Conditions We Treat
Breathing can be disturbed during sleep…
Sleep-disordered breathing is common and encompasses snoring, upper airway resistance syndrome and sleep apnoea. Our upper airway anatomy may predispose us to this condition, but weight gain makes it much more likely. By interfering with quality of sleep, sleep apnoea often leads to daytime sleepiness and poor concentration.
Snoring
While awake, breathing is usually easy and quiet. When asleep, the upper airway, between mouth and vocal cords, narrows as the body relaxes. It can also be affected by large tonsils. Smooth airflow can then be replaced by turbulent airflow which may cause vibration of the tongue, palate or throat. This results is the noise of snoring. This is very common. Although not usually life-threatening, it can be anti-social for loved ones, family and friends. The likelihood of snoring is increased by being overweight, smoking, drinking too much alcohol and sleeping in the back position.
Sleep Apnoea
Sleep apnoea means no breathing during sleep. Obstructive sleep apnoea (OSA) is the commonest type. During deep sleep, the upper airway collapses completely meaning that breathing stops which leads to a fall in oxygen levels. The resulting survival stress response leads to lighter sleep when breathing restarts. Deep refreshing sleep then follows as the body relaxes once again. However this sequence can occur multiple times through the night which disturbs normal sleep resulting in non-refreshing sleep. Morning headaches may be reported. Daytime sleepiness, poor concentration and memory problems may ensue. Because sleep is lighter, OSA frequently leads to multiple awakenings through the night to pass urine. Long term, OSA increases the risk of high blood pressure, heart disease, abnormal heart rhythms, stroke, diabetes, depressions and erectile dysfunction. A general anaesthetic can be riskier if untreated OSA is present.
Insomnia
Insomnia is common. It can present as difficulty in initiating sleep or maintaining sleep. It may be caused by another underlying sleep disorder such as sleep apnoea. A stressful life event can precipitate insomnia which sometimes persists for a long time.
CBT-I is recommended as the first-line treatment for chronic insomnia in adults, according to the NICE guidelines.
CBT-I is a multicomponent treatment approach that addresses both mental and physical factors that affect sleep. It is highly effective in the treatment of insomnia, and, unlike medication, it continues to be effective after termination of the sessions. This structured programme will help you identify and replace thoughts and behaviours that cause or worsen sleep problems, with habits that promote sound sleep.
CBT-I is collaborative and requires patient engagement and commitment which will improve efficiency of therapy and equip the individual with lifelong skills to achieve good quality sleep.
Driving Advice
Any condition which causes sleepiness, poor concentration or impaired vigilance needs to be controlled before driving. The DVLA have published guidance related to a number of medical conditions including obstructive sleep apnoea and excessive daytime sleepiness:
View the DVLA SLEEPINESS AND DRIVING GUIDANCE.
At Sleep Doctor we strive to ensure you can drive safely even if you have a sleep problem.
Sleep Hygiene
It’s important to optimise your chance of getting a good night’s sleep by eradicating bad habits and making sure the environment is conducive to sleep.
If possible try to stay close to a regular sleep-wake cycle throughout the week.
• Try to get plenty of bright daylight exposure during the day. This is hard in winter and when working indoors!
• Take regular exercise during the day.
• Avoid caffeine (tea, coffee, cola) for 5 hours before sleep time. Try not to eat your evening meal too late in the evening.
• High alcohol intake will reduce the quality of sleep.
• Blue light from electronic devices such as phones and tablets can switch off melatonin secretion which is the sleep-promoting hormone. Avoid these devices for 1 hour before bed, or use an orange filter.
• Make sure the bedroom is quiet, dark and at the correct temperature, usually on the cooler side.
• Get in to the habit of using your bedroom for sleep and sex only.