Berkshire Sleep Apnoea
and Respiratory Clinic

Conditions Treated

• You can be assessed at the Berkshire Sleep Apnoea and Respiratory Clinic for all sorts of common respiratory and thoracic disorders including:

  Snoring

  Snoring and sleep apnoea represent one end of a spectrum with normal quiet regular breathing at one end, moving through worsening levels of snoring, to sleep apnoea at the other end.

  Approximately 30-40% of the adult population snore and in some cases this so severe that it disrupts the partner’s sleep or even the sufferer's own sleep. This can lead to severe sleep deprivation, embarrassment and bedroom relationship problems. Snoring is result of vibration of the airway behind the tongue. The tongue, walls of the throat, and the uvula (the finger of tissue that hangs down at the back of the throat) all contribute to snoring. During the day there are muscles that hold the airway open, but during sleep the tone or stiffness in the muscles decreases, which mean the muscles become floppy. The airway behind the tongue becomes narrower as the muscle support is lost. This extra narrowing leads to impairment of airflow whilst breathing in, and causes the walls of the throat to vibrate, producing the characteristic sound of snoring.

  Factors that make snoring more likely include:

  1. Factors making the airway muscles floppier – especially alcohol and sedatives (e.g. sleeping tablets) as they narrow the airway behind the tongue during sleep. They are known to increase snoring. 
  2. Factors that contribute to obstruction elsewhere in the airway e.g. a blocked nose from a cold, sinusitis or hay fever.
  3. Factors that narrow the airway all the time (even during the day), and make it more likely to vibrate at night. The commonest cause of this is obesity in the neck. A neck circumference of over 17 inches is associated with snoring. Smoking can promote snoring by making the tissue at the back of the throat swell. Enlarged tonsils and a small lower jaw will also contribute.
  4. Factors that narrow the airway during sleep e.g. lying on the back, which causes the weight of the jaw and neck to push the tongue backwards. Bending the head, with the chin on the chest, will also narrow the airway. 

  There are several things that a snorer and his/her bed partner can do to lessen snoring. The correct advice can often be provided once you have been assessed and in some cases after you have had a diagnostic sleep study.

  Using dental appliances which work by advancing the lower jaw in sleep. Best for those where sleep study confirms snoring alone or mainly positional (on the back) milder sleep apnoea. 

  Sleeping position. If the sleep study confirms that snoring is predominantly when the snorer is on his/her back, the old fashioned remedy of a tennis ball sewn into the back of the pyjamas can help.

  Surgery. If these simple measure do not work then surgery by an ENT specialist to remove enlarged tonsils, straighten a broken nose, or remove nasal polyps may help. The back of the throat can also be tightened or the excess soft tissue that contributes to the vibration causing snoring can be removed. It is currently not possible to predict those who will benefit from surgery, and most ENT surgeons recommend a sleep study, to see how much the snoring is interfering with breathing, before deciding if an operation is appropriate.
   

  More information about snoring

• Sleep Apnoea

  There are two main types of sleep apnoea – obstructive and central. Obstructive sleep apnoea (OSA) is the most common form and is sometimes known as the obstructive sleep apnoea/hypopnoea syndrome (OSAHS).

  Obstructive sleep apnoea

  In OSA the upper airway collapses intermittently and repeatedly during sleep. This collapse can be complete, with total obstruction of the airway passage and no respiratory airflow (apnoea), or partial, with reduction in breathing called hypopnoea. An apnoea usually lasts for at least ten seconds but may be much longer in some cases.

  As the sufferer falls asleep the muscle tone in the upper airway decreases leading to narrowing of the passageway. This, in turn, produces an increase in breathing effort in an attempt to overcome this airway narrowing which then leads to a transient arousal from deep sleep to wakefulness or a lighter sleep phase. The patient then falls more deeply asleep again and the whole cycle repeats itself. This can occur many hundreds of times throughout the night leading to fragmentation of normal sleep architecture and a reduction in the quality of sleep with the generation of restless, disturbed and unsatisfying sleep. This in turn produces the symptoms of excessive daytime sleepiness, poor concentration and a reduction in alertness.

  Sleep apnoea can be associated with:

  • Tiredness and unrefreshing sleep
  • Excessive daytime sleepiness especially when driving
  • Poor concentration
  • Witnessed apnoeas and choking episodes during sleep
  • Restless sleep
  • Irritability / personality change
  • Reduced sex drive
  • High blood pressure, stroke, heart disease and diabetes (see associated conditions)
  • Sudden death (rare)

  Your symptoms can be assessed by a careful history and by use of questionnaires such as the Epworth Sleepiness Score (ESS). A Score of >9 out of 24 may be associated with sleep apnoea and snoring, but sometimes people with lower scores have significant sleep apnoea.

  Some patients with OSA will require treatment with a breathing machine at night called nasal-CPAP (continuous positive airways pressure).

  Central Sleep Apnoea

  Central sleep apnoea is much less common than OSA and is due to failure of the brain to send adequate impulses to the breathing muscles, predominantly the diaphragm. This can sometimes be an indication of a brain disorder such as a previous stroke, or is seen sometimes in association with some heart diseases.

  Associated Conditions

  Sleep apnoea has been linked with the following medical conditions:

  • High blood pressure (hypertension)
  • Heart disease and heart attacks (cardiovascular disease)
  • Heart rhythm disorders (arrhythmias)
  • Diabetes
  • Depression
  • Driving accidents
  • Thyroid and some endocrine disorders
  • Risk of stroke

  In most of these cases, it is not clear whether these conditions are linked directly by the OSA or to an underlying cause of the OSA itself, such as obesity. 

  If appropriate, your sleep study will help to establish whether you have sleep apnoea, snoring or both, and will guide decisions about treatment options.
   

  More information about sleep apnoea

• Respiratory problems

  You can be assessed at the Berkshire Sleep Apnoea and Respiratory Clinic for all sorts of common respiratory and thoracic disorders including:

  • Asbestos related lung disease
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic Cough
  • Suspected Lung cancer
  • Mesothelioma
  • Oxygen therapy
  • Pleural effusions
  • Pneumonia and lung infections
  • Pneumothorax
  • Pulmonary embolism
  • Pulmonary fibrosis
  • Smoking advice
  • Tuberculosis (TB)

  and symptoms or problems including:

  • Breathlessness
  • Non-cardiac chest pain
  • Recurrent cough and infections
  • Wheeze
  • Coughing blood (haemoptysis)
  • Abnormal chest Xray or CT scan
  • Abnormal lung function

  This list is not exhaustive – for more information please contact the clinic or discuss with your GP.
   

  More information about respiratory problems