Sleep Study FAQs

What is a sleep study? 
A sleep study is a medical test. Sleep is monitored to assist with the diagnosis of sleep problems. It may be done in the home or by staying overnight in a specialized sleep clinic, whichever is best for you.

What happens in a sleep study that is completed in a sleep clinic? 
Patients usually arrive in the early evening and go home on waking up in the morning. Trained scientists at the clinic will record signals from the brain and monitor breathing and oxygen levels in the blood. They will attach leads to do this. Most clinics will also record heart rate, leg movements, sleeping position and snoring.

What does a home sleep study involve? 
A number of hospitals and private clinics offer home sleep studies. Patients go to the clinic during the day and have monitoring leads attached. These leads are almost the same as those which are used for a study done overnight in the clinic. But patients can walk around and sleep in their own beds.

Which kind of study is the best?
A sleep clinic is a carefully controlled environment. The results from a study here will be the best they can be. The staff will constantly watch all the signals collected. However being in an unfamiliar environment can be difficult for some patients. For these people, the information from a home sleep study will be better than if they had to stay overnight in a sleep clinic. Both methods have their place and you should discuss this with your doctor.

What does the sleep study tell your doctor? 
The signals from the brain show when you are asleep and when you wake up from sleep. The breathing signals and oxygen levels give information about breathing during sleep. Some patients have stop-start breathing during the night, a disorder called sleep apnoea. The leg leads show if there is any movement or twitching, which may disturb sleep. A sleep study can also pick up other rarer sleep problems.

What are the risks of a sleep study? 
Using creams and tape, small leads are attached to your head and your body. In some people the cream may cause temporary skin irritation, but nothing done in a sleep study will hurt.

How do I know if I need a sleep study? 
If you are worried about your sleep or think that you may have a sleep problem, you should see your GP. Often, your GP can treat the problem. If not, you can be referred to a sleep specialist. This is the best person to work out if you need a sleep study. Having a sleep study without seeing a doctor is not the best way to do it. The wrong information may be collected and your sleep may not be helped. A sleep problem is a serious issue. It needs to be dealt with properly.

What do I need to do to get ready for my sleep study? 
The sleep study clinic will give you information about what you need to do and bring to your study. Usually, there are no special things that you need to do before your study - you should try and do exactly what you do on a normal day.

How much will a sleep study cost? 
This is very variable. You should check with the clinic before you book the sleep study.

Where can I find out more?
A sleep services directory for Australia and New Zealand is available at: http://www.sleep.org.au/servicesdirectory
More information about such studies is available at a number of web sites including http://www.talkaboutsleep.com/sleep-basics/viewasleepstudy.htm
 

Twelve Simple Tips to Improve Your Sleep

Falling asleep may seem like an impossible dream when you’re awake at 3 a.m., but good sleep is more under your control than you might think. Following healthy sleep habits can make the difference between restlessness and restful slumber. Researchers have identified a variety of practices and habits—known as “sleep hygiene"—that can help anyone maximize the hours they spend sleeping, even those whose sleep is affected by insomnia, jet lag, or shift work.

Sleep hygiene may sound unimaginative, but it just may be the best way to get the sleep you need in this 24/7 age. Here are some simple tips for making the sleep of your dreams a nightly reality:

#1 Avoid Caffeine, Alcohol, Nicotine, and Other Chemicals that Interfere with Sleep

As any coffee lover knows, caffeine is a stimulant that can keep you awake. So avoid caffeine (found in coffee, tea, chocolate, cola, and some pain relievers) for four to six hours before bedtime. Similarly, smokers should refrain from using tobacco products too close to bedtime.

Although alcohol may help bring on sleep, after a few hours it acts as a stimulant, increasing the number of awakenings and generally decreasing the quality of sleep later in the night. It is therefore best to limit alcohol consumption to one to two drinks per day, or less, and to avoid drinking within three hours of bedtime.

#2 Turn Your Bedroom into a Sleep-Inducing Environment

A quiet, dark, and cool environment can help promote sound slumber. Why do you think bats congregate in caves for their daytime sleep? To achieve such an environment, lower the volume of outside noise with earplugs or a "white noise" appliance. Use heavy curtains, blackout shades, or an eye mask to block light, a powerful cue that tells the brain that it's time to wake up. Keep the temperature comfortably cool—between 60 and 75°F—and the room well ventilated. And make sure your bedroom is equipped with a comfortable mattress and pillows. (Remember that most mattresses wear out after ten years.)

