At the Sleep Clinic of St Vincent's Hospital, sleep disorders are routinely diagnosed. In many cases snoring is harmless, but sleep apnoea is a potentially more serious problem, writes ITA KELLY.
WHEN Prof Walter McNicholas, a respiratory physician at St Vincent’s Hospital in Dublin, was studying in Canada in the late 1970s he became fascinated by sleep disorders and completed a fellowship on the topic.
At the time he thought he might treat a few such patients per year.
This year he is celebrating the 25th anniversary of Ireland’s first Sleep Clinic at St Vincent’s Hospital in Dublin and treats more than 400 patients a year, and the figures are growing all the time. While snorers are the butt of many jokes and elbows in the ribs in the dead of night, by the time they reach the Sleep Unit in St Vincent’s, most, including their sleep-deprived partners, have a real and pressing need to resolve their sleep issues.
The average patient who attends the Sleep Unit is middle-aged and upwards. Sixty per cent are men. While most women don’t believe or won’t admit that they snore, that 40 per cent remainder speaks for itself.
In most instances it is what they term the “bed partner” who spurs the patient to do something about their snoring in the first place, according to Prof McNicholas.
“Snoring in itself is harmless. Yes it is a nuisance, but it won’t adversely affect your health. What is bad for your health is a condition called sleep apnoea, where the throat collapses as often as once a minute giving the patient a choking sensation while sleeping. Such patients usually snore loudly, as well, and do not get a proper night’s sleep. They are also more likely to suffer from high blood pressure and are more predisposed to both strokes and cardiovascular problems”.
The purpose of the sleep clinic is to observe the patient whilst asleep.
Patients spend an overnight in the hospital, where a polysomnogram (PSG) is completed. This monitors and records the sleep patterns and any noise generated throughout a typical eight-hour period. It is entirely painless.
If the patient is just a snorer, this is good news. A further referral can then be made to an orthodontist, if desired, for a purpose-designed dental appliance that is worn at night to keep the throat and jaw taut, which helps reduce the snoring.
If the diagnosis is sleep apnoea, the resolution of it can be straightforward, but the solution is one that the patient must live with and use every night of their lives. It is called a Continuous Positive Airway Pressure (CPAP) machine, which the patient wears over their nose or mouth or both while they sleep. It forces the airway to stay open and therefore prevents the throat from collapsing, eliminating the snoring.
BRENDAN CULLEN, from Clane in Co Kildare had to wait almost 18 months to see Prof McNicholas. The diagnosis of severe sleep apnoea has meant that his wife has been able to get rid of her ear plugs and enjoy a restful night’s sleep. And Brendan can now have a decent night’s sleep, too.
“I had never heard of sleep apnoea. Four years ago I was driving from my mother-in-law’s funeral and drove the car into the ditch due to exhaustion. I knew then that it was time to do something about it. It was hard being on the waiting list but last October my life was turned around. St Vincent’s told me that I stopped breathing every 60 seconds and they recommend the CPAP device. I am no longer tired all day and nodding off at work. I would say that I found it hard to get used to the mask at night but I can certainly say that, after six months using it, I have never felt better.”
Prof McNicholas says some people snore for the simple reason that their throat is badly designed. He describes it as a “disordered physiology” – put simply, a design flaw. But he says there are other contributory factors, including excess weight, a collar size of 17 or over, muscles becoming older and less toned, and sleeping on your back.
“There is no magical solution coming down the road. In general, surgical solutions have not delivered results and while the CPAP device may seem inconvenient, it has a remarkably high compliance rate among patients, because it works and solves their problem. Sleep apnoea is not a sexy condition. There is no doubt about that. Tests have shown that two-thirds of all patients are still using it after eight years. That is an extraordinarily high compliance rate.”
Prof McNicholas says there is some merit in the old wives’ solution of sewing a tennis ball into the back of pyjamas, for the simple reason that it prevents the person from sleeping on their back and makes them less likely to snore. While he doesn’t dismiss the increasing number of over-the-counter solutions to snoring that are now available, including nasal strips and throat sprays, he leaves you in no doubt that they are unlikely to deliver the sort of results that he can.
Andy, a 40-year-old Dubliner who didn’t want to be identified for this piece, first went to his GP when his wife of three years announced that she wouldn’t be sleeping in the same room with him any more due to his loud snoring. Armed with a letter from his GP, citing the fact that his snoring was causing “marital distress”, he was referred to a Dublin sleep clinic. They referred him to an orthodontist but he decided not to proceed with it because his wife felt that she didn’t want to inflict this on him.
“I have decided to get fit instead and to lose some weight to reduce my collar size because I understand that a collar size of 17 or more contributes to snoring. My wife has also discovered that if she gets to sleep before me, the snoring no longer disturbs her.”
