Obstructive sleep apnoea/hypopnoea syndrome
Obstructive sleep apnoea/hypopnoea syndrome
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a breathing disorder characterised by recurrent episodes of complete or partial obstruction of the upper airway during sleep, causing either complete airflow obstruction with temporary cessation of breathing (apnoea) or decreased airflow (dyspnoea).
Common symptoms include excessive daytime sleepiness due to transient waking from sleep to restore normal airway muscle tone and airflow. The condition is more common in men and has increasing prevalence with age and obesity.
A sleep study is usually required to confirm the diagnosis, and moderate to severe cases often respond well to ongoing continuous positive airway pressure (CPAP) therapy. Evidence points towards improvements in daytime sleepiness, fatigue and quality of life. Pharmacy teams can assist patients who are struggling with CPAP. Common issues include ill-fitting masks, pressure intolerance, nasal dryness and throat irritation.
Individuals with mild OSAHS, or for whom CPAP is not suitable, may benefit from an intra-oral mandibular device, which maintains an open airway and prevents it from collapsing. Occasionally surgery, such as tonsillectomy, may be required. Risk factors, such as smoking, alcohol intake, back sleeping and being overweight should also be addressed. Guidance from the Sleep Apnoea Trust may help with this.
Circadian rhythm sleep disorders
Circadian rhythm sleep disorders (CRSDs) include shift work disorder (SWD) and jet lag disorder (JLD).
These differ to insomnia in that the sleep disturbance is due to changes in the circadian system or a misalignment between an individual’s circadian rhythm and environmental factors such as light and social cues that affect the timing or duration of sleep.
Impairment in social or occupational functioning is common and distinctive in nature from the difficulty of falling or staying asleep or frequent awakening that defines insomnia.
For SWD, occupational health should ideally be involved in order to minimise the impact, and there is also advice available from the Health and Safety Executive. Similarly, adhering to sleep hygiene measures will help someone with JLD. Note that the evidence for the use of melatonin is limited and conflicted in terms of benefit, with NICE’s Clinical Knowledge Summary advising against it. There are tips on the NHS website.
Jet lag can have implications for medication regimens, some of the most significant being for people with diabetes. Advice on this has been published by Diabetes UK.