Also, if a pet regularly wakes you during the night, you may want to consider keeping it out of your bedroom.

It may help to limit your bedroom activities to sleep and sex only. Keeping computers, TVs, and work materials out of the room will strengthen the mental association between your bedroom and sleep.

#3 Establish a Soothing Pre-Sleep Routine

Ease the transition from wake time to sleep time with a period of relaxing activities an hour or so before bed. Take a bath (the rise, then fall in body temperature promotes drowsiness), read a book, watch television, or practice relaxation exercises. Avoid stressful, stimulating activities—doing work, discussing emotional issues. Physically and psychologically stressful activities can cause the body to secrete the stress hormone cortisol, which is associated with increasing alertness. If you tend to take your problems to bed, try writing them down—and then putting them aside.

#4 Go to Sleep When You’re Truly Tired

Struggling to fall sleep just leads to frustration. If you’re not asleep after 20 minutes, get out of bed, go to another room, and do something relaxing, like reading or listening to music until you are tired enough to sleep.

#5 Don’t Be a Nighttime Clock-Watcher

Staring at a clock in your bedroom, either when you are trying to fall asleep or when you wake in the middle of the night, can actually increase stress, making it harder to fall asleep. Turn your clock’s face away from you.

And if you wake up in the middle of the night and can’t get back to sleep in about 20 minutes, get up and engage in a quiet, restful activity such as reading or listening to music. And keep the lights dim; bright light can stimulate your internal clock. When your eyelids are drooping and you are ready to sleep, return to bed.

#6 Use Light to Your Advantage

Natural light keeps your internal clock on a healthy sleep-wake cycle. So let in the light first thing in the morning and get out of the office for a sun break during the day.

#7 Keep Your Internal Clock Set with a Consistent Sleep Schedule

Going to bed and waking up at the same time each day sets the body’s "internal clock" to expect sleep at a certain time night after night. Try to stick as closely as possible to your routine on weekends to avoid a Monday morning sleep hangover. Waking up at the same time each day is the very best way to set your clock, and even if you did not sleep well the night before, the extra sleep drive will help you consolidate sleep the following night. Learn more about the importance of synchronizing the clock in The Drive to Sleep and Our Internal Clock.

#8 Nap Early—Or Not at All

Many people make naps a regular part of their day. However, for those who find falling asleep or staying asleep through the night problematic, afternoon napping may be one of the culprits. This is because late-day naps decrease sleep drive. If you must nap, it’s better to keep it short and before 5 p.m.

#9 Lighten Up on Evening Meals

Eating a pepperoni pizza at 10 p.m. may be a recipe for insomnia. Finish dinner several hours before bedtime and avoid foods that cause indigestion. If you get hungry at night, snack on foods that (in your experience) won't disturb your sleep, perhaps dairy foods and carbohydrates.

#10 Balance Fluid Intake

Drink enough fluid at night to keep from waking up thirsty—but not so much and so close to bedtime that you will be awakened by the need for a trip to the bathroom.

#11 Exercise Early

Exercise can help you fall asleep faster and sleep more soundly—as long as it's done at the right time. Exercise stimulates the body to secrete the stress hormone cortisol, which helps activate the alerting mechanism in the brain. This is fine, unless you're trying to fall asleep. Try to finish exercising at least three hours before bed or work out earlier in the day.

#12 Follow Through

Some of these tips will be easier to include in your daily and nightly routine than others. However, if you stick with them, your chances of achieving restful sleep will improve. That said, not all sleep problems are so easily treated and could signify the presence of a sleep disorder such as apnea, restless legs syndrome, narcolepsy, or another clinical sleep problem. If your sleep difficulties don’t improve through good sleep hygiene, you may want to consult your physician or a sleep specialist. Learn more at When to Seek Treatment.

Continuous Positive Airways Pressure (CPAP)

What is CPAP?

CPAP is Continuous Positive Airways Pressure. It is the most effective way to treat sleep apnoea. If you have Obstructive Sleep Apnea, your Sleep Specialists may give you a range of treatment choices and CPAP may be one of these.

How does CPAP work?

