Awakened Voices: Unmasking Sleep Apnea through Personal Stories.

Obstructive sleep apnea (OSA) is a common problem that blocks the upper airways at night. This can cause snoring, low oxygen levels, and waking up during the night. [6] Another study found that 6.6% of people aged 40 to 70 in Malta had obstructive sleep apnea [7]. This means that the condition affects a lot of people in the country. This rate could also be higher because being overweight or obese is a risk factor for OSA. Unfortunately, 70% of Maltese people were found to be overweight or obese in a 2016 study. [10]

OSA not only makes you less alert and less able to think clearly, but it also raises your chance of heart disease, metabolic diseases(such as diabetes and worsening of diabetes ) , and accidents on the road and at work. OSA is linked to more deaths from heart disease and other causes[6]. OSA is linked to being older, male, having problems with the face or skull, and, most importantly, being overweight or obese [6]. There is a strong link between obesity and OSA. A lot of fat people have OSA, and most people who come in with OSA are obese[6]. Some important facts about OSA are listed below:

Signs and symptoms

• Excessive daytime sleepiness

• Snoring loudly

• Witnessed episodes of not breathing during sleep

• Waking up in the middle of the night and panting or choking
  

• Getting up in the morning with a sore throat or dry mouth

• Headaches in the morning

• Not able to concentrate during the day

• Mood changes, like being depressed or easily upset

• High levels of blood pressure

• Less interest in having sex[1] [2] [3]

What Causes OSA

1. Relaxation of  the muscles that support the tongue and mouth or other soft tissues in the throat

2. Nasal passages that are narrowed because of things like being overweight, health problems, or family background

3. If you snore, it could mean you have OSA. [1] [2] [3]

What are the  Risk Factors for OSA

• Medical problems like hypothyroidism and polycystic ovary syndrome

• Overweight.

• Getting old

• Long-term stuffy nose

• Tobacco

• Diabetes

• Male sex

• A history of sleep apnea in the family

• Asthma

• Problems with the muscles that hold the head and neck up

• Down syndrome

• Enlarged adenoids/tonsils in children [1] [2] [3]

How to Diagnose and Problems

The best way to get a diagnosis of Obstructive Sleep Apnea (OSA) is to talk to a medical worker. They may use any of the following methods.

• Taking part in a sleep study, like a polysomnogram or a home sleep test

• A medical history and physical test

• Checking the heart rate and oxygen levels while you sleep[2] [3]
  

  

  Image: a patient attached to a polysomnogram (device to check for sleep apnea).

A sleep study, such as an in-hospital polysomnogram or a home sleep test, is often recommended as a diagnostic tool. The biggest difference is that the polysomnogram needs to be done in a hospital because it is a bit more invasive. The home sleep apnea test is thought to be less invasive than the polysomnogram because the home sleep test can be connected to the person while they are not in the hospital and record their sleep and oxygen saturation while they sleep at home[9]. An measure, such as the Apnea Hypopnea index (AHI) shows how bad the OSA is. The data and the level of severity of OSA are shown below. [8]

AHI = tot number of apneas and hypopneas per hour

For adults, an AHI of less than 5 times per hours is normal. An AHI of 5 to 14 is mild OSA, 15 to 29.9 is moderate OSA, and 30 or more is severe serious OSA.

One could also use a smartphone tool to see if he is snoring, which could be a sign of OSA even though it is not as accurate as sleep monitors. Click on this link to go to Snore Lab and download the free app.

 Issues that can arise from sleep apnoea

• Feeling tired and sleepy during the day

• Heart problems like heart failure, stroke, and high blood pressure

• Glaucoma and other eye problems

• Diseases of the metabolism, such as type 2 diabetes

• Problems during pregnancy, such as gestational diabetes

• Trouble with drugs and surgery

• Partners who can't sleep

• More likely to get COVID-19 [1] [2] [3]

Choices for Treatment

Because there are many treatment choices based on your needs and limitations, you should always talk to your doctor or other health care provider.

• Machines that use pressure to keep the mouth open while you sleep, like CPAP

• Mandibular devices that go in your mouth and push your lower jaw forward while you sleep

• Surgery if its needed

• Changes in your lifestyle, like losing weight and giving up smoking [1] [2] [3] [6] [8] Click on the words to get tips on how to make these changes to your life!

How important it is to diagnose and treat

Having obstructive sleep apnea is a serious disease that can have negative  effects, health problems, and even death. So, living a healthy life by keeping your BMI in check (see weight loss post), working out, breathing through your nose, and not smoking can help avoid OSA. Early identification and treatment can keep problems from getting worse and make life better [1, 2, 3]. So, if you have any of the above symptoms, you should talk to your doctor or another health care worker.

We at MBWA are aimed to treat people ; here we ask some questions to take in the account of a Maltese person who was diagnosed with Obstructive Sleep Apnea and uses the CPAP as his main treatment. We asked Mr.X a few questions to gain some insight on his condition ,the journey he took, and how he found the CPAP machine. 1. Can you describe your experience with sleep apnea and how it has affected your daily life?

“Before I was diagnosed with sleep apnoea, I had a lot of instances where I would fall asleep without any particular reason. For example, while sitting down even if it was only after an hour or two that I had that I had woken up from a whole night sleep, or even during the evening while on the sofa even though I was not particularly tired. On numerous occasions I would wake up with a head ache and dry mouth. All these seemingly minor issues had a negative impact on my daily routine as these situations made me very uncomfortable and Ilost precious time with my family.”

