Snoring & OSA

A Guide To Snoring & Sleep Apnea

February 28, 2023
A Guide To Snoring and Sleep Apnea

For many, snoring is little more than a minor nuisance. Everyone snores at some point in their lives, and for the most part it doesn’t have any long-term consequences. However for a small minority who snore chronically, snoring might actually be a symptom of something more problematic and can lead to some very serious issues if left unchecked.

Snoring indicates a resistance to normal airflow reaching the lungs. This can be caused by soft tissues collapsing in your throat, loose relaxed muscles, a compressed airway due to excess body fat, nasal congestion, or structural abnormalities in your nose or throat that decrease the size of your airways. If you do find yourself snoring on a regular basis, the best course of action is to visit an ear, nose, and throat specialist in Singapore to get a proper diagnosis for your condition.

In many cases snoring is due to lifestyle factors. Alcohol consumption or sedatives can relax the muscles in your upper airway, leading to both acute and chronic snoring. Enlarged soft tissues in the mouth, including enlarged tonsils, adenoids, or tongue can also lead to snoring. Other factors for snoring include excess body fat in the neck area, pregnancy, sleeping on your back, and nose or sinus issues.

For patients suffering from chronic snoring, it could indicate the presence of a more serious condition known as sleep apnea. Sleep apnea is a disorder that is most often characterised by start-stop breathing during sleep and can lead to a number of long-term physiological issues with alarming consequences.

To help patients understand a little more about sleep apnea and snoring treatments in Singapore, we’ve put together a guide that covers all the major points. Read on to learn more about snoring and sleep apnea.

The Different Types Of Sleep Apnea

There are three main types of sleep apnea, each tied to different underlying causes.

The Different Types Of Sleep Apnea-sleep apnea singapore

Obstructive Sleep Apnea

Obstructive Sleep Apnea, or OSA, is the most common form of sleep apnea encountered by patients. It occurs when the muscles and soft tissues at the back of your throat relax, resulting in a narrowing of the air passages due to obstructions caused by the soft palate, side walls of the throat, and your tongue.

If you have OSA your throat muscles relax as you fall asleep at night, causing your airway to become obstructed. Without sufficient air entering the lungs, the oxygen level in your blood drops. Your brain senses this change and momentarily awakens you so you are able to reopen your air passages. This awakening happens so quickly and so briefly that most people have no memory of it happening multiple times during sleep.

The periodic awakening also causes symptoms like snorting, choking, and gasping which can be noticed by your partner. The constant drop in blood oxygen and constant awakenings are responsible for the many symptoms and complications associated with sleep apnea.

Central Sleep Apnea

As compared to OSA, Central Sleep Apnea (CSA) is much less common. Like OSA, CSA also results in pauses in breathing at night. However for CSA, there may be no physical obstruction to breathing. Instead the interruptions in breathing are caused by the brain not sending proper signals to the muscles in your body that control breathing.

CSA can often present alongside other medical conditions like kidney disease, stroke, and congestive heart failure. It is a potentially fatal disorder that can adversely affect heart health.

Complex Sleep Apnea

Having one type of sleep apnea does not preclude you from having the other. In patients with complex sleep apnea, they may have a combination of both OSA and CSA. Treatment for complex sleep apnea can include a mix of different medical interventions.

Symptoms of Sleep Apnea-sleep apnea singapore

Symptoms of Sleep Apnea

Loud snoring is the symptom most strongly associated with sleep apnea. Snoring is often found in cases of OSA where the soft tissues and muscles obstructing your upper airway vibrate as air travels through.

Start-stop breathing is another important symptom of sleep apnea. Since most people are asleep when this happens, this symptom is often reported by their partners. Gasping for air is another sign of sleep apnea that falls under this category.

Other symptoms of sleep apnea include waking up with a dry mouth, waking up repeatedly at night, daytime sleepiness, difficulty concentrating on tasks, and headaches. If you notice these symptoms over a long period of time, it’s best to consult with an ENT specialist in Singapore to check if you may have sleep apnea.

