David Rose
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It is the cause of nocturnal misery and bedroom strife for millions of Britons and can even rival the volume of an express train. Snoring sits high on divorce petitions’ list of “unreasonable behaviour”. But where nasal strips, laser surgery and not-so-gentle shoving have failed, thousands of heavy snorers could soon be supplied with breathing masks on the NHS to give them – and their partners – a good night’s rest.
The National Institute for Health and Clinical Excellence (NICE), the watchdog that controls access to treatments, is ready to recommend wider use of the masks for sufferers of the condition known as obstructive sleep apnoea syndrome (OSAS), The Times has learnt. The condition causes people to stop breathing intermittently during sleep, often causing them to be excessively tired and moody.
If left untreated, it has been known to lead to serious daytime accidents. About one in 20 middle-aged men and one in 50 women lose sleep because of severe forms of the condition, which has been linked with obesity, high blood pressure and heart disease.
The continuous positive airways pressure (CPAP) devices, worn as masks covering the nose or face, cost £400 to £600 and emit gently pressurised air during the night to keep the airways open and aid breathing. But the treatment is currently available only through selected NHS trusts and sleep clinics, as some local primary care trusts refuse to fund it.
NICE is expected to publish draft guidance on the use of the masks for sufferers of sleep apnoea throughout England and Wales next week. But provisional details issued by the watchdog to medical experts last month indicate that the masks could be recommended for patients with moderate or severe symptoms from next year.
Overweight men between the ages of 30 and 65 and children with enlarged tonsils or adenoids are most affected by the condition. Symptoms, which include heavy snoring and rest-lessness, can be worse in those who sleep on their backs, take sleeping tablets or drink alcohol before sleep. But as many as one in four people may have milder forms of the condition and suffer no ill effects.
According to the British Snoring and Sleep Apnoea Association, there are an estimated 15 million snorers in Britain. A loud and persistent snorer can reach up to 90 decibels – about the same volume as a passing train.
Andrew Whitehouse, 49, a retired psychiatrist from Broughton Astley, Leicestershire, suffered from sleep apnoea for four years. His condition caused him to fall asleep anywhere at short notice and meant countless restless nights for his wife. But use of a CPAP mask at night has eliminated the symptoms, he says.
“I felt ill, like I had a hangover and nausea all the time. I also felt depressed and confused which made me irritable and hard to get on with,” Dr Whitehouse said. “It [the mask] felt claustrophobic at first but when I found one that it worked the effects were obvious.” His wife, Amanda, said: “Andrew always snored but it got worse, to the point where his whole body would shake as he tried to breathe and the noise was terrible. When he was diagnosed with sleep apnoea and found the right mask, I immediately noticed a difference. I was able to get a great night’s sleep for the first time in years.”
Michael Polkey, a specialist in sleep and respiratory medicine at the Royal Brompton Hospital, London, said: “Sufferers usually wake feeling that they haven’t had a full night’s sleep and may report difficulty maintaining concentration, poor memory, and excessive daytime sleepiness.” CPAP treatments seemed to work in 70 to 80 per cent of cases, he added.
A quiet night’s sleep
Almost half of people in Britain snore from time to time, and about a quarter are regular snorers
Measures to minimise snoring include sleeping on your side, maintaining a healthy diet and weight, and avoiding alcohol or smoking before bedtime
Keeping nasal passages clear by using adhesive strips or by rubbing eucalyptus or Olbas oil on to your pillowcase may also help. If an allergy is blocking your nose, try antihistamine tablets or a nasal spray
Devices that reposition the jaw, vibrating pillows and sewing a tennis ball into a pyjama top are also claimed to help
Surgery to correct snoring can include procedures to correct structural problems in the nose and the removal of excess tissue in the mouth and throat. However, some people may require several procedures
Sources: NHS Direct; British Snoring and Sleep Apnoea Association
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I am the proud owner of a CPAP machine and have been using it for the past 8 years. I am also a Board Certified Respiratory Care Practitioner licensed in the United States.
There maybe treatments other than CPAP for some patients. There wasn't for me. It has changed my life dramatically. I now receive a rested night of sleep and have more energy that I had previous to the treatment.
Snoring is the minor problem with OSA. Those with sleep apnea face a four times higher possibility of suffering a stroke or heart attack.
Being overweight, alcohol consumption and taking sleeping medications are not the only factors in causing this problem. Body construction and other underlying medical differences also play a large part in many individuals.
I don't sell the units , nor does my living depend on those that use CPAP, but I highly recommend the treatment. It is difficult for some people to become accustomed to the machine but it is well worth continued effort.
j hansen, walla walla, wa
I've tried the CPAP device twice within the last 20 years and found it unsatisfactory because it didn't alleviate my sleep apnea..
When a doctor finally sent me to an ear-nose-and-throat specialist, he found that I had a 'deviated septum' in my nasal passages. Simple out-patient surgery solved the problem.
Don Loughlin, Bellingham, USA / Washington
My wife suffered with my snoring for over 30 years. With the assistance of a dental device that looks very much like a retainer, my snoring has ended. This device has two parts, one for upper teeth and one for lower. They are connected with a hook that is adjustable, with the ability to pull my lower jaw out just a bit. This simple device keeps the muscles in my neck from closing down and my snoring has ceased--totally. The cost was US $600. It requires no forced air, it is silent, and it is easy to adjust to get the right position for silent sleeping.
