Obstructive Sleep Apnoea (OSA): A Comprehensive Guide to Snoring Problems in Singapore

sleep

As an ENT Specialist and Surgeon in Singapore, I have treated many patients who snore regularly. It often turns out that their snoring is actually caused by a medical condition called obstructive sleep apnoea (OSA) in Singapore. If left untreated, OSA can have serious implications on the health of the snorer.

Snoring is something most of us are familiar with – that loud troublesome noise that some of us make when we sleep. But what exactly is snoring, what causes it, and is it a sign of something serious? 

Let’s go through the link between snoring and OSA below, as well as causes, symptoms, treatment options, and more.

obstructive sleep apnoea (OSA)
Regular snoring may be an indicator of obstructive sleep apnoea (OSA).

What is the difference between snoring and obstructive sleep apnoea (OSA) in Singapore?

Snoring is caused by tissue vibrations [1] in our throat, which can happen when the upper airway is partially obstructed. This partial obstruction usually occurs as a result of allergies, illnesses such as the flu, or even a particular sleeping position. If there is only the sound of snoring, with no associated airway obstruction, this is known as simple snoring. Although this may be a nuisance, it is not as serious as the airway obstruction seen in obstructive sleep apnoea (OSA). We differentiate simple snorers from OSA by taking a thorough history during the consultation, but the definitive test is a sleep study.  

As mentioned above, while some cases of snoring are harmless, snoring can be potentially serious when it is caused by a medical condition known as obstructive sleep apnoea (OSA), where the airway is completely obstructed. 

There are different types of sleep apnoea, these are:

  • Central sleep apnoea (CSA): brain does not send the proper signals to the muscles that control breathing.
  • Obstructive sleep apnoea (OSA): most common type of sleep apnoea. Occurs when the throat muscles relax and completely block the airway, obstructing breathing.
  • Treatment-emergent central sleep apnoea: also known as complex sleep apnoea. Occurs when a person has OSA which then converts to CSA when the individual is receiving treatment for OSA.

For the purposes of this article, we will only be focusing on OSA. When a person is suffering from OSA, their breathing is continuously blocked when they sleep, causing their upper airways to collapse. This leads to the feeling and effect of suffocation or choking during the night.

When this happens, your breathing periodically stops, which decreases the levels of oxygen in the blood and causes carbon dioxide to build up. When your brain senses this, it wakes you up so that you can adjust and reopen your airflow. This awakening is usually brief and most people don’t even realise that it is happening. Sometimes it causes a gasping or choking sound as your body quickly tries to correct the lapse in breathing. 

differences between snoring and OSA
Grades of airway obstruction. OSA is associated with more severe airway obstruction compared to simple snoring.

For people with OSA, this pattern happens repeatedly and disrupts their sleep quality. It causes an inability to fall into the deeper stages of sleep that are important for growth and development, maintaining a healthy immune system, tissue repair, and cognitive function for the next day. This is why people with OSA often feel exhausted and have poor concentration during the day. 

It is also important to note that not everyone who snores has OSA, but many do. While OSA has serious implications on the individual’s health, snoring itself can be disruptive to everyday life, by affecting the snorer’s sleeping partner and family. 

Sleep is extremely important for health and overall well-being, and regular sleep deprivation can have several consequences. From feeling fatigued during the day and affecting job performance to developing depression and regular headaches, it can even pave the way for other serious medical issues to develop. 

Seeking treatment for snoring and/or OSA can drastically improve your health (both physically and mentally), as well as your relationships, and quality of life. 

snoring
Snoring and OSA can impact your partner as well.

Why do people with obstructive sleep apnoea (OSA) snore? 

Snoring happens when the upper airway becomes too narrow, blocking air from entering smoothly. For individuals with OSA, the soft tissues in your throat, mouth, and soft palate can become relaxed and block the passageway while pushing down on the windpipe as well. This airway obstruction in the throat leads to vibrations in the soft tissues of the throat, creating the ‘snoring’ sound.

