Ask an expert about Sleep Apnoea… 

Do you snore loudly and hold your breath during sleep? or just do not sleep well and  are sleepy during daytime? You may have sleep apnoea!.

Put your questions to our expert, consultant respiratory physician Dr Himeder Makker. Sleep apnoea is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing.  The result? Loud snoring and excessive tiredness which can have a huge impact on all aspects of life.  Dr Makker established the sleep service at University College Hospital where he continues to run weekly sleep clinics.  Dr Makker is involved in extensive research into sleep apnoea and as a recognised expert in the field, organises study days for other healthcare professionals.

Below is a transcript for the web chat.

2:13 UCLH: 
Good afternoon and welcome to our web chat. We will begin at 2.30pm but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 2.30pm.

Dr Himeder Makker will be joining us to take your questions on ‘Sleep Apnoea’ and will try to answer as many questions as possible within the hour long web chat.
2:27 [Comment From Guest: ] 
Does this exclude slightly loud (but louder than breathing)snoring?
2:28 Dr Himeder Makker: 
Dear Guest
Many thanks
Snoring is not sleep apnoea but a precursor of sleep apnoea- almost all obstructive sleep apnoea patient snore but not all snorers have sleep apnoea
2:28 [Comment From Guest: ] 
How is it that some people can hear themselves snoring (and wake up)? Could this be as a result of sleep apnoea?
2:28 Dr Himeder Makker: 
Dear Guest
Many thanks
Some people can hear them snore as they are just going off to sleep –when there are in light sleep-other can hear them snore even in deeper stage of sleep if they snore extremely loud- snoring sound can reach up to 100db rock concert.
People who snore extremely loud and snore every night are more likely to have obstructive sleep apnoea (OSA).
2:34 [Comment From Petra: ] 
what can one do about it if one doesn't sleep well and gets sleepy during the daytime, including falling asleep in any room where oxygen is short in supply
2:35 Dr Himeder Makker: 
Dear Petra
Many thanks Petra- you should see your GP to know why one does not sleep well. Is it due to gasping or choking during sleep? which is usually due to obstructive sleep apnoea, or just cannot fall asleep or wake up and cannot go to sleep?- which may be due to insomnia usually related to psychological problems or one moves too much during sleep or kick legs? –which is due to periodic limb movement syndrome. And there are many other reasons for not able to sleep well. Anything which affects one’s sleep quality or duration will make one sleepy and tired during sleep. We all need 7 to 8 hours of good quality sleep to function well during daytime.
2:41 [Comment From Melanie: ] 
Does alcohol make this worse? My husband sleeps v badly and snores after he has had even a tiny glass of wine.
2:42 Dr Himeder Makker: 
Dear Melanie
Many thanks. Alcohol –particularly excessive alcohol more than two units can make normal people snore and people who snore make them snore louder and people who snore loud develop apnoea. Alcohol worsens snoring and causes apnoea through its muscle relaxation effect. Avoidance of alcohol late in evening before going to sleep can reduce snoring and apnoea
2:47 [Comment From Phillip: ] 
What does it mean if on several occasions throughout the year you wake up struggling for breathe with what feels like a small amount of vomit in your throat? This has happened to me on a umber of occasoins although usually when I have eaten later than normal.
2:48 Dr Himeder Makker: 
Dear Phillip
Many thanks. This may be due to gastro oesophageal reflux. Some people particularly who have hiatus hernia cannot hold their stomach content from moving back to gullet when they lie flat for sleep and stomach content travel up from gullet to back of throat –stomach contents are usually acidic and bitter and irritate throat and voice box and make one wake up coughing and not able to breath
2:49 [Comment From Guest: ] 
Can you really function on four hours sleep?
2:50 Dr Himeder Makker: 
Dear Guest
Many thanks. Yes perhaps for few days to week but soon you will need to catch up with sleep loss and sleep for 9 to 10 hours for few night -not a good ideas overall. Margaret Thatcher needed four of sleep is just a myth
2:52 [Comment From Sallie: ] 
Does this effect children? My five year old constantly snuffles and has interupted sleep
2:53 Dr Himeder Makker: 
Many thanks Sallie
Yes, children can also have obstructive sleep apnoea-usually its tends to due be large tonsils and adenoids. ENT examination is useful
2:58 [Comment From Guest: ] 
Does SA have the potential to cause death? I took the test online (Epsworth: 17/24, Berlin: 2, general: 7) and was advised to seek professional help asap. However, I am reluctant to waste the GP's time if this could be resolved by using something like Rhinyl.
2:58 Dr Himeder Makker: 
Dear Guest
Many thanks
Yes, patients with untreated severe obstructive apnoea are at twice the risk of death from cardiovascular problems than patients without sleep apnoea.
You have excessive daytime sleepiness and obstructive sleep apnoea is one of the most common causes of EDS. You must see you GP and will not be wasting his or your time
3:08 [Comment From Peter: ] 
do you clinically manage patients with narcolepsy? do you prescribe sodium oxybate is central sleep apnoea different from other types and if so how?
3:08 Dr Himeder Makker: 
Dear Peter
Many thanks. I am a respiratory physician and mainly manage obstructive sleep apnoea but we have UCLH Sleep Group-that consists of neurologist who manages problems like narcolepsy- in fact one of my neurologist colleague Professor Mathew Walker is world expert in narcolepsy. I am sure he will be able to advise you on management of narcolepsy. Other members of the sleep group are psychiatrist who manages insomnia and ENT surgeon who is able to help some patients with sleep apnoea and snoring.
I am sure about sodium oxybate about central sleep apnoea but my colleagues certainly use it for a few problematic patients with narcolepsy.
3:10 Dr Himeder Makker: 
Dear Peter
Please find link for Professor Mathew Walker
3:16 Dr Himeder Makker: 
These are the different sleep services at UCLH:
3:19 Dr Himeder Makker: 
We have been running UCLH Sleep Medicine one day course for to raise awareness about different type of sleep disorders among health professionals for last few years. Our next UCLH Sleep Medicine Course is on 3rd March 2016. It will be advertised soon
3:21 Dr Himeder Makker: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

3:22 [Comment From Guest: ] 
Thanks Dr Makker. (My question seems to be lost so I am re-writing) Do people ever get to a point where they can stop using equipment (e.g. CPAP) or do they have to use them permanently in order to maintain control of SA?
3:25 Dr Himeder Makker: 
Many thanks Guest
Yes a few patients get to point where they can come off CPAP. This mainly through weigh loss - reduction in body weight by 10% can reduce your sleep apnoea by one third. Many patient with OSA come off CPAP after they lose weight following bariatric surgery.
3:25 [Comment From Emma Szelepet: ] 
Dear Dr Makker, Thank you very much for really helpful answers thus far. Does lack of sleep increase a person's vulnerability to serious illnesses such as cancer and dementia? Is it the quality of sleep, the length, or both, that matter? Very many thanks
3:29 Dr Himeder Makker: 
Many thanks Emma
Recent long term studies have shown a higher risk of cancer and cancer related deaths in patients with untreated severe obstructive sleep apnoea. We do not understand the reasons for that but it is thought to be due to chronic lack of oxygen and inflammation as a results of sleep apnoea.
Sleep apnoea impaires finer brain function such as concentration, and memory and can contribute to dementia.
Sleep quality is key- slow wave deep sleep and dream sleep are essential for restoring brain and body

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