Sleep apnoea
Sleep apnoea: breathing repeatedly stops during sleep, often without you noticing. Excess weight is the most important risk factor, and losing weight helps measurably.
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In obstructive sleep apnoea, the airways repeatedly collapse during sleep: breathing stops for ten seconds or longer, the body briefly jolts awake and starts breathing again – in severe cases dozens of times an hour, without the person noticing. Typical signs are loud, irregular snoring with pauses in breathing that a partner notices, morning headaches, a dry mouth and, above all, leaden daytime sleepiness.
Excess weight is the most important risk factor, because fatty tissue in the neck and around the throat narrows the airways; around two thirds of those affected are overweight. A receding chin, alcohol in the evening, smoking and sleeping on your back also play a part. Estimates suggest that a large proportion of cases are never diagnosed – men are affected more often, but women catch up after the menopause.
Untreated, sleep apnoea is more than a nuisance: the night-time drops in oxygen drive up blood pressure and heart rate, promote heart rhythm disorders, insulin resistance and type 2 diabetes, and make you inattentive during the day – which is dangerous when driving. And it can make losing weight harder: if you sleep badly, you're exhausted during the day, move less and often have a bigger appetite – in studies, lack of sleep throws the appetite hormones ghrelin and leptin out of balance.
Diagnosis is straightforward: a screening device for use at home or a night in a sleep lab. Depending on severity, treatment involves a breathing mask (CPAP), a mandibular advancement splint or positional therapy. And weight has a direct effect: in a much-cited study (Peppard 2000), a 10% weight loss reduced the number of breathing pauses by about a quarter – in some people, the apnoea disappears completely.
Children can have sleep apnoea too, usually because of enlarged adenoids or tonsils: snoring, mouth breathing, restless sleep, fidgetiness or difficulty concentrating during the day. This should be checked by a paediatrician or an ear, nose and throat (ENT) specialist – it can be treated well.