CPAP is a simple concept. The equipment has three basic parts. The first is an air pump. The second is a mask that covers the nostrils or nose and sometimes the mouth. The third is a tube to link the two. The CPAP pump takes air from the room and gently pressurises it. The air blows through the tube and mask into the throat. The pressure of the air keeps the throat open while you are asleep.
The pump should not stop either you or your partner from sleeping well during the night. In fact, it is designed to do the reverse and should help both of you to sleep better. It is very quiet and makes you quiet as well. You do need to make sure that the mask fits comfortably without any leak (apart from that coming from the exit port in the mask). If it leaks, this can be noisy and air may blow into your eyes or at your partner.
There are many different types of pumps and masks, so there will be one that suits you.

How long does CPAP take to work?

CPAP will stop your sleep apnea straight away. You might start to feel better on the day after your first night of using it effectively. But some people find it takes a bit longer. It might take some time for both you and your partner to get used to CPAP. At first, you might not be able to use it for the whole night. This is common. It is better to build up use slowly than to try very hard too early and give up. What you need to do is to get any problems you are having seen to by your CPAP supplier and to keep trying. Be patient with yourself and with the device. Ask for help. Almost all the problems with CPAP can be solved with a little help and persistence

How do I start on CPAP treatment?

The pressure delivered by the pump needs to be adjusted to the right level to hold your airway open. Some people need more pressure than others. There are two ways to find out how much you need:

Sleep Lab CPAP study.

You will have an overnight Sleep Study. This may be like the one used to diagnose the sleep apnea. With this sleep study, you will sleep in a Sleep Laboratory with the CPAP on. There will be someone there who will gradually turn up the pressure on the pump. They will do this until it is just enough to keep your airway open. In the morning, you will get a prescription. You can take this to a CPAP supplier. This will tell them what mask is likely to fit well. It will also say what pressure you need on your pump.
or

Home CPAP study.

You will meet with a CPAP therapist during the day. He or she will show you how to use the CPAP pump. They will fit you with a comfortable mask as well. You then take the pump and mask home to use at night. You might have it for only 1 night, or you might have it for a week or two. The machine will work out how much pressure you need and keeps a record of this. When you go back to the CPAP therapist, they will download the information from the machine. You will be given a prescription for the pressure and best mask for you. With some CPAP suppliers you can hire a CPAP machine for several weeks to make sure that it is the right one for you.
Two basic types of CPAP Pump
There are two basic types of CPAP pump: those that deliver a fixed pressure and those that automatically adjust the pressure. Fixed pressure pumps run at a pressure that has been set to suit your needs. They have a ramp function (see below) which allows this pressure to increase slowly to this level after it is put on, if you prefer. They are cheaper than auto-adjusting devices and highly acceptable to many patients, particularly for average pressure requirements. Auto-adjusting devices monitor airflow and continuously adjust pressure overnight to keep the throat open. They are very useful in patients where pressure requirements vary a lot during sleep and are high at times. Your sleep specialist and CPAP therapist can help you decide which is best for you

Does it have any side-effects?

CPAP is very safe. It has few side effects. The most common problems are:

Mouth leakage.

Some people find it hard to sleep with a nose mask and keep their mouth closed. For them, when the machine goes on, the air goes in through their nose but then rushes out through their mouth. This can be uncomfortable and may wake them. Or this extra flow of air can also go unnoticed at night and lead to drying of the nose and throat, a runny nose, a stuffy nose or sneezing. One way to solve this is with a chin strap. This is a band of fabric that goes around the head and holds the mouth closed. Another solution is to use a mask that covers both your mouth and your nose.
Nose and throat difficulties.
Another way to solve problems with airway drying or a stuffy or runny nose is with a humidifier which fits onto the pump. It is filled with water. When the pump goes on, the water heats up and warms and moistens the air. Not everyone needs it. Some people only need it in cold weather. Some people need it every night.
Water in the mask and tubing.
This often happens in cold weather. If you are using a humidifier, the air that is being blown into the tubing is warm and moist. If the air in your bedroom is cold, this warm, moist air condenses in the cold tubing and the water is left in the tube and mask. To prevent this, the tube must be kept warm. An easy way to do this is to insulate it. You can wrap some aluminum foil and a towel around it, run it under your blanket or use a commercial tubing “cosy”. Some CPAP manufacturers have an adjustable heating wire in the tubing which helps to prevent the problem. When you are using this heated tubing it should not be wrapped in insulation.