What are the common signs and symptoms of obstructive sleep apnoea (OSA) in Singapore?

Anyone can potentially develop OSA, including children. 

The symptoms of OSA vary between adults and children:

Adults

  • Snoring (often loudly)
  • Waking up with gasping 
  • Breathing stops during sleep or choking during sleep (as observed by another person)
  • Headaches in the morning
  • Sweating during the night
  • Poor concentration during the day
  • Excessive sleepiness during the day
  • Waking up with a dry mouth or sore throat
  • High blood pressure
  • Insomnia and sleeping problems
  • Depression or other mood changes

Children

  • Drooling or gasping for breath at night
  • Bed-wetting
  • Snoring
  • Grinding teeth 
  • Restless at night
  • Learning and behaviour issues
  • Sluggishness and fatigue
  • Breathing problems during sleep
  • Unusual sleeping positions
  • Sweating at night
  • Poor performance at school
OSA airway
The airway becomes blocked for those with OSA, leading to snoring and other issues.

What are the complications of snoring and obstructive sleep apnoea (OSA)?

Long-term snoring can be detrimental to health, especially if it is caused by OSA. This is because blood oxygen levels drop during sleep when breathing and airflow is obstructed. Repeated blockage of the airway results in fragmented sleep and poor sleep quality, resulting in chronic sleep deprivation. 

In general, some long-term complications of OSA, if left untreated include:

  • Fatigue
  • High blood pressure
  • Heart disease, including heart attacks (myocardial infarction) 
  • Stroke
  • Diabetes
  • Mental health problems such as depression or anxiety
sleep deprivation OSA
Sleep deprivation due to OSA can have serious consequences on physical and mental health.

Is obstructive sleep apnoea (OSA) life-threatening?

Due to the complications stated above, OSA can be life-threatening if left untreated and worsens over time. If you have any symptoms of OSA, including snoring, seek medical advice from a licensed ENT as soon as possible. 

Why do people develop obstructive sleep apnoea (OSA) in Singapore?

The relaxation and narrowing of muscles in the upper airway cause OSA, which can be exacerbated due to nasal blockage or a deviated septum that affects airflow. Large tonsils, nasal polyps, a large soft palate or tongue, or excessive soft tissue can also cause blockage in the upper airway.

Some common causes of OSA include: 

  • Obesity and excessive weight gain: excess fat and weight gain [3] can increase the soft tissues surrounding the throat and upper airway, causing airway obstruction.
  • Endocrine imbalances: hyperthyroidism and polycystic ovary syndrome [4] can be associated with OSA. 
  • Lung disease and related issues: respiratory diseases [5] such as asthma, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis can contribute to, worsen, or trigger OSA. 
  • Heart or chronic kidney disease: studies show that chronic diseases such as heart disease and kidney disease [6] can contribute towards OSA as these conditions can cause a build-up of fluid in the neck and block the airways. 
  • Pregnancy or menopause: studies [7] have shown that the risk of OSA is higher in postmenopausal women than in pre-menopausal women.
  • Neuromuscular conditions: stroke [8] has been found to be related to OSA. 
sleep
A good night’s sleep without any interruption is essential for good health and well-being.

When is snoring an indicator of obstructive sleep apnoea (OSA)?

Not all people who snore have OSA. However, if you snore regularly and have any of the other symptoms of OSA outlined above, it could be an indicator of obstructive sleep apnoea. Make an appointment with us to get a proper diagnosis and appropriate treatment. 

Who is at risk of snoring and obstructive sleep apnoea (OSA) in Singapore?

There are certain factors that can increase your risk of OSA. 

