‘Why am I tired all the time?’ You might have sleep apnoea and not know it

Being diagnosed, and therefore treated, is vital. Why are so few diagnosed?

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There is a range of reasons, Bilston explains, including that not all people with sleep apnoea are excessively sleepy during the day; many do not realise that their symptoms (like snoring, daytime sleepiness, or poor concentration) could be due to sleep apnoea; if they sleep alone, they might not realise they snore; not all GPs are good at recognising sleep apnoea, as many other disorders can have similar symptoms; and not everyone has access to a sleep specialist.

Given the total cost of sleep disorders was estimated to be $51 billion in Australia in 2019-20, it’s an issue that affects the individuals who have it as well as those who don’t.

Who is most at risk?

OSA affects more men than women – at least one in four men compared with one in ten women, and is more common in older people, affecting about 50 per cent of elderly people. Overweight people are almost twice as likely to have it.

“Putting a bit of weight (or muscle) on around the neck just closes the hole inside it a lot more easily,” says maxillofacial surgeon and sleep apnoea expert, Dr Paul Coceancig.

It can also be the result of anatomy, like a receding chin, narrow throat or small jaw.

“One factor that is often overlooked is the relationship between sleep issues and our facial structure,” Coceancig says. “Our face shape is a major cause of snoring, in particular having a smaller face and jaw.”

People often think their tongue or tonsils are too big, he adds, but it tends to be the normal weight of the tongue, inside a small jaw, that collapse the airway at night causing OSA.

Research from Stanford suggests that softening of diets, especially with the invention of ultra-processed foods, means less chewing is needed in today’s world, which has led to underdeveloped jaws. Poor ‘oral posture’, where our mouths are slack when we are not eating or speaking, may result from sleeping on soft surfaces with soft pillows, has also added to the issue of underdeveloped jaws.

The treatments

Mouth breathing, which causes the tongue to fall backward and obstruct the airways, can also cause OSA.

This has led to a trend where people tape their mouths shut at night to force them to breathe through their noses. While there are some suggestions this may help with sleep apnoea, evidence is limited, and it could be dangerous for those who struggle to breathe properly through their nose.

Breathing exercises to tone the upper airway muscles, like speech therapy exercises or playing the didgeridoo, may also reduce the severity of sleep apnoea, although again there is little research.

While weight-loss can cure OSA in some people, the gold standard treatment is still the CPAP (continuous positive airway pressure) machine, which was developed in Australia in the 1980s, and which uses mild air pressure to keep breathing airways open during sleep.

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Another Australian invention, the Mandibular Advancement Splint (MAS), which is like a mouthguard that pulls the jaw forward, works for only about 35-to-40 per cent of patients, Bilston says.

Sleeping on your side can help a “subset” of people, she adds, and while there are various devices that encourage people to sleep on their side, the cheapest option is a tennis ball sewn into the back of pyjamas.

Implantable electrical stimulation therapy, which Bilston explains is similar to a cardiac pacemaker, activates the muscles in the tongue to keep the airway open during sleep, but is not widely available and not suitable for everyone.

Finally, surgery is an option for some people, which can be accessed through Medicare. To treat small jaws, Coceancig favours a technique called IMDO surgery, which stretches the tongue out and opens up the airway behind it. “It’s a far better way of treating obstructive sleep apnoea than removing tonsils or having throat surgery,” he says.

If you think you might have sleep apnoea, see a healthcare professional, who can conduct a sleep study. It’s vital, Blston says: “It affects not only the individual’s health and quality of life, but untreated OSA patients who continue to drive are placing the rest of the community at risk.”

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