Leaking mask.

If your mask does not fit well, it will leak. You can often solve this by adjusting the mask and straps, but you may need to change your mask. CPAP should be very quiet. When patients complain that it is not, it is usually due to a leaking mask.
Manufacturer’s User Guide/Manual
As with any medical device, make sure you read the user guide for your pump before using it so that you understand it well.
Are there any dangers with CPAP? 
CPAP is extremely safe. If you are having surgery, talk with your surgeon about when it is safe to use CPAP. This is especially the case if the operation is on your nose or airways. Many surgeons and anaesthetists prefer their patients to bring their CPAP into hospital with them, because it helps recovery after the operation.

How long will I need to use CPAP?

Unfortunately, CPAP does not cure sleep apnoea. All it does is keep the airway open to control the symptoms. If you stop using CPAP, your airway will once again repeatedly obstruct during sleep. Sometimes if you lose a lot of weight, you may need less pressure or even be able to do without CPAP. But you should talk about that with your sleep specialist.

Do I need to use CPAP all night?

Almost as soon as you stop CPAP your sleep apnoea will come back. You should use your CPAP whenever you sleep, including if you take daytime naps. Some people find this hard, but you should try to use it all night, every night. Remember that if you don't use it, it does not work. Recent studies show that the more you use it, the more you get out of it.

What happens if I can't use CPAP for one or two nights?

One or two nights with no CPAP (e.g. if you are on holidays) is not likely to be a big problem to you. Most people with sleep apnoea have had it for years before they knew and during this time they didn't have any treatment. But you need to know that all your symptoms will come back very quickly. You will snore at night and feel tired during the day. You may need to adjust your lifestyle (e.g. not drive) if you are sleepy or tired during the day. If you have a cold with a blocked nose, use a nose spray which is available from your chemist. It is fine to use these across-the-counter sprays for up to a week, but avoid more prolonged use of them. Sometimes CPAP with the humidifier can help the blocked nose. Using a full face mask is an alternative if you have prolonged nose obstruction. Your CPAP supplier may have one for you to use

What is a ramp?

Most CPAP machines can be set to start with a lower pressure. This goes up over 15 to 30 minutes until it gets to your pressure. This is to help make CPAP more comfortable for you as you fall asleep.

Can I take my CPAP on holidays?

You should certainly try to use CPAP on holidays. It will help you and those you travel with enjoy the holiday more. Most CPAP machines now work on both 110 and 240 volts. Many can also run on a 12 volt battery. This means they can be used when overseas and while camping. To learn more, see Travelling with CPAP.

Sources of help and information

If you are concerned about sleep apnoea, you should talk with your GP. They can refer you to a Sleep Specialists. Patient support groups such as Sleep Disorders Australia have branches throughout Australia. They hold information sessions as well.

Treatments of OSA

Important things to know about OSA treatments

As the causes of sleep apnea vary there is no single treatment that works for everyone.
Deciding which treatment is most appropriate is best done by talking to your doctor.
Weight loss is advisable in anyone who is overweight.
Reduction of alcohol consumption, avoidance of sleep on your back, and the use of nasal sprays can be helpful in some cases.
When the sleep apnea is mild, treatment may be optional and a range of options may be considered.
When the sleep apnea is moderate or severe, the use of CPAP is generally recommended.
Oral appliances generally work best in mild to moderate sleep apnea.
Surgery may be considered where there is a distinct obstruction to the nose and/or throat

What is sleep apnea and how is it diagnosed?

Obstructive sleep apnea (OSA) is present when the airway at the back of the throat is repeatedly blocked, partly or completely, during sleep. Snoring, obesity, observed apneas and sleepiness in the day may suggest that a person has sleep apnea. See our OSA link. The best way to be really sure about an OSA diagnosis is with an overnight sleep study and a clinical assessment by your doctor.

What are the treatment options?