Causes And Risk Factors Of Sleep Apnea

OSA can be triggered by a number of factors. Excess weight can lead to obstructions in your airway due to fat deposits in the neck compressing the airway and is a risk factor in developing OSA. Males are more likely to develop OSA while family history also plays a part in determining risk.

Lifestyle habits such as frequent alcohol consumption, sedative use, and smoking also correlate with sleep apnea risk. Finally, medical conditions like congestive heart failure, high blood pressure, type 2 diabetes, or parkinsons are also possible risk factors to consider for Obstructive Sleep Apnea.

Learn More: How Weight Loss Plays A Role In Obstructive Sleep Apnea

Central sleep apnea can be due to other underlying medical conditions such as heart disease or stroke. Some narcotic pain medication can also cause central sleep apnea. Low blood oxygen levels at high altitudes can also be a reason for someone developing central sleep apnea and is a concern among mountain climbers.

Possible Complications Of Sleep Apnea

Possible Complications Of Sleep Apnea-sleep apnea singapore

Daytime Fatigue

Sleep apnea in Singapore is much more serious than just snoring. The constant night time awakenings adversely affect your sleep cycle and make it difficult to stay alert and awake in the day. Excessive daytime sleepiness can lead to various issues on its own, and patients with sleep apnea are at higher risk of getting into motor vehicle or workplace accidents. People who regularly operate heavy machinery need to be especially cautious, due to the dangerous nature of their occupation.

It can also affect office productivity for adults which can hinder employment prospects. Students with sleep apnea may find that their school work and academic performance suffer due to the lack of restful night sleep. Behavioural changes associated with sleep apnea can include moodiness, irritability, and depression. Physical symptoms like headaches are likely to also compound the problems faced.

Hypertension and Heart Problems

Patients with sleep apnea regularly go through periods of low blood oxygen levels during sleep. Sudden falls in blood oxygen levels tend to stress the cardiovascular system by increasing blood pressure. OSA raises your chance of developing high blood pressure, also known as hypertension, which by itself can lead to heart attacks, stroke, kidney problems, or aneurysms.

Sleep apnea can also make it more likely that a patient may suffer from recurrent heart attacks and irregular heartbeats. If you have sleep apnea alongside heart disease, having your blood oxygen levels drop frequently can lead to death from an arrhythmia. 

Learn More: Snoring and breathing problems: Effects sleep apnea has on your health

Increased Risk Of Other Conditions

The effects of sleep apnea can also affect your body functioning in other ways. Sleep apnea is linked to an increased risk of developing insulin resistance and type 2 diabetes.

Metabolic syndrome is also a disorder that can be a complication of sleep apnea. Metabolic syndrome is a grouping of different health problems that can make it more likely for a patient to develop heart disease, diabetes, or suffer from a stroke.

The liver is another organ which can potentially be damaged by sleep apnea. Liver scarring and nonalcoholic fatty liver disease are two liver problems which have a correlation with sleep apnea.

Diagnosis & Treatment Options For Sleep Apnea

Diagnosis Of Sleep Apnea-sleep apnea singapore

 

Diagnosis Of Sleep Apnea

Diagnosing sleep apnea involves a thorough evaluation of your symptoms and details of your sleep history from your spouse or partner, if applicable. You may also be recommended to a sleep clinic in Singapore for overnight monitoring and observation.
Assessment of a patient with suspected sleep apnea includes a nasoendoscopy (nose scope) to determine potential areas of narrowing  in the upper airway. A nasoendoscopy is a relatively painless procedure that allows the ENT specialist to assess the nasal cavity, back of tongue and voice box region. The procedure is done after the nose is decongested and numbed with a nose spray. The whole process usually takes less than 5 minutes. 

To diagnose sleep apnoea, a sleep study (also known as nocturnal polysomnography) is required. A nocturnal polysomnography measures vital signs like heart, lung, and brain activity along with respiratory patterns, heart rate, and blood oxygen levels. These are all key indicators that can be used to detect sleep apnea.