2. What symptoms led you to suspect that you might have sleep apnea? 

"Family members and colleagues told me on different occasions that although I snore loudly what worried them was that it seems that I stop breathing for long periods of time sometimes almost for a whole minute. However, on one particular occasion I was at talking to a friend that happened to work at the sleep lab. He asked me if I wake up frequently during the night to urinate, and yes that was another issue that was worrying me. When I confirmed this fact to him, he said that I would better talk to a respiratory consultant as that is a clear symptom of sleep apnea. As a matter of fact, I did this and it was then that I was diagnosed with sleep apnea." NOTE: Sleep apnoea and nocturia often go along for more than just disrupted sleep. Because overnight urination affects up to half of OSA patients, some specialists recommend asking about it during screening.

Research suggests several ways OSA may cause midnight urination. OSA causes frequent airway blockages while sleeping, lowering blood oxygen levels. ANP is released in reaction. This hormone causes the kidneys to produce more salt and water, increasing nighttime urine output.

3. How long did it take for you to receive a diagnosis after you first noticed symptoms? “I had the symptoms for more than a decade before realizing what my problem was. But like I mentioned in the previous answer once I talked to the respiratory consultant it only took few weeks from the test to being diagnosed.”

4. What treatments or lifestyle changes have you found to be most effective in managing your sleep apnea? “Definitely the use of the CPAP machine was life changing in addition to weight loss and a healthier life style.”

5. How did sleep apnea impact your quality of sleep and overall health, did any intervention you made found useful? “Before the diagnosis my sleep patterns where disturbed, but after I started using the CPAP all went back to normal.”

6. Have you noticed any changes in your mood or cognitive function since being diagnosed and started using a CPAP? 

“Although I cannot say that I noticed any drastic changes, alertness improved a lot due to the fact that since using CPAP I am no longer sleeping in situations where sleep would not be normal.”

7. What advice would you give to someone who suspects they might have sleep apnea? “Definitely to seek medical help and follow any given instructions.”

8. How do you manage your sleep apnea when traveling or in unfamiliar environments?  “More than a decade using the CPAP I had two different brands. The last one I bought more than a year ago works also using a battery as I needed it when sleeping overnight on my boat, and it turned out to be a very good purchase. I also have documentation to show what CPAP is and why I need it to show at the airport if the need arises.”

9. Can you share any misconceptions about sleep apnea that you think should be addressed? 

“The most common misconception I hear is that the only symptom is snoring, which from my own experience I can say that snoring was the least of the problems and snoring does not necessarily mean that one suffers from sleep apnoea.”

10. What support systems or resources have you found helpful in dealing with your condition?

“My main support system is using the CPAP on a daily basis.”

We at MBWA can’t emphasize enough how important it is to diagnose yourself if you think you have sleep apnea. Through a consultation and a small device you can regain your health back. 

One: "Obstructive Sleep Apnoea." Accessed July 14, 2023, from www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090, the Mayo Clinic is part of the Mayo Foundation for Medical Education and Research.

[2] "Obstructive Sleep Apnoea." On June 21, 2024, Johns Hopkins Medicine published information about obstructive sleep apnoea at www.hopkinsmedicine.org/health/conditions-and-diseases.

3. “Definition, Causes, Symptoms, Diagnosis, and Treatment of Obstructive Sleep Apnoea (OSA).” According to WebMD, you can learn more about obstructive sleep apnoea syndrome at www.webmd.com/sleep-disorders/sleep-apnea. Found on June 24, 2024.

Obstructive Sleep Apnoea (OSA) | NHS INFORM, www.nhsinform.scot/illnesses-and-conditions/lungs-and-airways/obstructive-sleep-apnoea/. Found on June 24, 2024.

5. "Sleep Apnoea." The Mayo Clinic and the Mayo Foundation for Medical Education and Research made this page available on April 6, 2023: www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.

It was written by Araghi, M.H., et al. (2013) and was published in Sleep. The article is called "Effectiveness of lifestyle interventions on obstructive sleep apnoea (OSA): Systematic review and meta-analysis." You can find it at doi:10.5665/sleep.3056.

The study by Gauci et al. (2019) on the prevalence of obstructive sleep apnoea syndrome in Malta can be found in Epidemiology [Preprint]. The doi number is 10.1183/13993003.congress-2019.pa4414.

[8] "Diagnosis and Management of Obstructive Sleep Apnoea" by Goyal, Munish, and Jeremy Johnson. The U.S. National Library of Medicine has information on Missouri Medicine at www.ncbi.nlm.nih.gov/pmc/articles/PMC6140019. If OCST is done, the severity of OSA is (REI). & AHI or REI levels of 5% to 30% per hour are indicative of severe OSA. Found on June 24, 2024.

[9] Stuart F. Quan et al. "Out of Centre Sleep Testing in Ostensibly Healthy Middle-Aged to Older Adults." You can find the Southwest Journal of Pulmonary & Critical Care at www.ncbi.nlm.nih.gov/pmc/articles/PMC6528663/#:~:text=Most%20have%20used%20PSG%20recorded,actual%20sleep%20is%20not%20recorded. Found on June 24, 2024.

[10] Cuschieri, S., et al., "Prevalence of Obesity in Malta." www.ncbi.nlm.nih.gov/pmc/articles/PMC5192534#::text=Results, Obesity Science & Practice, U.S. National Library of Medicine, p. 0.0001. Found on June 24, 2024.