Once a diagnosis of OSA is established, talk with your doctor about the need for treatment and the options available for you. The circumstances often vary from person to person, since the underlying causes may be different. Generally speaking, the options can include one or more of the following:

Weight loss – For anyone who is overweight, losing weight is recommended. While this may not necessarily cure the OSA, it usually improves snoring and OSA, and can help other treatments work more effectively. It also provides general health benefits.
Reduce alcohol consumption – Alcohol usually worsens snoring and OSA due to the throat muscles relaxing. For some people drinking alcohol makes their OSA worse. If this is the case for you then less or no alcohol may be a useful treatment.
Body position during sleep – Snoring and OSA are usually worse when lying on the back. This is because of the effects of gravity on the tongue. Avoiding sleep in this position can improve OSA. In some people it can completely control the problem. This is best achieved by wearing a device that makes it uncomfortable to sleep on your back. Some such devices can be purchased or it can be as simple as sleeping with a tennis ball sewn into a pocket on the back of your pyjamas.
Managing blocked nose – A blocked nose causes mouth breathing, which can lead to snoring and OSA. The blocked nose can be due to different problems, such as allergies, sinus disease, and a deviated septum. Your doctor can assess and provide treatment, depending on the problem. This may involve the use of nasal sprays to relieve congestion. Sometimes surgery is required to correct anatomical problems.
CPAP (Continuous Positive Airways Pressure) - This is generally considered to be the most effective way to treat OSA. It involves the use of a special machine during sleep, connected to a nose or face mask via tubing. The machine gently increases air pressure in your throat holding it open, thus preventing snoring and OSA.

Oral Appliances – These are specially made dental plates that are worn during sleep. They push your lower jaw forwards so that your throat opens up, reducing the risk that it will vibrate (snore) or obstruct. The appliances have various names such as Mandibular Advancement Splints (MAS) or Mandibular Advancement Devices (MAD) or Mandibular Repositioning Appliances (MRA). Your suitability for this form of treatment is best discussed with your sleep physician, who will then refer you to a trained dentist.

Surgery – Surgery may help in cases of OSA caused by a discrete blockage of some part of the nose or throat. There are many types of operations depending on where in your nose and/or throat the problem lies. The decision about whether surgery is right for you may require the expert input of an ENT surgeon. The risks and benefits need to be weighed up in each case. In adults, surgery is often the last resort, after other treatments have been tried first. Nasal surgery may be useful to help CPAP treatment by allowing nasal masks once the nasal blockage is repaired. In children with OSA, surgery to remove tonsils and adenoids is quite commonly done and is often very helpful.

Sleep Hygiene

What are good sleep habits?
Good sleep habits are often referred to as good sleep hygeine. There are many things that can be done to improve sleep. While most of these are common sense, life is very busy and we often don't think about them. Here, we will give you some guidelines for what you should and should not do for a good night's sleep. Many people have trouble with their sleep. If you are one of them, some of these simple things may help.

What should I do in the evening?
Try to go to bed at the same time each night. The body has an internal clock and hormones that control sleepiness and wakefulness. This clock works best if there is a regular sleep routine. When working well, you will feel sleepy at bed time. Try not to ignore this by staying up, as this is a window of opportunity for sleep. Going to bed too early can also disturb your sleep. In the hour before going to bed, it is important to have a relaxing sleep routine. This may include a warm bath, reading quietly or a warm milk drink. Going to the the toilet is important to avoid having to get up in the night.

Are there things that I should not do in the evening?
Caffeine should be avoided for at least 4 hours before going to bed. This isn't just coffee and tea. It is also found in colas and soft drinks. Smoking also makes it difficult to go to sleep, so there should be no cigarettes before going to bed or during the night. Alcohol might help you get to sleep, but it will make it harder to stay asleep. It makes sleep problems like snoring and sleep apnoea worse as well. Activities that are stimulating should be avoided in the hour before bed. This includes moderate exercise, computer games, television, movies and important discussions. Being in brightly lit environments or the blue light of the computer can reduce evening levels of the a sleep-promoting hormone, melatonin. Don’t fall asleep on the couch during the evening as it reduces your sleep pressure and makes it harder to fall asleep when you go to bed.

What about meals and sleep?
It is important to not be hungry at bedtime. But having a full stomach makes it difficult to sleep. The evening meal should be at least 2 hours before bedtime. Some people find that having a small snack at bedtime helps them to sleep better.

What should I do when I'm in bed?
The bed must be comfortable. Warmth is important, both the temperature of the room and having enough blankets. Having warm hands and feet is essential. The mattress, pillow and blankets should be comfortable and restful. There should be no distractions in the bedroom. This may mean removing the television, computer, radio and telephone. If there is a clock in the bedroom, it should be covered to avoid watching clock-watching. If possible, don’t allow children and pets to be a disturbance.

