Sleep Apnoea on TalkSPORT Radio

Here is an excerpt of a recent radio interview with RealSleep Clinical Nurse Specialist Beccy Mullins on the Duncan Barkes show on TalkSPORT. Interview date - 9th Feb 2011.

Here is a text transcript of the interview:

Duncan:
It is Talksport. I'm Duncan Barkes. As we head from Wednesday night into Thursday morning, thank you very much for tuning us in, wherever you might be around the United Kingdom. Something that's relevant to a lot of blokes listening to this radio show, at this precise moment in time, is something called obstructive sleep apnoea. It's believed that it's particularly prevalent in middle-aged men.

Onset is most common between the ages of 35 and 54.That's a hell of a lot of us listening right now, including this bloke who's talking to you, wherever you might be in the United Kingdom. I'm wanting to find out more about this, because it does have some very serious consequences if you do have this particular condition. Rebecca Mullins is the Clinical Nurse Specialist at a business called ResMed, and she joins me on Talksport. Rebecca, welcome.

Rebecca:
Hi, Duncan.

Duncan:
I suppose the obvious question; obstructive sleep apnoea. There'll be some people listening to this who may have heard it floating around in the past, but not have too much of an idea to the background, or what it actually is. Give us the benefit of your knowledge, please.

Rebecca:
Okay. Well, obstructive sleep apnoea is a really prevalent condition, but unfortunately, it's not highly diagnosed.

Duncan:
Right.

Rebecca:
It affects about 2-4% of the adult population, which is similar numbers to that of diabetes. Someone who's actually got sleep apnoea will often experience symptoms such as snoring, along with-characterised by pauses in breathing while they're sleeping. This actually happens because the airway starts to narrow during the night, and it's followed by a collapse of the airway.

It can happen between 5 and 100 times an hour, and these pauses can be anything from 10 seconds to over a minute long. The disturbances in their sleep, these pauses in their breathing, actually cause disturbances during their sleep, so they have symptoms such as excessive daytime sleepiness.

Duncan:
Okay.

Rebecca:
They have poor concentration levels; they wake feeling unrefreshed. Have morning headaches. What actually happens during the night: as the airway starts to narrow, it causes a decrease in their oxygen levels, which causes their brain to wake, so they open their airway again and start to breathe. So the sleeper doesn't actually ever have sufficient deep, refreshing sleep.

Duncan:
All right. So you're not getting the-to use it in layman's terms-you're not getting the decent amount of quality kip that you need to get to actually be refreshed, and fully concentrate, the next day, yes?

Rebecca:
That's right, yes. The sleep disturbances they have-it's often characterised-they have snoring. And often the sleeper is totally unaware that the condition even exists, so the partner's actually disturbed-the bed partner's disturbed by the snoring, and actually, usually is the one who notices these pauses in breathing. It can be quite scary.

Duncan:
And you're so right-you're so right, because I've got a friend who has got this, and it was his wife who picked up on it. And without trying to over-egg the pudding here, she was so frightened, because at some points, it was almost like he'd stopped breathing, in the middle of the night. And she said, "Look-"

Rebecca:
That's exactly what happens.

Duncan:
Yes. She said, "Look, this is not normal. You've got to get it checked out.” And he was diagnosed with obstructive sleep apnoea. So, I mean-what I'm interested about-something you said at the beginning of our conversation, Rebecca: that's it's not highly diagnosed. Why would that be?

Rebecca:
GPs generally-they're not highly educated. It's not their fault, but when they go to medical school, they don't have much on sleep medicine, unfortunately. So they're not aware of sleep apnoea, and quite often, when these people go along to the GP, they're presenting with symptoms which are similar to that of diabetes, depression; and quite often, patients with sleep apnoea will be overweight.

So they're sent away to try to lose some weight, tested for diabetes-which quite often, they will have, because of the increased weight-and so the GP doesn't actually recognise the symptoms of sleep apnoea. So it's quite important that the sufferer goes along with some information about the condition, and points out to the GP they feel they may have it.

Duncan:
Hence your awareness campaign, because the last thing you want is someone being-I suppose-misdiagnosed.

Rebecca:
Absolutely. You know, I've been in sleep medicine, now, as a nurse, for over 14 years. And I've seen many patients that have gone to their GP numerous times; been told to lose weight, treated for depression. And it takes a little while before the GP picks up and refers them to a sleep specialist for a diagnosis of sleep apnoea.

The worrying thing, as well, is that research has now shown that in patients who are left untreated, sleep apnoea can cause things such as heart disease, which increases the risk of stroke; high blood pressure. There's also links to diabetes; these are really strong links. And once they're treated, these conditions can actually improve with the treatment for sleep apnoea.

Duncan:
One of the reasons I wanted to get you on, apart from the fact that I think this needs to be-there needs to be more awareness of this particular condition, is that I'm reading here that obstructive sleep apnoea contributes to around 20% of all road traffic accidents.

Now, you might not know this, but overnight listenership here at Talksport is made up of hundreds of thousands of different kinds of people, but one of the chunks, if you like, of those hundreds of thousands, are drivers: people who drive through the night as truckers, or courier drivers, or whatever. And I mean-20% of all road traffic accidents being caused, potentially, by this condition. One in five; I mean, that is a startling statistic.

Rebecca:
Yes. Yes-it's-you're quite right with the statistic there. Road traffic accidents are common with those with sleep apnoea, because they have disturbed sleep, so they have poor concentration levels, and they have this increased sleepiness level by day, because they're not being treated. So they're at high-risk, and obviously, the consequences of a road traffic accident are horrendous. So it's another reason for these drivers to actually go out and get treated. There's a bit of a misconception that some of your drivers may have heard about: if they're aware of sleep apnoea, that you lose your driving licence if you're diagnosed with sleep apnoea. It's completely untrue.

Duncan:
Really?

Rebecca:
If you get treated, and you're compliant with your treatment, your licence will remain with you, and there's absolutely no issue with it at all. The DVLA do have a regulation for anyone; for you, for me-if we're sleepy, we shouldn't drive. If you're diagnosed with sleep apnoea, you simply inform the DVLA, who contact your consultant, who says, "Yes, being treated; daytime symptoms are controlled.” And your licence remains effective.

Duncan:
Do you know, I'm so glad you pointed that out, because I was under the impression that if you did have this; you might actually lose your ability to drive. So it's great that you've pointed that out, and that will be of great comfort to many of my listeners.

Rebecca:
Yes. It's really important to get that message across; that the consequences of being untreated far outweigh the treatment. The treatment itself can actually be life-changing, and improve their quality of life. And they won't lose their driving licence, if they're compliant with treatment.

Duncan:
Okay. Just so we don't leave anyone in any doubt this morning about the kind of things they need to look out for here, we're talking about snoring, but I'm guessing pretty excessive snoring as an indicator, here. Also, excessive daytime sleepiness. We're not talking about feeling a bit knackered, but I guess we're talking about people thinking that they could literally just, at any moment, curl up into a ball and sleep for a couple of hours. Is that right?

Rebecca:
Absolutely. It would be someone who snores quite severely, and snores most nights. And quite often, these patients are overweight, although that's not always the case. But usually, they're overweight, and the common patient that we would see would be a middle-aged male, overweight, whose neck size is more than 17 inches; daytime sleepiness, snoring. Those are the classic symptoms.

And if someone wants to read more about it; thinks they may have symptoms of sleep apnoea, if they go to the website www.osauk.org, they'll actually find a list of symptoms; how the other disorders can affect it, such as heart disease, diabetes, and what they should do about it. And there's information there they can print off, and they can take it to their GP, if they feel that they may be at risk. There's actually a sleepiness score that they can fill in to see how sleepy they actually are, and whether they're at risk of sleep apnoea.

Duncan:
You mention treatment; when we talk about treatment, what does it actually entail?

Rebecca:
Treatment is really simply. It's actually what we call CPAP, which stands for Continuous Positive Airway Pressure, and it involves wearing a small mask at night, whilst you're sleeping, and it's attached to a small, quiet blower unit, which delivers air to the person sleeping, at a set pressure.

And this air acts as a splint to hold the airway open, which allows the sleeper to sleep peacefully; restfully, and awake in the morning feeling refreshed. And quite a number of patients actually feel immediate benefit from this treatment. And if not, then they usually feel it over a course of weeks. And it can absolutely, dramatically, improve their quality of life, and improve other health issues.

Duncan:
So that's the treatment. Is there a cure, or does it go hand in hand with the fact that what you need to do is have the treatment, but also look at some of the contributing factors towards having this condition, which is maybe lose a bit of weight?

Rebecca:
Unfortunately, there's not a cure for sleep apnoea. The CPAP is gold-standard treatment. But sometimes, patients can look at their lifestyle-make some lifestyle changes. If they look at weight loss, that can sometimes decrease the severity, so that they don't need to have treatment. Sometimes alcohol and sedatives-they can affect the severity of sleep apnoea, and smoking also does. So, if they address lifestyle changes, they can sometimes decrease the severity of the condition, to perhaps not need treatment.

But obviously, weight loss takes time to do. It's not an overnight solution, so in the meantime, they potentially need to get treated for sleep apnoea, and then start to do the weight loss. It is a bit of a vicious circle, because if you've got disturbed sleep, you actually have-when you're having these disturbances of pauses in breathing-it actually affects one of the hormones which suppresses our appetite, normally. But they don't have that, because of their disturbed sleep, so they actually have increased hunger, and then they crave carbohydrates because they're tired, which is increasing their weight, and increases the severity of the sleep apnoea.

Duncan:
It's the vicious circle, yes.

Rebecca:
Yes, so-need to get treated. Really do, so it's really important that these people go along to their GP and discuss these symptoms. And the potential that they may have it, because the tests are so simple. They go into hospital, and quite often now, the diagnosis for it is a simple sleep study overnight, that can often be carried out by taking the equipment home to do in your own bedroom, which is much more convenient.

Duncan:
Absolutely. Listen, this has been a really informative conversation. I appreciate you coming on the show. I've made a note of the website here: www.osauk.org

www.osauk.org is the website address. Go and have a look at it if you're concerned about some of the things we've been talking about. Rebecca Mullins, Clinical Nurse Specialist for ResMed; thank you for your time here at Talksport. And I wanted to get Rebecca on, and just talk about this obstructive sleep apnoea, particularly when you consider the statistic that it contributes to 20% of all road traffic accidents.

And I know a lot of you guys listening to this; blokes in that kind of like typical common age range of 35-54, or whatever. You drive for a living, or whatever. And if you're feeling a little bit knackered behind the wheel, and I'm talking about excessive sleepiness, it might be worth getting it checked out. It's certainly worth having a look at this website: www.osauk.org

This is Talksport. / END OF AUDIO