Winston, Peoria, AZ, USA
Your article makes no mention of the use of Dental Appliances in the treatment of snoring and sleep apnoea disorders.
There is a strong correlation between sleep disturbing tooth grinding, snoring and sleep apnoea ( which could also well be affected by your readers neck brace ).
The first line, of a logical approach, in diagnosis and understanding, is to provide a bite correcting appliance, at an increased bite height to see if it makes any difference, which it usually does.
If that is unsuccessful the dental appliance that holds the jaw in a forward position, thus opening the airway, is invariably successful, and much less sleep disturbing than CPAP.
Peter Bishop, Bristol, UK
While I understand that obstructive sleep apnoea is a serious issue for a tiny minority or people, most people who snore do so because they are fat, smoke, or drunk.
The lifestyles these people lead directly contributes to their nocturnal grunts and splutters. The partners of these people are the ones who suffer most. For them, there is no relief other than earplugs* or a separate bedroom. It's rather like expecting the partner of an amputee to cut off one of their own limbs so they can experience the same level of disability.
* I buy mine from www.snorestore.co.uk
Jessica Gooch, London,
Has this actually happened, or is it speculation and not actually news. Either way, the numbers are not large and as has been said, the vast majority of snoring is not this serious.
Open mouth snoring accounts for about 70% of the problem.
P J Boden's idea may be similar to that on www.thesnoringcap.com.
Bob, ASCOT, UK
I am in Germany and have been using a CPAP mask since last October. I cannot praise this therapy enough. It has given me a complete new life. Please let this mask be made more freely available in GB. I used to be exhausted even after 7 hours' "sleep" and after 11 a.m. was useless, with my body screaming silently for sleep. Now I am fit until 22h and wake up ready to take on anything.
M.C.McQueen, Frauenchiemsee, Bavaria, Germany
After an accident that broke both my legs and hurt my neck. I was confined to bed for several weeks. As a precaution I wore a neck brace all the time. I had been a casual snorer but. miraculously I never snored wearing the neck brace even though I spent most of the time, confined several weeks, in bed lying. on my back .
My wife reported that i never snored when I wore my brace.
I was aware that several of my friends had complaining wifes about husbands' snoring and I asked the offending husdands to wear a my spare brace. For some reason none of them would experiment. I could have patented this but couldn' t confirm it.
Has anybody else tried it ????
Dr P J Boden, Nottingham, UK
Why do couples where one partner snores insist on continuing to share the same bed, even where a spare bed exits? Sleep is an extremely personal thing, but even still we doggedly try to get sleep virtually on top of our partners when they snore, read with the light on, want to watch tv or just take up too much space. I suggest we start a trend for separate bedrooms s(where space permits) so that after a good night cuddle parties can retire (if they wish) to their own bed in their own room - how fabulous would that be? I would argue that it would improve relationships far more than it would distance couples. But this separate rooms or beds seems to be such a stigma for some reason. Let's ditch the stigma and all get a decent nights sleep.
Bella T, UK,
Mislading - people with OSA snore but that's not why they need CPAP. Untreated, the underlying breathing difficulty can lead to more serious health problems and expense for the NHS. I seriously doubt that NICE has sanctioned the use of CPAP for snoring in general.
colin, preston, uk
Neil, From what I've read it makes far more financial sense for the NHS to pay £500 for a CPAP machine, than to fund the treatment of the potential long term consequences such as heart disease and stroke, should the OSA not be managed.
Lee, Bristol,
is anyone else outraged that the nhs are so badly run as to aloow this you only have to look at the state of nhs care homes to know that this is a joke.... we cant keep our hospitals clean or look after our elderly properly but can afford to fork out for this?!?! i would rather MY £400 go to a care home (we'll all be there eventually)!
Andy, aberdeen,
What should be made clear through this article is that Obstructive Sleep Apnoea can be extremely debilitating. Imagine how you, as a 'normal' person feel after 1 or 2 poor nights' sleep. Now imagine that your sleep is (unbeknown to you) being disrupted anything from 10 to 120 times an hour because the upper airway is collapsing. When this is happening every night, and has gone unrecognised for years because your partner has got used to the snoring, or you're sleeping in another room the effect on your heart and blood pressure, memory and concentration and many other areas can be enormous. You can fall asleep as soon as you sit still for a minute, not good at traffic lights. People with untreated OSA should not be driving, yet many sufferers drive for a living because their sedentary jobs lead to them becoming overweight.
Snoring is still seen by many as amusing, as shown by the 'Comment' article, but it can wreck homes and lives and should be treated in that manner.
Hannah, London,
A member of my family uses the mask. The only downsides are:
1 - the user has immense difficulty explaining to people at check-in and security for planes what the whole device is for. If you receive one of these, be prepared to obtain a doctor's note providing explanation before travelling;
2 - they end up sounding like Darth Vader when asleep!
JS, Cambridge,
This is why the NHS is in financial trouble there is no need for this to be provided on the NHS this should a private medicine item as should IVF and sex changes.
Neil, edinburhg, scotland