Sleep Apnoea

What it is

Obstructive sleep apnoea is a condition in which the muscles around the throat relax during sleep and allow the airway to narrow or close, so breathing repeatedly pauses (apnoea) or becomes very shallow (hypopnoea). Each pause briefly starves the body of oxygen and forces the brain to rouse just enough to reopen the airway, often with a gasp or snort, before sleep resumes. This can happen dozens or even hundreds of times a night, wrecking the quality of sleep without the person ever fully waking or remembering it.

Although it shows up as a sleep problem, sleep apnoea is very much a whole-body medical condition. The repeated drops in oxygen and the constant micro-arousals strain the heart and blood vessels and disturb the body's metabolism, which is why it matters far beyond feeling tired.

What it can feel like

For the person, the daytime signs are loudest: waking unrefreshed despite a full night in bed, heavy daytime sleepiness, morning headaches, poor concentration and memory, irritability, and low mood. Many people fall asleep easily in quiet moments and may nod off while driving, a serious danger.

Often it is the bed partner who first raises the alarm, describing loud, chronic snoring punctuated by frightening silences that end in a gasp. Snoring alone is common and usually harmless, but snoring with witnessed pauses is the classic warning sign. People with sleep apnoea are frequently surprised to learn how disrupted their nights are, because the arousals are too brief to remember.

How common is it

Sleep apnoea is common and substantially under-diagnosed. Estimates vary with how it is measured, but a meaningful proportion of middle-aged adults have it, more men than women, with risk rising with age and weight. As rates of obesity rise across African cities, so does this condition, yet awareness and access to diagnosis remain low, leaving many cases untreated.

What causes it

The core problem is an airway prone to collapsing during sleep. Several factors raise the risk: excess weight, particularly around the neck; the natural shape of a person's airway, jaw and tonsils; ageing; alcohol and sedatives, which relax the throat further; sleeping on the back; and, in children, enlarged tonsils and adenoids. It is not caused by laziness or by choosing to snore; it is a physical, mechanical problem with the airway, made worse by some modifiable factors.

How it is diagnosed

Diagnosis rests on a sleep study that records breathing, oxygen levels and sleep through the night, done either in a sleep laboratory or, increasingly, with a portable device used at home. The study counts how often breathing pauses or becomes shallow each hour, which grades the severity. A doctor combines this with the history of snoring, witnessed pauses, sleepiness and related health problems. Because untreated sleep apnoea raises the risk of high blood pressure, heart disease, stroke and diabetes, diagnosis is worth pursuing rather than enduring.

How it is treated

Treatment is effective and often life-changing. The most established treatment for moderate to severe sleep apnoea is CPAP, a machine that gently blows air through a mask to hold the airway open through the night; used consistently, it can restore refreshing sleep and lower the associated health risks. Other options, depending on severity and cause, include a custom dental device that holds the lower jaw forward, weight loss where excess weight is a factor, treating nasal problems, avoiding alcohol and sedatives near bedtime, and surgery in selected cases, including removing enlarged tonsils and adenoids in children. Because the condition harms the heart and metabolism over time, treating it protects far more than sleep.

Sleep apnoea in the African context

Obstructive sleep apnoea is very common and very under-recognised here, and the loud snoring and brief stops in breathing it causes are usually seen as a harmless joke rather than a medical condition. This matters, because untreated sleep apnoea strains the heart and raises blood pressure, the risk of stroke, and the danger of falling asleep while driving, all serious in our setting, and the daytime exhaustion it causes is often misread as laziness. Diagnosis and treatment, including CPAP machines, can be hard to access and afford, but weight management where relevant, side-sleeping, and avoiding alcohol before bed help, and recognising the condition is the first step toward protecting the heart and preventing accidents.

Managing it day to day

Alongside medical treatment, these steps help.

• Take loud snoring with pauses in breathing seriously, and seek assessment rather than dismissing it.
• Where weight is a factor, gradual weight loss can significantly reduce apnoea.
• Sleep on your side rather than your back, and avoid alcohol and sedatives in the evening, which worsen it.
• Use any prescribed treatment such as CPAP consistently, since the benefits come with regular use.
• Treat the daytime sleepiness as a safety issue, especially for driving, and seek review if it persists.