Wednesday 25 April 2018

I struggle for breath while asleep. Is it sleep apnoea ?

Try elevating your bedhead by a few inches, or else encourage a more comfortable side-sleeping position by using an orthopaedic pillow
Try elevating your bedhead by a few inches, or else encourage a more comfortable side-sleeping position by using an orthopaedic pillow

Advice from our GP on sleep apnoea and clues on how to identify the culprit of vaginal discharge.

Q. My partner has long commented on how I "give her a fright" when I'm sleeping. I snore which can sometimes be a problem for her, but she has regularly stated that I often stop breathing in my sleep entirely and for very long periods before resuming again, while other times I appear to be struggling for breath. This is considerably worse, apparently, on occasions I have been drinking alcohol. Recently, on mentioning this to a relative, I was told that it might be sleep apnoea. An uncle of mine has been diagnosed with it and sleeps wearing an oxygen mask. This is beginning to worry me. What can you tell me about my symptoms and might it be dangerous? I am a man in my mid-40s.

Dr Nina replies: When we sleep, the muscles in our throat become more floppy. In most people this is not a problem. However, in those with obstructive sleep apnoea (OSA), the muscles are so floppy that they cause the airway to narrow or collapse completely. This blocks off the airway causing breathing to stop (apnoea) or episodes of very shallow breathing (hypopnoea). Classically these episodes cause grunting, gasping or missed breaths during sleep. The afflicted person is unaware but their partner will hear them and may find these episodes frightening. Many will often worry that the next breath may never come.

Reduced airflow leads to a fall in oxygen levels in the blood. The brain responds by increasing the effort to breathe, usually causing the person to gasp, grunt or wake briefly. The person then settles back to sleep and the cycle starts again. We all have occasional episodes of apnoea but if these episodes are occurring more than five times an hour, then OSA is the likely diagnosis. Many people who suffer from OSA are unaware that they are not sleeping well. They don't recall the frequent nocturnal waking but their partners are acutely aware of the problem.

Those with severe OSA may fall asleep during daily activities such as driving or operating machinery; the risk of car crash is increased by 7pc to 12pc. Other symptoms include poor concentration or irritability, morning headaches, unrefreshing sleep and depression.

The recurrent episodes of low oxygen cause increased release of stress hormones. This ultimately puts a strain on the heart leading to an increased risk of high blood pressure, stroke, heart attack, and heart failure. There is also a link between OSA and diabetes.

Risks that increase the chance of OSA include obesity, smoking, drinking alcohol in the evening, taking sedative medication, sleeping on your back and having enlarged tonsils or a receding jaw. The risk increases to about 10pc in those over the age of 65 and there is a familial disposition.

The diagnosis of OSA is confirmed by a sleep study. This involves attending a specialist unit where your sleep is monitored. The amount of apnoeic episodes can be recorded along with levels of oxygen and vital signs. Once a diagnosis is made, the most common treatment is CPAP (continuous positive airway pressure). This involves wearing a special mask at night that is connected to a machine emitting air. This airflow keeps the airway open thus preventing apnoeic episodes. The result can be life transforming.

Lifestyle modification plays a very important role in the treatment of OSA. This condition is most common in those who are overweight. It is essential to lose weight, avoid alcohol for four to six hours before bed, avoid sedatives, sleep on your side (special pillows can help) and stop smoking. It is estimated that 4pc of middle-aged men and 2pc of middle-aged women suffer from this condition.

It sounds like your relation may well be correct. A good first step is a visit to the GP who can examine you and facilitate referral to a sleep centre. There are a number of excellent sleep consultants available.

When it comes to itchy, uncomfortable vaginal discharge, thrush isn’t the only culprit around. Here are some clues to help you identify the cause.

Many women assume they have thrush when faced with uncomfortable vaginal discharge. But thrush isn’t the only cause of these symptoms. Another common cause is bacterial vaginosis. Thrush occurs when a yeast that normally lives in the vagina starts to multiple rapidly. Bacterial vaginosis occurs when the natural balance of vaginal micro-organisms is disrupted. Triggers for both can include antibiotics, menstruation and intercourse.

Both infections cause discharge. Thrush often resembles cottage cheese, being white, thick and curd-like.

Bacterial vaginosis causes a watery discharge which is either clear, creamy or grey. Women often report that their underwear feels wet with it. Thrush discharge doesn’t usually have an odour, whereas bacterial vaginosis can cause a very unpleasant fishy smell. Thrush nearly always causes itching. This is less common in bacterial vaginosis, but can occur in up to 50pc of those affected.

The best way to diagnose the infection is to visit your GP. A vaginal swab confirms the diagnosis. Thrush is usually easily treated with over-the-counter creams and vaginal pessaries, while bacterial vaginosis requires a prescription antibiotic. Treating a sexual partner may also be prudent if you have thrush as this can transfer by direct contact.

The organisms that cause bacterial vaginosis cannot live outside the vagina and so this infection does not transmit to sexual partners. In order to avoid both infections, cleanse with unperfumed gentle cleansers. Don’t use vaginal douches or washes. Change pads and tampons frequently and consider taking probiotics when on a course of oral antibiotic treatment.

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