Learn More: 5 Signs You Need to Have a Sleep Study Performed

Another option would be a home sleep test with portable devices which are more simplified than polysomnography tests. If you show positive signs for sleep apnea via home tests, treatment can then be immediately prescribed. However if the results are negative, you might still need to go for a nocturnal polysomnography conducted by a sleep specialist in Singapore as home tests may not always detect cases of sleep apnea.

Non-Surgical Treatments for Sleep Apnea

Once a diagnosis of sleep apnea is confirmed, the next step is treatment. The chosen modality will depend on the type and severity of sleep apnea. For patients with milder cases of sleep apnea, lifestyle changes alone may be able to solve many of their issues. Such recommendations may include losing weight, quitting smoking, reducing alcohol consumption, allergy treatment, or changing sleep positions.

Non-Surgical Treatments for Sleep Apnea-sleep apnea singapore

Continuous Positive Airway Pressure (CPAP)

Continuous Positive Airway Pressure (CPAP) machines have been used to successfully treat many cases of sleep apnea. They can benefit patients who have either OSA or CSA. CPAP machines work by filtering and pressurising air before delivering it to the patient while they sleep at night. The constant airflow and higher pressure can stop soft tissues from obstructing your breathing passages and keep them open for continuous respiration.

CPAP machines are some of the best and most reliable ways to treat sleep apnea in patients. When used successfully they can improve sleep quality, lower the risk of chronic and life-threatening diseases, and reduce daytime fatigue.

BPAP And Other Machines

Where CPAP machines only deliver a standard preset air pressure, BPAP machines are able to send two different air pressures for both inhalation and exhalation. Thus some patients may find it easier to breathe at night with a BPAP machine.

Auto-CPAP machines take things a step further and adjust the set air pressure breath by breath. This allows them to deliver different air pressures depending on the stage of sleep. While CPAP machines remain the treatment of choice, these alternatives may help patients who have difficulty breathing using a CPAP machine.

Oral Appliances

For patients who are unable to benefit from PAP machines, specially designed oral appliances can be prescribed. These devices are made to keep your airways clear while you sleep and either stop your tongue from blocking your throat or help to bring your jaw forward to relieve snoring and sleep apnea.

As mentioned, CPAP is the gold-standard treatment for sleep apnea but oral appliances are easier to use for some patients. A sleep specialist and a dentist with expertise in oral appliances should both be consulted to make a determination if this form of treatment can be effective for a patient. 

Treating Underlying Conditions

Cardiovascular or neurological problems may be at the root of Central Sleep Apnea in certain patients. It can be useful to ascertain the underlying issues in the heart or brain and treat those disorders to help cure CSA in such cases.

Oxygen Therapy

Oxygen therapy is sometimes prescribed for patients with central sleep apnea. Since sleep apnea causes oxygen levels to drop periodically, delivering supplemental oxygen to the lungs may help reduce the risk of abnormal cardiovascular function and hypertension.

Medication for CSA

Medications such as acetazolamide can help stimulate the breathing drive in patients with CSA. It may be especially useful for patients who have CSA due to high altitudes.

Some opioids may worsen a patient’s CSA. If your physician finds that to be the case, a reduction of dosage or other prescriptions may be sought to manage your sleep apnea.

Adaptive servo-ventilation (ASV)

If CPAP machines and other snoring treatments don’t effectively help with your condition, then Adaptive Servo-ventilation is a more technologically advanced option. For patients who develop Central Sleep Apnea during treatment for OSA, ASV machines have also been shown to help.

ASV devices utilise a complex algorithm that learns your breathing patterns and uses this information to help maintain consistent respiration. Beyond treating a number of different breathing problems during sleep, ASV also provides support to ensure that oxygen levels never fall below 90%. However ASV machines can increase mortality risk for certain kinds of severe heart failure patients, and hence cannot be recommended in those cases.

