Sleep apnoea — The norm rather than the exception!
It is probably not an exaggeration to say that almost all adult males and post-menopausal females suffer a degree of sleep apnoea. This condition may also occur in children and women in their reproductive years.
But, in the vast majority of cases, the apnoea is only mild and does not require investigation & intervention. One important question can determine whether you need to have your sleep apnoea investigated further.
When you wake up in the morning after what you perceive to be a reasonable night’s sleep — do you feel refreshed or unrefreshed? If you wake up feeling unrefreshed then you probably have significant sleep apnoea that needs management.
There are basically two types of sleep apnoea, obstructive and central. Obstructive sleep apnoea is the most common and is due to varying degrees of collapse of the upper airways during deep sleep.
Central sleep apnoea it is due to dysregulated breathing during deep sleep where the brain stem sends the wrong messages to the lungs and the person who suffers this condition stops breathing.
As with most medical conditions, lifestyle changes will have significant benefits. Weight loss, smoking cessation & alcohol reduction have a profound benefit. Investigation for secondary causes of fatigue such as thyroid disorders, iron abnormalities & a variety of other medical conditions, may also mimic many of the symptoms of sleep apnoea.
The gold standard therapy for sleep apnoea is nasal CPAP which over the years has become more streamlined and easier to use. Unfortunately, there are still a significant amount of people who cannot tolerate the nasal mask and therefore don’t benefit from the therapy.
There are also a variety of mouth guards that pull the jaw forward during sleep and offer certain people a degree of relief from this very ubiquitous condition.
Specialized ear, nose and throat surgeons perform extensive and intricate surgery on the upper airway which in certain cases offer significant relief from obstructive sleep apnoea.
Unfortunately many people either cannot tolerate these therapies or the therapies do not work and thus many researchers around the world are looking for alternative treatments. The Austin Hospital in Melbourne has been trialling for a number of years a pacemaker that is switched on at night. It is buried beneath the skin up to the back of the throat and also another electrode is placed onto the lungs. The pacemaker allows the tongue to be retracted so it does not close off the airway during deep sleep and maintains a normal breathing pattern.
Interestingly, a number of pharmaceutical therapies have been trialled for sleep apnoea. 12 years ago, a study was published looking at a commonly used antihypertensive/diuretic drug known as Spironolactone. In a small study of 12 patients with refractory hypertension and obstructive sleep apnoea, doses of between 25 to 50 mg per day demonstrated a significant reduction in the amount of apnoeic episodes. This study followed other trials that suggested a benefit from this drug.
In April 2022, the anticonvulsant drug Sulthiame demonstrated a significant improvement in sleep apnoea episodes in 60 people with moderate to severe sleep apnoea. This is now being trialled in over 400 patients with the results expected next year.
Two years ago, Flinders University in Adelaide published a trial in the Journal of Physiology of 15 otherwise healthy volunteers with obstructive sleep apnoea using a combination of Reboxetine — a relatively commonly prescribed anti-depressant, and butyl bromide (Buscopan) — an antispasmodic agent used for abdominal cramping. This showed a 30% reduction in the severity of sleep apnoea.
The most recent trial looked at Reboxetine alone in a dose of 4 mg before bed showing a significant reduction in the degree of sleep apnoea. The addition of oxybutynin — a drug used for bladder spasm, gave no added benefit in the situation. Reboxetine is a particular type of anti-depressant known as a noradrenaline reuptake inhibitor which is as effective as most of the newer antidepressants for the management of depression.
Sleep apnoea is an extremely common condition that affects quality of life and any new therapies that may help in this situation are most welcome. The common symptoms of sleep apnoea are waking unrefreshed, daytime fatigue and sleepiness and most seriously falling asleep inappropriately in situations such as driving which may be fatal for the sufferer and other people involved in a potential car accident.
If you are experiencing any of the above symptoms or your partner is disturbed by your heavy snoring, don’t see this as a trivial inconvenience that should be ignored. Having sleep apnoea investigated & managed may not only markedly improve the quality of your life, but may indeed, save it.