What should I do during the day?
One very important thing is to stay out of bed. Some people use the bedroom as a living room, where they study, watch television, make phone calls and read books. This will make it harder to sleep. The brain will no longer link the bed with sleep. The bedroom should be used for sleeping and intimacy only. As a rule, exercise is good for sleep, but not just before going to bed. The best times are in the morning and before the evening meal. Being out in the sun during the day will improve sleep at night. This will help with your body clock and the melatonin levels in the body. It is best to be outside in the early part of the day.

What should I do if I can't get to sleep?
Sleep is not something that you can force to happen. If you are not asleep within 20 to 30 minutes of going to bed you should get up. Go to another darkened room and sit quietly. Do not watch television, use a computer, eat, drink or do household chores. When you feel tired again go back to bed. This helps your mind link bed with sleep – not with being unhappy and not sleeping. Do not look at the clock because no matter what time it is you will have an emotional reaction. Rest is good – it does not have to be sleep. Don’t label yourself as an insomniac.

What if you can’t shut off your mind?
Some people lie awake in bed at night and cannot switch of their thoughts. If this is a problem, set aside a ‘worry time’ during the evening. Use this time to think about what has been happening during the day, make plans and possible solutions. Then don’t think about these things until the next day. Keep the hour before bed as your wind down time – develop a routine that prepares your body and mind for sleep. Listen to quiet music or do relaxation. Remember that we can never shut off our mind. Our thoughts continue all the time, so try to make them calmer thoughts. Create a favourite fantasy place. Or daydream of your favourite holiday spot. If other thoughts come in, consider them for a moment and then try to gently replace them with calm thoughts.

Are naps good or bad?
It depends. Remember that the average adult sleeps for between seven and nine hours a day. Naps will take up some of this time. But if you are taking short afternoon naps without any problems, then you might want to keep doing this. On the other hand, naps in the evening, or dozing in front of the TV, can make it harder to get to sleep at night.

What about prescription medicines and sleep?
Some of these will make it easier to get to sleep. But others will keep you awake. It is best to take them only when your doctor or pharmacist says so. Sleeping pills can be good when a specific event in your life is making it hard to sleep. But they are only a short term fix. If you take regular doses, they will stop working. Once you stop them, you might find it harder to get to sleep. Also they can make you sleepy during the day.

How much sleep do I need?
Most adults need between seven and nine hours sleep each day. But this may include naps and time spent dozing in front of the TV. Be realistic about your needs. Younger people have different sleep needs. If you are a poor sleeper it is very important you do not spend too long in bed. Spend no more than 8 or so hours in your bed. If you spend more time in bed, you will be telling your body that it’s OK to drift in and out of sleep all night. Going to bed later at night may be the single best thing to help reduce your wake time during the night in bed.

How important is a routine?
Try to stick to a good sleep routine. Improved sleep will not happen as soon as changes are made. But if good sleep habits are maintained, sleep will certainly get better. It is not possible to do the same thing every day, but it should be most days. Different things work for different people. Find what works for you and stick with it. If you try everything and your sleep still doesn't get any better, then see your GP.

Obstructive Sleep Apnoea

1. What is it?

Patients with obstructive sleep apnea (OSA) have repeated episodes of partial or complete obstruction of the throat (also known as "pharynx" or "upper airway") during sleep. A narrow floppy throat is also more likely to vibrate during sleep, which causes snoring. If partial or complete obstructions occur breathing is reduced or stops for a short time – from 10 seconds up to a minute or more – and blood oxygen levels fall as a result. A brief interruption to sleep (an arousal) that lasts for as little as 3 seconds then occurs, allowing breathing to start again but your sleep is disrupted as a result. These episodes of obstruction may happen many times – even hundreds of times - overnight. Some people know that their breathing is not normal at night, but may be unaware that this is a medical problem that is causing them harm. Fortunately, good treatments are available.

2. What are the symptoms of obstructive sleep apnea?

If you have OSA you may snore, toss and turn and others may notice that you stop breathing during the night. Because of the disruptive effects of OSA on sleep you may find yourself waking up often during the night, sometimes gasping or choking, although this does not always happen. However, even if there are few awakenings overnight, sleep is disturbed and you may be unrefreshed by it because of this. As the day goes on, you may struggle to stay awake, especially in the afternoon. Grumpiness and other mood changes are common in untreated OSA.