Surgical Treatments for Obstructive Sleep Apnea-sleep apnea singapore

Surgical Treatments for Obstructive Sleep Apnea

For patients with OSA, surgically removing or shrinking the soft tissue obstructions may help them breathe better at night. Surgery can also be indicated for patients who have structural abnormalities that hinder respiration. In most cases, surgery is a last option that is only considered after other treatment modalities have not shown consistent results.

Septoplasty

A septoplasty is a procedure to straighten a deviated septum. The septum is the space between your nostrils and a deviated septum can make breathing difficult and lead to sleep apnea.

If your OSA is linked to a deviated septum, a septoplasty procedure can help provide a permanent improvement to your quality of life and allow you to breathe better.

Inferior Turbinoplasty

Often done alongside a septoplasty, an inferior turbinoplasty is a surgery to reduce the size of the inferior turbinate. The inferior turbinate is the lowest section of the turbinate, a structure located in the nose at the sides of the nasal cavities. When the inferior turbinate is enlarged, it can cause significant nasal blockage.

Adenoidectomy

The adenoids are small tissues located behind the nose in your upper airway. In children they form part of their immune system and shrink as they get older. Usually by the age of 13, adenoids would have disappeared. 

An adenoidectomy can be performed under general anaesthesia to remove the enlarged adenoids and aid breathing. Septoplasty, inferior turbinoplasty, and adenoidectomy are all procedures to unblock the nose and treat patients who have sleep apnea due to obstructions in their nasal passages. 

Tonsillectomy

The tonsils are two lymph nodes at the back of your throat. Their purpose is to filter out bacteria to prevent infections. However enlarged tonsils may end up obstructing your air passageways.

A tonsillectomy is a surgery for tonsil removal in Singapore. Your surgeon may use a scalpel to cut out your tonsils or high-energy heat or sound waves may be used to remove or destroy the tissues. Like any surgery there are risks involved and recovery may stretch to a few days.

If your sleep apnea is related to complications from enlarged tonsils, and other treatment methods have been rendered ineffective, a tonsillectomy can help with the condition.

Learn More: Reasons Why You May Need to Remove Your Tonsils & How It Is Done

Uvulopalatopharyngoplasty (UPPP)

UPPP is a surgery often performed together with tonsillectomy in adult patients with OSA. The purpose of UPPP is to widen the throat region as well as to stiffen the soft palate to prevent it from collapsing during sleep. UPPP is highly successful when performed in patients with large tonsils. However, it usually causes severe sore throat that resolves over a period of 2-3 weeks. 

Hypoglossal Nerve Stimulation

Where CPAP machines and their counterparts are not suitable, and other surgical procedures are ineffective in treating obstructive sleep apnea, hypoglossal nerve stimulation may be able to improve outcomes for patients. 

The hypoglossal nerve is mostly involved in tongue movements and can be a useful treatment modality for patients with a bulky tongue base causing sleep apnea. By implanting a medical device to stimulate this nerve at periodic intervals, in sync with breathing patterns, your airways can be stabilised while you sleep. The nerve stimulations are done via mild electric shocks which cause tongue advancement resulting in air passage expansion to allow for better airflow and breathing.

Hypoglossal Nerve Stimulation-sleep apnea singapore

Tracheostomy

In extreme cases where a patient presents with serious life-threatening sleep apnea, an opening in your neck may be needed to provide an alternate route for air to enter your lungs. 

Known as a tracheostomy, it is a procedure where a surgeon makes an opening in your neck and inserts a tube. This tube will be covered during the day and can be opened up at night to allow you to breathe normally, while bypassing obstructions in your normal air passages.

Misconceptions About Sleep Apnea

While people may know about snoring and sleep apnea, they may not be aware of how serious it is or who can be affected by sleep apnea. To help spread awareness about this condition, we address some misconceptions about sleep apnea below.

      1) Everyone who snores has sleep apnea

While snoring is strongly associated with sleep apnea, not all snorers have sleep apnea and not all cases of sleep apnea might involve snoring.

To determine if a patient has sleep apnea, they must also exhibit some of the other symptoms of sleep apnea and the diagnosis has to be done by a qualified medical professional. 