These include:

  • Weight: being overweight or obese increases your risk of developing OSA.
  • Gender: men are more prone to developing OSA, however women who have reached menopause are also at a higher risk.
  • Age: older adults are more susceptible to OSA compared to younger ones.
  • Nasal congestion and breathing problems: individuals with stuffy nose or breathing problems have a higher risk of developing OSA due to nasal obstruction.
  • Chronic disease: type 2 diabetes, high blood pressure, congestive heart failure, stroke, polycystic ovary syndrome (PCOS), lung diseases, and hormonal imbalances can increase the risk of OSA.
  • Large tonsils, soft palate, or tongue: these can obstruct the airway, increasing your risk of OSA.
  • Deviated septum: another cause of obstructed airway, thus increasing your risk of OSA.
  • Broad neck: having a collar size of 16 inches or greater increases your risk of developing OSA. 
  • Smoking: studies [9] have shown that smoking increases your risk of developing OSA.
  • Genetics: having a family history of OSA increases your risk.
  • Narrow airway or palate: leads to an obstructed airway, thus increasing your risk of OSA.
  • Use of sedative substances: medications, tranquillisers, and alcohol reduces muscle tone in the throat during sleep and triggers OSA. Excessive alcohol in particular, affects the sleep wave pattern, reduces deep sleep, and increases sleep fragmentation, resulting in poorer quality sleep. 

How is snoring and obstructive sleep apnoea (OSA) usually diagnosed in Singapore? 

In order to diagnose OSA, a doctor will normally conduct an examination of the mouth, nose, and throat, and take note of all the symptoms that you are facing.

Other tests may include:

  • Blood pressure test to check for high blood pressure.
  • Polysomnography, a sleep study test where sensors will monitor your heart, lungs, brain activity, breathing, blood oxygen levels, and body movements during sleep.

Components of the above sleep test may include the following: 

  • EEG (electroencephalogram) to measure brain activity.
  • EKG (electrocardiogram) to measure heart rate and test for abnormal heart rhythm.
  • EOG (electrooculogram) to record eye movements in different sleep stages, particularly during REM stage sleep. 

We can arrange for the suitable sleep tests to be performed in the comfort of your own bed in your own home. 

What are the treatment options for snoring and obstructive sleep apnoea (OSA) in Singapore?

There are several treatment options for snoring and OSA. Some are non-surgical, while others are surgical. 

For early stages, lifestyle changes is recommended, such as:

  • Weight loss
  • Stop smoking and moderate alcohol intake
  • Change sleep positions
  • Avoid sedatives and sleeping pills
  • Eat healthy and exercise regularly
  • Take antihistamines or nasal decongestants at night, if confirmed by testing to have allergic rhinitis
  • Use a humidifier at night
lifestyle changes OSA
Lifestyle changes such as losing weight through exercise can significantly improve OSA symptoms.

For severe cases or if OSA does not improve despite lifestyle changes, treatment may include:

