Sleep apnoea: when snoring becomes dangerous

“Bad sleep can happen for many different reasons,” says nurse Karen Bacon – a highly specialist medical technologist and senior nurse in non-invasive ventilation at one of the largest sleep clinics in the UK.

“Improving quality of sleep can make a huge difference to someone’s life; that’s why it’s so important to find out what’s causing sleep struggles,” says Karen.

Causes of poor sleep can include basic poor sleep hygiene, external influences such as shift work or medication/drug use, and sleep disorders which require treatment. Even something as simple as watching screens late at night can reduce the body’s natural sleep hormone, melatonin.

Good sleep is all about balance

Many common health issues are linked to poor sleep including depression, mood disorders, cardiovascular disease and metabolic and hormonal disruption.

“We’re living in a time when we’re bombarded with information all day and this is having a detrimental effect on sleep,” says Karen. “Good sleep for most people is all about balance; making sure you’re eating well, taking time away from screens and doing relaxing, calming activities.”

But for some people, persistent tiredness, low energy and difficulty managing day‑to‑day tasks can signal something more serious.

Sleep conditions

Diagnosis and treatment of OSA is where Karen and her team come in. Based in Guy’s and St Thomas’ NHS Foundation Trust in London, the sleep clinic spans three floors treating thousands of patients each year. Most are referred by their GP with symptoms of poor or disrupted sleep.

Karen is part of a large multi-disciplinary specialist team who diagnose and treat all sleep disorders. These include sleep-related breathing conditions such as OSA but also sleep-related movement disorders such as periodic limb movement disorder, hypersomnolence (excessive sleepiness), parasomnia (such as sleepwalking) and more.

• Read next: weight loss drugs: explained

Although being overweight can exacerbate OSA, around one-third of people with the condition aren’t obese. For those who are overweight, losing weight can sometimes reduce snoring and lower the likelihood of developing sleep apnoea.

As a sleep specialist nurse, Karen manages an outpatient team who deliver and evaluate CPAP (continuous positive airway pressure) therapy which is the gold standard treatment for OSA.

With more than £40bn lost to the UK economy each year due to sleep issues and one-sixth of vehicle accidents caused by lack of sleep, improving sleep is beneficial not just for individuals but for society.

“I’ve seen all sorts of reasons why someone doesn’t get good sleep, but with the right treatment, many sleep issues can be fixed,” says Karen.

It’s a cliche but I love helping people who’ve been suffering a long time

Karen says nursing staff in all settings can play a vital role in recognising when someone may have an underlying sleep condition. For example, a GP nurse might see a patient presenting with low energy, or extreme tiredness and fatigue.

“It’s important nursing staff listen if someone says they don’t feel they get enough sleep or if they feel overly tired,” she says. “Don’t dismiss those concerns as sleep apnoea could be the cause.”

Nursing staff in acute settings can also observe breathing or sleeping difficulties for patients overnight.

“I’d encourage ward nurses to listen to their patients breathing at night, if possible. Loud snoring and frequent waking could suggest they might benefit from a sleep study to investigate further.”

Sleep study

Once referred to the sleep clinic, patients undergo a thorough assessment covering medical history, respiratory and neurological issues, and general sleep hygiene. This can be done in a patient’s home or in the sleep clinic.

“To assess for sleep-related breathing disorders a home study is typically arranged as modern equipment is portable and easy to use at home,” says Karen.

“For more complex sleep investigations a polysomnography study is performed which gathers biophysiological data including electroencephalogram (EEG).”

A team of specialist physiologists and nurses analyse the data which is given to the consultant for evaluation and review.

Snoring is a primary symptom of OSA but not all snorers have it

A person with OSA will wake several times during sleep as their oxygen levels drop, caused by pauses in breathing of 10 seconds or longer. OSA occurs when the upper airway collapses in on itself causing the obstruction.

Other compounding factors include large tonsils or adenoids, a large neck circumference, sleeping on your back which causes the jaw and tongue to fall backwards and many anatomical variations such as a small or set back jaw or excess tissue in the soft palate.

Snoring is a primary symptom of OSA, but not all snorers have OSA, explains Karen. “Snoring with no disruption to oxygen could be solved simply by sleeping on your side and not on your back.”

Sleep apnoea treatment

A CPAP machine is a medical device used to treat OSA by delivering pressurised air through a mask worn over the nose or both the nose and mouth. This prevents the airway from collapsing and ensures continuous airflow during sleep, leading to better sleep quality and reduced health risks.

Karen explains: “It's a common treatment for sleep apnoea, but wearing the mask can take some getting used to.”

• Read next: Stopping smoking: are vapes the answer?

The machine itself produces a low humming sound, but Karen says it’s not as loud as snoring, and most people report improved sleep within days.

“I know it’s a cliche, but I love that we can help people who may have been suffering a long time and we’re making a difference,” says Karen. “We see people who are often very down and tired, family members are complaining about their snoring, but after a couple of months with the CPAP, they’re doing so much better.”

“I can see how this simple solution can have a direct impact on a person’s life and I love that I’m a part of that.”