      2) You only have sleep apnea if you snore at night

Snoring is often found in patients with OSA as the obstructions in their airway can create the rumbling sound as air is forced through narrowing passageways. However some patients with OSA or CSA may not snore at all.

The best way to tell if you have sleep apnea even if you don’t snore, is to check for other symptoms like daytime fatigue, pauses in breathing while sleeping, dry mouth, headache, and waking up at night gasping for air.

Misconceptions About Sleep Apnea-sleep apnea singapore

      3) Only men can get affected by sleep apnea

While men are much more likely to be afflicted by sleep apnea, women can on occasion also  develop sleep apnea. If you experience any of the symptoms associated with the condition, it’s important to visit a specialist and get a proper diagnosis.

      4) Sleep apnea is a minor condition

Sleep apnea can be a serious and even potentially life threatening condition. It increases the risks of many diseases and can severely lower your quality of life. In many cases it is also very treatable and patients should seek medical attention as soon as they notice symptoms of sleep apnea.

      5) Only older people get sleep apnea

Patients are more likely to develop sleep apnea as they get older due to various factors. However people of any age can develop sleep apnea. Issues such as enlarged tonsils and adenoids can cause sleep apnea in children and therefore will need to be monitored carefully. Parents need to be vigilant and watch out for symptoms like daytime sleepiness and trouble concentrating in school, which can be signs that your child is suffering from sleep apnea.

Common Questions You May Have

      1) Can you get sleep apnea if you’re skinny?

Obesity and increased body fat are risk factors for developing sleep apnea. However you can still get sleep apnea if you are of a healthy weight. Enlarged tissues in your mouth and throat, anatomical features, allergies, are all factors that can also lead to sleep apnea. Additionally, central sleep apnea can also manifest in patients who have healthy BMIs.

      2) Does sleep apnea go away on its own?

In most cases, sleep apnea will not go away on its own without medication, lifestyle changes, surgery, or medical devices. The best way to tackle the disorder is to talk to a medical professional to determine the cause of your sleep apnea and follow the recommended treatment plan.

      3) Are there any side effects of using a CPAP machine?

CPAP machines are large and unwieldy and some users may experience side effects like insomnia, dry mouth, nasal congestion, nosebleeds, and skin irritation while using it. Many of these side effects can be managed, although some patients may not be able to get a good night’s sleep with a CPAP machine. In those cases, alternative therapies may be required.

      4) What are the risks and side effects of sleep apnea surgery?

All surgeries carry with them a certain amount of risk. For sleep apnea surgery, the possible complications depend on the type of procedure you are undergoing. Generally speaking the risks of any major surgery include excessive bleeding, infection, and adverse reactions to anaesthetic.

More specific risks and side effects of sleep apnea surgery involve decreased sense of smell, nosebleeds, nasal dryness, sore throat, change in voice, device migration (in the case of hypoglossal nerve stimulation), and failure to resolve the underlying problem.

Conclusion

Sleep apnea is more than just loud disruptive snoring. It has far-reaching adverse health effects that can cause significant physical and mental harm. Associated with life-threatening diseases like heart disease, stroke, and diabetes, sleep apnea should always be taken seriously. When symptoms of sleep apnea are noticed, medical attention should quickly be sought as early treatment is usually more effective. 

For patients with sleep apnea, there are many different treatment methods which can be prescribed for their condition. Some like the CPAP machines are very effective at treating the symptoms, while surgical procedures may be able to solve the underlying issues leading to the condition.

If you or a family member is showing signs and symptoms of sleep apnea, the best course of action is to bring them to an established ENT specialist doctor for a thorough checkup. From there, various treatment options can be explored.

An ENT doctor with years of training under his belt, Dr Gan Eng Cern has a wide range of experience in his field. To make an appointment at his clinic in Mount Elizabeth Novena Hospital reach out to us through our contact us page and our support team will get back to you.

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

    Awards

    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award

    Qualifications

    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

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