Sleep apnoea in older adults: snoring, tiredness and CPAP treatment

The NHS says sleep apnoea happens when the airways become too narrow during sleep, which stops you breathing properly. NICE CKS describes obstructive sleep apnoea/hypopnoea syndrome as recurrent episodes of complete or partial obstruction of the upper airway during sleep, causing apnoea (complete airflow obstruction) or hypopnoea (reduced airflow), with brief arousals from sleep to restore airway muscle tone. Because each arousal interrupts sleep, people feel unrefreshed even after a night in bed.

Linked factors listed by the NHS include obesity, a large neck, getting older (although children and young adults can get it too), other family members with it, alcohol, smoking, large tonsils or adenoids, sleeping on your back, and COPD. NICE CKS adds male sex, nasopharyngeal obstruction, craniofacial abnormalities and neuromuscular disorders.

At night the NHS lists breathing stopping and starting, gasping, snorting or choking noises, waking a lot and loud snoring. By day: feeling very tired, difficulty concentrating, mood swings and morning headaches. The NHS says it can be hard to tell if you have it, and that it may help to ask someone to stay with you while you sleep to check for the symptoms. NICE CKS lists excessive daytime sleepiness, snoring, fatigue, witnessed apnoeas, unrefreshing sleep and impaired concentration in adults.

In older people, sleepiness may be put down to age, poor sleep or medicines, and a partner may no longer be there to witness pauses. Alzheimer's Research UK lists sleep disorders such as sleep apnoea among health problems that can cause memory and thinking difficulties, so untreated apnoea is worth considering when an older person's concentration declines. The NHS says to see a GP if your breathing stops and starts, you make gasping or choking noises, or you always feel very tired in the day, and to bring anyone who has seen the symptoms.

The NHS says a GP who suspects sleep apnoea may refer you to a specialist sleep clinic. You may be given devices to wear overnight that check things like your breathing and heartbeat, usually at home but sometimes in the clinic overnight. The results give an AHI (apnoea-hypopnoea index) score based on how often breathing stops during sleep.

NICE CKS advises that an adult with suspected OSA is referred urgently to a sleep clinic if excessive sleepiness affects their work as a professional driver or safety-critical worker, if OSA could worsen a co-existing heart or lung condition, or in some other situations such as pregnancy or pre-operative assessment for major surgery. Referral is routine if symptoms are moderate or severe, or mild but affecting quality of life. For older adults with heart failure, atrial fibrillation or lung disease, mentioning the condition when you are referred is therefore relevant.

The NHS says mild sleep apnoea can sometimes be treated with lifestyle changes: losing weight, giving up smoking and cutting down alcohol. Many people need a CPAP (continuous positive airway pressure) machine, which gently pumps air into a mask over the nose, or nose and mouth, during sleep. It can improve breathing, sleep quality and tiredness and reduce the risk of problems such as high blood pressure. It may feel strange at first; the NHS says to keep using it, that it works best every night, and to tell your doctor if it is uncomfortable or hard to use.

Other treatments the NHS says are sometimes used include a mandibular advancement device (like a gum shield), surgery such as removing large tonsils, mouth and facial muscle exercises, and hypoglossal nerve stimulation. Self-help from the NHS includes regular exercise, a dark and quiet bedroom with regular sleep times, sleeping on your side (for example with a tennis ball taped to the back of sleepwear or a wedge pillow), not drinking too much alcohol especially close to bedtime, and not taking sleeping pills unless a doctor recommends them, because they can make sleep apnoea worse. This is relevant to older people who may have been prescribed sleep aids; review them with the GP rather than stopping suddenly.

The NHS says that without treatment sleep apnoea can lead to high blood pressure, a higher chance of stroke, type 2 diabetes, heart disease, depression or mood changes, a higher chance of a serious accident caused by tiredness such as a car accident, and difficulty concentrating. NICE CKS notes associations with cardiometabolic conditions, depression and increased risk of road traffic collisions.

On driving, the NHS says you may need to tell the DVLA, and that if sleep apnoea with excessive sleepiness has been confirmed you must not drive until tiredness is under control. NICE CKS says primary care should give advice on driving and when to notify the DVLA, and about occupational injury risk.