the Chinese population – likely due to certain bone features that are more common within that ethnic group – followed by the Malays and Indians.
The treatment plan will depend on the analysis of the sleep study, as well as the severity of symptoms and patient’s age, BMI, and physical features. In treating OSA, the goal is to make sure airflow is sustained during sleep.
Continuous Positive Airway Pressure (CPAP) therapy is the first line of treatment. In this treatment, a CPAP machine is used to deliver a stable flow of oxygen into your nose and mouth to keep the airway open.
A CPAP machine generates a steady stream of pressurised air that travels through an air filter into a flexible tube. This airstream pushes against any blockages, and keeps your airway open so your lungs can receive adequate oxygen.
There are different mask styles with different CPAP machines. The type of mask you wear would depend on your breathing habits, how comfortable the mask is, and the kind of sleep apnea disorder you have. The three types of mask styles are:
Where CPAP therapy is not effective, Bilevel Positive Airway Pressure (BPAP) machines may be used. BPAP machines are non-invasive ventilators that deliver pressure in response to you inhaling and exhaling, to facilitate breathing. Home BPAP machines are about the size of a toaster, and feature a tube that connects to a mask worn over your mouth and nose.
A BPAP machine does exactly what a CPAP machine does — delivers pressurised air to keep the airway open, so that your lungs can receive oxygen. The main difference is that a BPAP machine is able to deliver air at two levels of pressure while a CPAP machine delivers air at a constant pressure.
When you inhale, BPAP machines deliver more air pressure. When you breathe out, the machine reduces the air pressure. Some BPAP machines have a timer that can be programmed to maintain a certain number of breaths per minute.
Patients may also undergo positional therapy to learn to sleep on their side, instead of on their back which can make OSA worse for some patients. Positional therapy involves wearing a device that keeps you from sleeping on your back.
Some of these devices are worn around your waist or back, or you can make use of a backpack or tennis balls as alternatives to keep you from lying on your back. Newer devices today use gentle vibration that prompts you when you are starting to roll onto your back. Some are programmed to increase vibration when you remain on your back and the vibration only stops when you roll onto your side or stomach.
Besides keeping your off your back, these devices can also collect data about your snoring and how frequently you switch positions during your sleep. This information will be useful for your doctor.
Positional therapy may be applied on its own or combined with another treatment.
As obesity is associated with OSA, obsessed patients with OSA are advised to undergo a weight loss programme to alleviate the severity of OSA. Losing weight could also improve quality of life and reduce daytime fatigue.
In cases where none of these methods work, you may consider surgery. Surgery may be most effective for patients whose OSA can be surgically corrected as in the case of an obstructing lesion in the airway. While surgical treatment can be effective, it does not completely eliminate OSA.