  • Continuous positive airway pressure (CPAP): a machine that provides air pressure through a device or mask that is placed over your nose and/or mouth while you sleep to regulate breathing and airflow. Highly effective at improving sleep and significantly reducing snoring while improving energy levels during the day. However, the machine may be disruptive to some people, although many people get used to it over time. There are many different types of masks and CPAP machines available today, and we can help you find a suitable one. 
  • Adaptive servo-ventilation (ASV): a device recently approved for OSA and central apnoea, it takes note of your typical breathing pattern and stores the data in a computer. When you sleep, the device releases pressure to regulate your breathing. 
  • Oral appliances: usually recommended for those with mild to moderate OSA or those who are unable to use the CPAP machine. In theory, these appliances keep your throat and airways open during sleep and help to relieve snoring. You may need to consult with a dentist specialising in dental sleep medicine to get fitted for this device.
  • Radiofrequency thermal ablation: used to treat snoring in OSA patients, this therapy shrinks the tissues in the soft palate and tongue, and nasal tissues to improve airflow. This is particularly effective for reducing snoring or mild OSA. 
  • Hypoglossal nerve stimulation: a form of therapy that improves upper airway muscle tone during sleep through a device that is implanted in the neck (onto the hypoglossal nerve that controls the function of the tongue muscles). Before sleep, the device is switched on and mildly stimulates the hypoglossal nerve in the tongue during sleep.
  • Surgery: for serious cases of OSA that do not improve with any other treatment options, surgery may be required. Surgical procedures include:
  • Uvulopalatopharyngoplasty (UPPP) and expansion pharyngoplasty procedures: these are performed under general anaesthesia where the surgeon improves the muscle tone and tension in the soft palate and throat to improve airflow. Where necessary, tonsils and adenoids may be removed. 
  • Sinus and nasal surgery: presence of chronic sinusitis and polyps are initially medically treated, but if it fails, endoscopic surgery can be performed to remove the inflammatory tissues/polyps and restore a patent upper airway. At the same time, if the nasal septum is significantly deviated and contributes to the upper airway obstruction, this is surgically corrected at the same time with a hidden scar inside the nose.
  • Jaw surgery (maxillomandibular advancement): upper and lower parts of the jaw are adjusted and moved forward to enlarge the gap between the tongue and soft palate to reduce obstructions in the throat. 
  • Tracheostomy: usually for severe or life-threatening cases where a surgeon makes an opening in the neck and inserts a metal or plastic tube to facilitate breathing through the lungs, bypassing the obstructed throat. This is rarely done, and is the last resort in very severe cases which do not respond to all other options of treatment. 
CPAP machine
The CPAP machine is a common treatment option for those with OSA.

Is there a cure for snoring and obstructive sleep apnoea (OSA)?

With the treatment options available in Singapore and lifestyle changes outlined above, airway obstruction caused by OSA and snoring can be resolved. It requires the patient and the treating doctor to work together to achieve this target through a variety of treatment options.

When should I see a doctor about snoring and obstructive sleep apnoea (OSA)?

As mentioned above, both snoring and OSA can be life-threatening and have serious consequences on health. If you are facing symptoms such as sleep deprivation, waking up with headaches, feeling fatigued during the day, along with loud snoring at night, it is time to consult an ENT specialist.

Book a consultation with Dr Soma at his ENT clinic today to find out more. 

Frequently asked questions

How do I know if I have OSA?

If you snore regularly and have other symptoms such as blocked breathing during sleep, waking up with a gasp, insomnia, and headaches in the morning, you may be suffering from OSA. Consult with a doctor if you believe you have OSA. 

Why do I snore so much?

Snoring is caused by blocked airflow and the vibration of tissues in the throat. It can be due to excessive weight gain, certain medications, or an underlying condition. Long-term snoring can have serious effects on health so it should be treated, especially if it is interfering with your quality of life.

Can OSA go away on its own?

For mild cases, OSA can be resolved with lifestyle changes including weight loss. However, it depends on the individual and if you have any other underlying health conditions that are causing OSA. 

Does OSA get worse as you get older?

Without medical intervention or lifestyle changes, OSA can worsen as you age. 

What is the main treatment for OSA?

The use of CPAP (continuous positive airway pressure) machine is a common treatment for moderate to severe cases of OSA as it will overcome the airway obstruction and help you breathe at night. 

What is the best sleeping position for those with OSA?

It is highly recommended for those with OSA to sleep on their side, instead of the back as this prevents the soft tissues in the throat, as well as the tongue from blocking the upper airway. 

References

Book An Appointment




    * Please note that the requested appointment date and time is subject to availability. The respective clinic will contact you for confirmation.

    Allergy & Sinus ENT Specialist Centre
    Head & Neck Surgery Singapore

    Dr Soma Subramaniam
    MBBCH (IRE), DOHNS(ENG), MMED-ORL(NUS), FRCS-ORL(ENG)
    Consultant ENT Specialist and Surgeon




      * Please note that the requested appointment date and time is subject to availability. The respective clinic will contact you for confirmation.

      Copyright © 2022 Allergy & Sinus ENT Specialist Centre
      linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram