Members’ Questions & Answers

Welcome to the Members’ Questions section of our web site. We know that each patient and family member has their own issues with the condition, its treatment, and the effects on their lifestyle. The replies come from our team of medical experts and trusted sources and we hope you find them useful.

The answers should be taken as informative rather than authoritative. Patients should always direct any medical questions they may have about their condition to their own clinician.

We have organised the answers by area of interest. Use the links below to go to the subject of interest.

About Sleep Apnoea
Air Travel
Using CPAP
Hospitals
Humidifiers
Medical
OSA and other Conditions
Other Treatments
Sleep Clinics
Bloating (Aerophagia)
Restless Legs Syndrome

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About Sleep Apnoea

Sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and can happen many times a night. There are four main types of sleep apnoea:

  1. Obstructive Sleep Apnoea (OSA) – is a respiratory illness and the most common type, where the upper airway is narrow or has become blocked due to being obese or overweight
  2. Central Sleep Apnoea (CSA) is an uncommon neurological illness, where the brain does not signal the respiratory muscles to breathe.
  3. Mixed Sleep Apnoea is a combination of OSA and CSA.
  4. Obesity Hypoventilation.
  1. Obstructive Sleep Apnoea (OSA).

People with Obstructive Sleep Apnoea (OSA) are unable to sleep properly. Their sleep is constantly disrupted by snoring and obstructed breathing to the extent that they briefly stop breathing. This can happen several hundred times each night. Sufferers often fall asleep during the day even whilst working or driving.

OSA is caused by excessive narrowing of the throat during sleep. Anything that makes the throat narrower to start with (for example enlarged tonsils or a set-back lower jaw) means that it is easy for the throat to close off a bit more and block the airway. A partially blocked nose generates lower pressures in the throat whilst taking a breath in, which tends to suck the walls of the throat together.

For the majority of sufferers, the most important factor is being overweight with a big neck. Extra fat in the neck squashes the throat from outside, particularly when the throat muscles become floppier with sleep.

  1. Central Sleep Apnoea (CSA)

Central Sleep Apnoea (CSA) differs from OSA in that while your breathing stops and eventually restarts, the brain signalling you to breathe again due to low oxygen levels should occur—BUT DOES NOT. With CSA the signal from the brain to breathe is either not sent or not received. The incidence of CSA is far lower that OSA and is thought to be around one in two thousand of the adult population. In very, very simple terms, OSA is a mechanical blockage treated by increasing air pressure to overcome the blockage while CSA is an electrical fault, where the connection between the brain and the breathing muscles is faulty, possibly in the brainstem.

  1. Mixed Sleep Apnoea

Mixed sleep apnoea, the third type, is a combination of central and obstructive factors occurring in the same episode of sleep apnoea. Episodes of mixed sleep apnoea most often begin as obstructive apnoeas and are treated as such, but the standard treatment, a CPAP device, does not reduce the stop breathing episodes to around 5 or below.

  1. Obesity Hypoventilation (Also known as Pickwickian Syndrome)

Obesity hypoventilation syndrome is a breathing disorder that affects some people who have been diagnosed with obesity. The syndrome causes you to have too much carbon dioxide and too little oxygen in your blood. Without treatment it can lead to serious and even life-threatening health problems. It is commonly associated with obese people who also suffer from obstructive sleep apnoea

Because sleep can be so disrupted by the body having to wake up briefly to reverse the upper airway obstruction, sufferers experience severe daytime sleepiness. To start with this occurs only during potentially boring activities such as reading, watching television or driving on motorways. However, when the sleepiness gets worse it begins to interfere with most activities, with patients falling asleep talking or eating. Poor work performance can lose the sufferer his job and of course sleepiness whilst driving can be fatal (sleep apnoea sufferers are about seven times more likely to have car accidents). Snoring will usually have been present for many years, and have gone well beyond a joke within the family.

There are many other symptoms that one would predict in someone seriously sleep deprived (irritability for example) but the twin symptoms of snoring and excessive sleepiness during waking hours are the best pointers to the diagnosis.

It is estimated that up to 13% of adult men (20 to 70) and 6% of adult women (20 to 70) in the UK suffer from Obstructive Sleep Apnoea (OSA).  That is 4 million people.  They are mostly (but not all) men, mostly (but not all) overweight, especially around the neck, and they all snore. They feel tired and sleepy during the day and at night are often observed to stop breathing.

The sort of person we see most commonly with heavy snoring and sleep apnoea is a middle-aged man, usually taking a size 17″ collar or more. However, there are many patients with sleep apnoea who are not particularly overweight. In some patients we simply do not understand why they have sleep apnoea.

Sleep apnoea and heavy snoring, severe enough to interfere with sleep quality, is probably much more common than is realised.

OSA and CHILDREN – If you suspect your child has sleep apnoea, the Great Ormond Street Hospital for Children has excellent information for parents on its website and you can reach it by clicking here.

In children the commonest cause is enlarged tonsils. Nowadays sleep apnoea is a common reason for recommending that a young child has a tonsillectomy.

There are two self-assessment forms you can use.

The first, STOP BANG identifies if there is likelihood you may have obstructive sleep apnoea. If you score is over 3 or over you are at risk of having obstructive sleep apnoea. Take the STOP BANG to your GP and discuss a referral to a Sleep Clinic

Stop Bang Questionnaire Jan 2019

The second, the Epworth Sleepiness Scale (ESS), identifies if you may be suffering from excessive sleepiness during waking hours, a common symptom of a sleep disorder. If your score is 10 or over take the ESS to your GP and discuss referral to a specialist sleep clinic.

Epworth Sleepiness Scale for SATA

Yes there are – these are dealt with in more detail on our Driving and Sleep Apnoea  click here

An explanatory letter from your Sleep Clinic should accompany the machine to show to Customs or Security officials.

Always check the electrical details of the countries you are visiting in advance. Some Sleep Clinics have multi-voltage machines available on loan or hire so please check in plenty of time. Remember, you may need an extra-long extension lead and fuses can also be helpful.

When flying, the CPAP machine must be carried as hand luggage as checked bags can lost and the low temperatures in the hold could cause damage.

For more information about the individual airlines flying out of the UK click here.

If you would like to learn more, contact the Sleep Apnoea Trust direct by clicking here.

Air Travel

CPAPs are fairly common, so much less need these days, but if you have a letter carry it with you. Airport security personnel can be very suspicious, and an official-looking letter can help.

Always take it as hand baggage. The airlines have to  accept it as medical equipment (and therefore hand baggage), some as a free extra, others within basic allowance. Hold baggage could be damaged, left behind or lost, which would be dangerous for the patient. But check with the airline before you fly, not at the gate

Keep your CPAP with you, don’t let it go to the hold. Give them any other carry-on baggage you have, carry a plastic bag or similar just for the CPAP.

Not lead acid, usually not gel-based, usually lithium-ion is OK. Some lithium batteries have caught fire in the past, so airlines are suspicious. There may be a limit on the number, or the energy capacity, of batteries you can take. Talk to the airline before you fly.

This can be subject to an airlines policy on Covid rules and is entirely in the hands of the airlines, some of whom are CPAP-friendly, others are not. Some will allow the use of their main power sockets for CPAP use (with suitable early warning); others the use of seat socket power (for laptops, etc.) Humidifiers need too much power for seat supply, so must be switched off. Other airlines allow battery use from Lithium-Ion batteries. Always check with the airline when you buy the tickets.

Security people are now better-informed, and recognise CPAP machines, but do sometimes test for explosive residue (swab test). Occasionally, in the US, they will set up the machine and start it, to prove it does what it says. CPAPs are not affected by X-ray machines. SATA suggests taking an A5 letter from a GP identifying the unit and what it’s for and having a Medical Equipment bag tag attached to your CPAP bag.

An aircraft pressurised to 9000 feet, although flying at 30,000 feet, would be identical to being up a mountain at 9000 feet. The percentage oxygen remains constant wherever you are, it is simply that as the pressure falls there are less molecules of oxygen around which lowers their partial pressure. Because the performance of a fan is altered by the ambient pressure, some machines are affected more than others, and some even have automatic adjustment up to a certain point. The safest thing is to check with the manufacturer’s specifications.

Using CPAP

YES – you never know where the power point is in a strange place. CPAPs don’t take much power, so 3 amp rated cable is enough. 5 metres is good for home, 10 metres covers most hotels. Don’t forget a loose cable could be a trip hazard, specially in the dark, so try to cover the cable with a towel wherever you might walk over it. Some hotels may provide extension cables with a local plug, but don’t rely on it.

So long as the CPAP machine is operational with a reliable power supply, OSA will be largely controlled. However the performance of a fan is altered by the ambient pressure, so the pressure delivered to the airway may be marginally less than at sea level. Some machines have automatic compensation up to a certain point; others are affected more. It is worth checking the manufacturer’s specifications.

Exposure to altitude can occur either in an aircraft or at elevation on Earth. There are not many cities above 2000 metres. An aircraft is pressurised to 2750 metres, although flying at over 10,000 metres; this would be identical to being up a mountain at 2750 metres. The percentage of oxygen remains constant wherever you are; it is simply that as the pressure falls there are fewer molecules of oxygen around, which lowers their partial pressure.

As soon as you lie down, prepared for sleep. Use the “ramp up” facility if your CPAP has one, and if you feel more comfortable with it. If you can’t sleep, getting up and doing something else until tired often helps.

Preferably, so that it is in operation when going back to sleep. Treat the situation the same as going to sleep for the first time, and use the “ramp up” if it’s more comfortable.

It is important not to over-tighten mask straps because this does not allow the mask cushion to inflate properly, and so increases the chances of a leak. A full-face mask may help. Mask liners can be helpful, though the proprietary liners are expensive, especially as they are supposed to be used once only.

This is a matter of personal preference; some people have problems with mask leakage, and there is a smaller area to seal with nasal pillows. Ask your local sleep clinic to check your mask fit, and if there’s still a problem consider the pillows.

A mucus-producing membrane covers all the respiratory tract, including the lining of the nose. Air blowing in from your nasal pillows can dry this membrane, causing irritation and sometimes cracking. Lightly coating the inside of the nose from a tube of Boots Maternity Lanolin Nipple Cream will prevent the drying, soothe the irritation and reduce any damage. (Other similar products may be available.)

The best way to clean equipment is with a drop of plain washing-up liquid and hand hot water. Under no circumstances should a sterilising solution be used, because this hardens the cushion and makes it ineffective. Nor should liquid hand soap or washing soap be used as they contain emollients, which can also damage the mask cushion.

For tubing, wash once a week in plain washing-up liquid and hand hot water.

Yes, you can wash heated CPAP tubing with mild soap and water and should do so every week. Just don’t soak it, and make sure it’s completely dry before re-attaching it to your CPAP device. You can also try cleaning your CPAP hose with a half and half solution of vinegar and soapy water.

A mask harness with a chin strap helps keep the mouth closed, and allows the CPAP unit to work correctly.

It’s not likely to lead to medical problems. Studies have shown that the head position is critical in determining which way air goes. Sleeping with the head back (the “sniffing the morning air” position) should help. NB If bloating is a problem refer to this section of our Q&As.

Whichever is most comfortable. A slightly higher CPAP pressure may be necessary when sleeping on the back, so if CPAP pressure is a little too low, it may cause slight problems.

Make a DIY Chinstrap – Ladies stretchy fabric headband is just as good for a chinstrap

Use a neck pillow to raise mask from the pillow when lying on your side

To avoid cold air run hose under bed covers to keep air warm. Some CPAP machines come with a heated tube for added comfort

Use a straw to have a drink at night with, or drink from a sports bottle with a nozzle – saves removing mask completely.

Hospitals

Yes you can, and you should definitely take your machine in with you. During the pandemic, circuits were used with a filter over the expiratory port to reduce COVID transmission. However we now know that CPAP is not an aerosol generating procedure, therefore this is probably not necessary. The staff at the hospital will advise regarding what you need to do.

Nurses are not always very familiar regarding the various CPAP machines; take your instruction booklet in with your machine. Always advise hospitals before going in for operations where possible, pre-planning always helps.

No, using CPAP is not a reason to be refused surgery. The anaesthetist will assess all risk factors prior to surgery, and if there is scope to increase safety by making changes prior to surgery, then the surgery may be delayed.

Connectors are available to join CPAP masks and separate oxygen. Should be available automatically, but for pre-planned operations advanced warning is also good.

Doctors doing gastroscopies will use varying amounts of sedation. The more the sedation, the more the problem for somebody with obstructive sleep apnoea. If you are having a gastroscopy take your CPAP machine with you and ask that it be used immediately a gastroscopy has finished, unless it is done without sedation.

Humidifiers

Dry air dries out the nasal passages and airways, because with CPAP more air goes up the nose than the nose is designed to cope with. Nasal pillows can increase the flow even further because the air is channelled through a smaller opening, which accelerates the flow. A humidifier moistens the air to minimise this.

It varies with the seasons, the temperature, and humidity in the atmosphere. In winter (cold, damp air) put the temperature on the humidifier down. If the mouth is dry, increase the temperature on the humidifier. It always depends on the patient – if in doubt, contact your sleep clinic.

New humidifiers have safety cut-outs, and this would operate when the level is too low. There should be enough for 8 hours of sleep at least. An empty humidifier could indicate other problems, the most likely being mask leakage. If in doubt, contact your sleep clinic.

It depends on the machine; and it is best to follow the manufacturer’s instructions, which come with the machine. If in doubt use distilled, purified or filtered water, or cooled pre-boiled water. When necessary, clean the chamber in a hand hot water with a drop of plain washing up liquid and, if it has one, change the water filter.

A humidifier helps to reduce irritation in the nasal passages, which can reduce nasal drip. Noses don’t expect to have to deal with extra air caused by a leakage through the mouth, causing over-drying at night. This leads to nasal stuffiness, sneezing, and sometimes excessive nasal dripping during the day. The humidifier is solving this problem.

Possibly not if sleeping in ambient conditions, but in an air-conditioned hotel room it would still be advisable to use the humidifier.

If you commonly get a dry mouth on waking, or a blocked nose, or sinusitis. It also usefully warms the air inbound. However, the problem could be caused by not properly closing the mouth – try this first.

Not if it’s kept clean – wash in warm soapy water (washing up liquid), dishwasher only if the manufacturer agrees. Use “Pure” water where possible, or cooled boiled water, or distilled but not de-ionised as it can contain bacteria and viruses. Water needs to be clear of lime scale.

Similar to a laptop, but it depends on whether or not you use a humidifier and the hours of use per day.
Based on £0.27 per kWh Oct 2022:
CPAP 4 hours use £24 per year or 8 hours £48 per year
CPAP with humidifier 4 hours use £48 per year or 8 hours £96 per year

If you are on benefits or have a listed medical condition, you may be eligible to apply for the ‘Watersure’ scheme (which caps your water bills) but you should contact your water supplier to see if you are eligible (you may need confirmation of your condition from your doctor).

NHS England state that water that is boiled in the kettle and left to go cold is perfectly acceptable.

If you are on benefits or have a listed medical condition, you may be eligible to apply for the ‘Watersure’ scheme (which caps your water bills) but you should contact your water supplier to see if you are eligible (you may need confirmation of your condition from your doctor).

To descale your humidifier, use 50% boiled water & 50% distilled vinegar – scale dissolves in mild acid after a while. Also works with lemon or lime juice, and Cola

Medical

It’s not likely to lead to medical problems. Studies have shown that the head position is critical in determining which way air goes. Sleeping with the head back (the “sniffing the morning air” position) should help.

Whichever is most comfortable. A slightly higher CPAP pressure may be necessary when sleeping on the back, so if CPAP pressure is a little too low, it may cause slight problems.

No, intermittent hypoxia due to OSA does not cause cancer.

No, being a CPAP user is not a reason to have an automatic flu jab. However there may be other reasons, like being of older age or obese.

No. If you get a cold or flu, use either Otrivine™ or Vicks Sinex™ to dry the nose for clear breathing, BUT only for a few days. With a really heavy cold it is not always possible to cope with CPAP, and it may be necessary to go without if for a day or two.

Mandibular advancement may work and can be available on the NHS depending on your local Hospital. But if you have to be treated privately it can be very expensive it’s a risk before you know it works. There are simple ones to see if you can tolerate such a device. Using a CPAP also moves the tongue forward.

Some people can’t accept a CPAP psychologically, with its restrictions. Technically, it treats the large majority of cases well when used.

Not all snorers have OSA of course. GP awareness of OSA is generally low but getting better.

Everyone is different, with a range of 7 to 9 hours. The quality of sleep is as important; people with untreated OSA tend to go for quantity, since they don’t get the quality. Treatment improves the quality, so needing less, but around 7 hours should be a minimum.

Optimal adherence to CPAP therapy is conventionally considered to be 4 hours or more per night or using CPAP for an average of more than 4 hours per night for 70% or more nights. Early adherence studies focused on control of sleepiness but there is evidence that increased CPAP use of more than 5 hours a night in OSAHS benefits other aspects of health such as control of blood pressure and cardiovascular risk. However, it is recognised that people can gain some benefit from a shorter period of use, and individual response is variable. People should be encouraged to maximise their CPAP use to achieve optimal control of their symptoms, underlying conditions, sleep quality and quality of life.

It depends on how much you need to lose. Some patients losing a lot of weight (50kg) by bariatric surgery are cured of OSA. Yes, it’s possible.

You would get OSA when unconscious if you have it asleep. Being put in the recovery position will help to open the airway. That is why we recommend getting a Medical Alert card or wearing a wrist band.

Yes it does – it’s more likely that a sleep-deprived person fails to take the memory in, and therefore can’t remember it, not that he forgets it.

Variable by region and staffing, sadly. Some examples: – 6 weeks (but 2-day fast track); 3 months; 4-6 weeks; 12 weeks for diagnosis then treatment 1 week. The NHS standard is 18 weeks. With the current temporary global CPAP shortage, waiting times can be much longer and even up to a year.

With the current shortage the make of machine will vary. Typically they will include, DeVilbiss, Fisher & Paykel, Lowenstein, Philips, ResMed and Sefam that will meet the NHS standards. Most will have a variety of masks to improve patient acceptance.

Usually the Sleep Clinic at the hospital based on their clinical requirements and the NHS standards.

It can be – if you’re always tired it can lead to depression. Mood tends to improve after treatment.

If you can stay awake, sedation in dentistry is not a problem. Afterwards, if there are traces of sedation left and you are likely to nod off, make sure to use your CPAP.

Yes, some risk factors can be inherited such as jaw shape or a propensity to be over-weight.

No, no evidence that it helps with CPAP usage.

Motor neurone disease causes degeneration of muscles, including the breathing muscles. This leads to under breathing, particularly at night, and a fall in oxygen levels, and rising carbon dioxide levels. If a patient is given oxygen this may fool the patient’s breathing control centre into breathing less and allow carbon dioxide levels to rise even further which make you feel awful with a headache.

No – OSA only affects the upper airway, the diaphragm is not involved, so no benefit.

Low thyroid certainly is a potential cause of OSA and sometimes the way it presents. Treating the low thyroid with tablets of thyroid often solves the problem but the sleep apnoea does not always fully recover, and may remain due to the weight gain that often goes with a low thyroid.

There are two small studies, one using the didgeridoo and one using speech therapy, to suggest that upper airway muscle training may slightly improve sleep apnoea. One has to spend over an hour a day trying to exercise these muscles and certainly it does not cure sleep apnoea. Training other neck muscles, such as through weight lifting, actually increases sleep apnoea as these muscles become a dead weight on the throat when asleep.

The problem is in the back of the throat not the nose so that dilating the nose rarely helps. In fact most operations on the back of the throat, apart from tonsillectomy, do not really help sleep apnoea.

Interesting question, worth looking again at study results. 14 cm is quite a high setting anyway. No single pressure is best for a patient, a range of pressures is also fine.  Autoset does save nurse time with patients, and simplifies follow-up.

Doctors doing gastroscopies will use varying amounts of sedation. The more the sedation, the more the problem for somebody with obstructive sleep apnoea. If you are having a gastroscopy, take your CPAP machine with you and ask that it be used immediately the gastroscopy has finished, unless it is done without sedation.

Obstructive sleep apnoea causes lots of variation in BP during the actual obstructive sleep apnoea. It is not clear how damaging these are but they are cured by using CPAP. In addition those with untreated sleep apnoea tend to have slightly higher blood pressures during the day but this is quite variable.

Probably not. Difficult to see how training muscles during the day would help a situation at night.

Laser simply acts like a knife, although the laser seals the cut. The evidence is not there to support the effectiveness of laser scarring of the throat.

Tiredness from medications can add together with tiredness/ sleepiness from obstructive sleep apnoea and aggravate the symptoms.

There is some evidence that some heart related problems improve once CPAP treatment is started, others stay the same. Nothing to suggest heart conditions worsen as a result of CPAP treatment.

A chin strap can help to keep the mouth closed; switching to a full-face mask might  be better.

OSA is rarely put as a cause of death, or noted as an existing problem on the death certificate as most people who die with it are older and the causes are other things such as cancers, stroke etc. It would be worth doing some research into maybe having SA put on the death certificate as an existing medical condition .

Very interesting points, and am talking to the NHS. Can get information scanning live patients at the moment, which is not perfect, as you can tell where the blood supply is but not the cells. There is a need to study patients while they are alive and after they die, but thanks to CPAP, most OSA patients live a long time.

The presence of obstructive sleep apnoea is likely to be listed rather than the treatment with CPAP.

Numbers of studies have been undertaken in recent years to determine if there is any association between OSA and cancer. Reviewers note that the situation is not clear. Some studies reported increased incidence of cancer in groups of OSA patients, others did not. Their conclusion is that, although most studies indicate that OSA may increase cancer risk, firm evidence is lacking and further studies are required. (Sleep Matters Aug 2019). It may well be obesity rather than OSA that is the risk factor.

Yes, because the fatty deposits on the inside of the pharynx contribute to the syndrome. In studies there is no doubt that in many cases, weight loss improves the sleep apnoea.

Asthma is not caused by sleep apnoea but evidence suggests that patients with asthma and sleep apnoea have poorer control of their asthma.

Yes, some risk factors can be inherited such as jaw shape or a propensity to be over-weight. Sleep Apnoea is undoubtedly influenced by body weight. Appetite and the laws of thermodynamics conspire so if energy in exceeds energy out, then you put on weight. In general there are no hard and fast rules but weight loss generally improves things. Appetite has a much greater influence on weight than the subtle differences in which human bodies handle energy.

There is no evidence whatsoever to link OSA to this disease. But there is some research going on in the older population to see if OSA is linked to excessive memory loss (an entirely different affliction).

No single person is the same as another and there is a wide range of treatments for sleep apnoea. However, 95% of people diagnosed with OSA are successfully treated with CPAP and this simple treatment keeps the airways open. A full face mask only helps if you breath with your mouth open, and there is no evidence that just improving nasal patency cures sleep apnoea.

A lot of children have OSA due to enlarged tonsils and this often leads to them being mouth breathers. This mouth breathing may lead to underdevelopment of the lower jaw and contribute to OSA in later life; tonsillectomy and resolution of mouth breathing should prevent this.

OSA and other Conditions

Low thyroid certainly is a potential cause of OSA and sometimes the way it presents. Treating the low thyroid with tablets of thyroid often solves that problem, but the sleep apnoea does not always fully recover, and may remain due to the weight gain that often goes with a low thyroid.

Obstructive sleep apnoea causes lots of variation in BP during the actual obstructive sleep apnoea. It is not clear how damaging these are but they are cured by using CPAP. In addition those with untreated sleep apnoea tend to have slightly higher blood pressures during the day, but this is quite variable.

A really heavy cold with a blocked nose may make CPAP treatment more difficult, but the use of Otrivine (a decongestant) may help. Though Otrivine should not be used on a regular and continuous basis, its use for two or three days during the peak of a cold is useful and justified.

Yes, because the fatty deposits on the inside of the pharynx contribute to the syndrome. In studies there is no doubt that in many cases, weight loss improves the sleep apnoea. Neck size is sometimes taken as an indicator of the likelihood of having OSA.

Asthma is not caused by sleep apnoea, but evidence suggests that patients with asthma and sleep apnoea have poorer control of their asthma.

There is no evidence whatsoever to link OSA to this disease. There is, however, some research going on in the older population to see if OSA is linked to excessive memory loss (an entirely different affliction).

A lot of children have OSA due to enlarged tonsils and this often leads to them being mouth breathers. This mouth breathing may lead to underdevelopment of the lower jaw and contribute to OSA in later life. Tonsillectomy and resolution of mouth breathing and nasal blockage may eventually lead to the abnormal jaw development correcting itself. Heavy snoring in young children is not normal.

Other Treatments

No- OSA only affects the upper airway, the diaphragm is not involved, so no benefit.

There are two small studies, one using the didgeridoo and one using speech therapy, to suggest that upper airway muscle training may slightly improve sleep apnoea. One has to spend over an hour a day trying to exercise these muscles and certainly it does not cure sleep apnoea. Training other neck muscles, such as through weight lifting, actually increases sleep apnoea as these muscles become a dead weight on the throat when asleep.

The problem is in the back of the throat, not the nose, so that dilating the nose rarely helps. In fact most operations on the back of the throat, apart from tonsillectomy, do not really help sleep apnoea.

There is very little hard data available. Sleep apnoea is undoubtedly influenced by body weight. Appetite and the laws of thermodynamics conspire so if energy in exceeds energy out, then you put on weight. In general there are no hard and fast rules but weight loss generally improves things. Appetite has a much greater influence on weight than the subtle differences in which human bodies handle energy.

Sleep Clinics

This varies widely between Health areas. Manufacturers say that current machines need no significant maintenance in a 7-year life span. If you have telemonitoring, your CPAP usage data is transmitted to the Sleep Clinic, and the duration of transmission varies. The sleep centre will usually not be checking your data outside of appointment times. Other options such as filter changes can be done by the patient. If you do not have telemonitoring then a simple download of patient data from the CPAP machine to a pressure check with mask fit and filters can be done by the Sleep Clinic.

Due to improved technology, telemonitoring and budgetary constraints, routine follow up appointments have not been available for some years, though patients are always able to get appointments for mask fit or other problems.

A prescription is necessary to purchase a CPAP privately. Though Sleep Clinics would not maintain a second, privately-owned CPAP, some assistance, e.g. with setting pressure etc, might be available.

Bloating (Aerophagia)

Some CPAP users experience bloating, medically described as aerophagia. This occurs when air from a CPAP enters the oesophagus and goes into the stomach area, rather than the airway and into the lungs. This can cause gas pains and distension of the stomach. It is common and can happen to anyone who uses CPAP. But when it becomes chronic, it is serious as it may prevent you from receiving the full benefits of CPAP. It is a symptom that can be overcome when the cause is properly determined.

There are many possible causes and solutions.

  • Your CPAP pressure may be higher than you require. The extra air has nowhere else to go so it flows into to the oesophagus and then the stomach. If you suspect your CPAP machine air pressure might be excessive discuss a pressure change with your Sleep Clinic.
  • Your pressure may be too low and inadequate to resolve your apnoea (paused breathing) event. To get more air into your lungs, you gulp air in quickly and it is forced into the oesophagus instead. If you suspect your CPAP machine air pressure might be inadequate discuss a pressure change with your Sleep Clinic.
  • You may have nasal congestion from a cold, flu or allergies. When your nose is stuffy, you may not be able to receive the CPAP air pressure you need, so you gulp air by mouth and down into the oesophagus and stomach. Discuss this with your Sleep Clinic.
  • You may be a mouth breather, who is wearing a traditional nasal mask or nasal pillows. As your mouth falls open during sleep, the air that is delivered by CPAP and intended to enter the lungs may instead, escape through your mouth. Your apnoea (paused breathing) events are not being resolved and in your unconscious panic to breathe, you may suddenly have a choking sensation and gulp air in quickly, forcing it into the oesophagus and stomach. Consider if the mask you are using is the best choice.
  • Your mask may not be the best size or style suited for your face. If you experience frequent mask leak, or pressure point soreness from over tightening straps to eliminate leak, consider choosing a different mask. suited for your face. If you experience frequent mask leak, or pressure point soreness from over tightening straps to eliminate leak, consider choosing a different mask.
  • Make sure you know how to properly fit and adjust your mask for best seal. After you have chosen the best mask size and style for your face, you must adjust it properly before sleep. Sit on your bed, turn the machine on, and place mask on your face with straps loose. Lay down in your sleeping position with your head on your pillow as you would normally sleep. Slowly pull the straps JUST UNTIL you get a good seal. If your mask has a dual cushion, it will need to be “seated.” After you have fitted and adjusted your mask using the steps above, to “seat,” gently pull the mask straight out and away from your face to allow the dual cushions to inflate properly. Lay the mask gently back onto your face. You should know, by feel, that a good comfortable seal is achieved.
  • You may be having difficulty learning and adjusting to exhale (breathe out) over the constant pressure of the air delivered by CPAP. This is especially difficult for those patients on mid- to high-CPAP pressures. Inhalation of high pressures may be easy, but exhaling may cause anxiety, panic and a feeling of suffocation or choking. When this occurs, the patient may fall out of the natural rhythm of breathing and hyperventilation (excessive breathing) may occur. This can result in a quick sucking in or gulping of air, and that air may be forced into the oesophagus and stomach rather than the lungs. Expiratory Pressure Relief (EPR) features are available on most CPAP machines today. Depending on machine brand, EPR may be called CFLEX, AFLEX or BIFLEX This feature automatically reduces air pressure upon exhalation and can help reduce or eliminate aerophagia. Contact your Sleep Clinic to get it set on your machine. It can be a patient controlled feature, so ask to be shown how to use it.
  • If you suspect your aerophagia is the result of hyperventilation caused from anxiety, consult your Sleep Clinic.
  • Learning the cause of aerophagia is key to resolving it. As always, discuss this issue with your Sleep Clinic to help determine your causes and resolutions.

Restless Legs Syndrome (RLS)/Periodic Limb Movement (PLM)

Symptoms of restless legs syndrome (also known as Willis-Ekbom disease)

The main symptom of restless legs syndrome is an overwhelming urge to move your legs. It can also cause an unpleasant crawling or creeping sensation in the feet, calves and thighs. The sensation is often worse in the evening or at night. Occasionally, the arms are affected, too. Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements (PLM). Some people have the symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a person’s daily activities.

What causes restless legs syndrome?

In the majority of cases, there’s no obvious cause of restless legs syndrome. This is known as idiopathic or primary restless legs syndrome, and it can run in families. Some neurologists (specialists in treating conditions that affect the nervous system) believe the symptoms of restless legs syndrome may have something to do with how the body handles a chemical called dopamine. Dopamine is involved in controlling muscle movement and may be responsible for the involuntary leg movements associated with restless legs syndrome. In some cases, restless legs syndrome is caused by an underlying health condition, such as iron deficiency anaemia or kidney failure. This is known as secondary restless legs syndrome. There’s also a link between restless legs syndrome and pregnancy. About 1 in 5 pregnant women will experience symptoms in the last 3 months of their pregnancy, although it’s not clear exactly why this is. In such cases, restless legs syndrome usually disappears after the woman has given birth.

There are a number of triggers that don’t cause restless legs syndrome, but can make symptoms worse.

These include medications such as:

Other possible triggers include:

  • excessive caffeine or alcohol
  • smoking
  • being overweight or obese
  • stress


Treating restless legs syndrome

Mild cases of restless legs syndrome that are not linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes.

These include:

  • tips for how to get to sleep (for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night)
  • quitting smoking if you smoke
  • exercising regularly during the daytime

If your symptoms are more severe, you may need medication to regulate the levels of dopamine and iron in your body.

If restless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all that’s needed to treat the symptoms.

Who’s affected by restless legs syndrome?

Restless legs syndrome is a common condition that can affect anyone at any point in their life.

But women are twice as likely to develop restless legs syndrome as men.

It’s also more common in middle age, although the symptoms can develop at any age, including childhood.

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