3. Obstructive sleep apnea affects families

Snoring can keep a bed partner awake and sometimes people in other parts of the house. Some partners try to stay awake to make sure that the person with OSA starts breathing again after a breathing pause. Lack of sleep may make people who are living with a person with OSA more grumpy and irritable. OSA is a problem not only for the person with it, but also other family members.

4. Why you should worry if you have obstructive sleep apnea symptoms

There is strong evidence that people with untreated moderate to severe OSA have other health problems. If you have OSA, you are more likely to have high blood pressure and other cardiovascular disease than someone without it. Each time you stop breathing, your blood pressure may go up. Over time, this may also contribute to high blood pressure during the day (hypertension). There is also evidence that having OSA, particularly if severe, may increase the risk of diabetes, heart attack, stroke or depression. Treating sleep apnea may reduce these risks.

5. Obstructive sleep apnea causes motor vehicle accidents
People with OSA are approximately two and half times more likely to have a motor vehicle accident than others. Broken night-time sleep leads to less alertness, slower reaction times, poorer concentration and more chance of falling asleep at the wheel. The risk of work accidents is increased if your job involves operating machinery or transport.

6. Who gets obstructive sleep apnea?
OSA can occur at any age. In children, it is often the result of enlarged tonsils or adenoids (see Childhood Snoring and Sleep Apnea). In adults, OSA is more common in middle age and in older people. It is also more common in men than in women, although after menopause the risk becomes similar. Many, but not all, people with OSA are overweight. Being overweight can cause a narrowing of the throat due to fatty tissue. Also, having a large waistline can make the lungs smaller during the night, which makes the throat more likely to collapse. Some people are born with a narrow throat or have a facial structure which leads to narrowing.

7. How is obstructive sleep apnea diagnosed?
Signs and symptoms such as snoring, obesity, observed breathing pauses and sleepiness during the day may suggest that a person has OSA. The best way to be really sure is with an overnight sleep study. This measures your sleep, breathing and oxygen levels. Your GP can refer you for a sleep study.

8. How is obstructive sleep apnea treated?
For people with a mild level of OSA and few symptoms, losing weight, decreasing the amount of alcohol consumed in the evening or adjusting the sleeping position may be all that is needed. Most people have more OSA episodes sleeping on their backs.

However, for those with moderate or severe OSA more active treatment is often required. This is particularly so if daytime tiredness is present or there is a background of heart disease, stroke or high blood pressure that has been difficult to control. The two most commonly used treatments for moderate to severe OSA are nasal continuous positive airway pressure (CPAP) or an oral appliance.

CPAP uses a small, quiet air pump that takes air from the room and delivers it under gentle pressure to a mask that covers your nose. This acts to hold your throat open during the night. You only use CPAP at night in bed. It is very good in controlling the symptoms and the long term effects of sleep apnea. It stops the snoring and the machine noise is very much quieter than the snoring was. Sometimes it takes a while to get used to CPAP and tips to help can be found on our CPAP- Making It Work For You fact sheet.

For some people an oral appliance (or mandibular advancement device), fitted by a specialist dentist, is suitable. It is like a double mouthguard that goes over both the upper and lower teeth. The upper and lower mouthguards clip together, so that the jaw is held forward during the night and this helps keep the airway open. These devices are particularly useful for snoring and milder forms of sleep apnea.

There are several surgical operations available for sleep apnea. These are not usually offered unless both CPAP and oral appliances have not worked. It is important to select the right operation and an experienced surgeon is essential.

A number of other remedies have been marketed, some of which have value for selected patients while many others have been shown to be of no benefit. Your doctor will be able to advise you.

9. Other things you can do if you have sleep apnea
In many people, being overweight contributes to sleep apnea. Losing weight may help or even cure the OSA and is extremely beneficial for other health problems, including high blood pressure, diabetes, high cholesterol and joint problems.

If you are diagnosed with OSA, it is a good time to make sure that you are doing everything right to improve your sleep. Alcohol and sleeping tablets relax muscles and may worsen sleep apnea. Their use should be minimised. It is also important to make sure that you are having a regular sleep pattern and sleep as well as possible.