Sleep apnoea and CPAP - information for patients

About obstructive sleep apnoea

When you sleep, the muscles that hold your throat open relax. In obstructive
sleep apnoea, the throat narrows or closes completely for a few seconds at a
time, so breathing stops or becomes very shallow. Your brain briefly wakes you
to reopen the airway - usually without you knowing - and this can happen
dozens or hundreds of times a night.

The result is broken sleep. That is why people with sleep apnoea feel
unrefreshed and sleepy during the day despite spending long enough in bed, and
why their partner may notice loud snoring and pauses in breathing.

It is common, it is treatable, and treating it usually makes people feel
substantially better.

About CPAP

CPAP stands for continuous positive airway pressure. A small machine by the bed
blows air through a tube into a mask you wear at night. The gentle pressure
holds your throat open, so the airway does not collapse.

It is not oxygen, and it does not breathe for you. It is a splint made of air.

Used regularly, CPAP reduces daytime sleepiness, improves concentration and
mood, improves quality of life, and helps blood pressure control. Most people
who stick with it say they had forgotten what proper sleep felt like.

The first two weeks

This is the part worth knowing about in advance, because it is where most
people who give up do so.

The mask feels strange at first. Almost everyone finds it odd, and most people
get used to it within one to two weeks.

Common early problems, all of which we can fix:

- a leaking mask, or marks on the face: usually the wrong size or the wrong
  style, and there are many alternatives
- a dry nose or mouth: a humidifier can be added
- a blocked nose: treatable, and worth telling us about
- feeling that the pressure is too much: the machine can be adjusted, and can
  be set to build up gradually while you fall asleep
- taking the mask off in your sleep without remembering.

Please do not decide it is not for you in the first fortnight. Contact the
sleep service instead - almost every early problem has a straightforward
solution, and it is much easier to fix at two weeks than at six months.

Use it every night, for the whole night. Benefit depends on hours of use.
Using it for a few hours at the start of the night gives you a fraction of the
benefit.

Driving

This matters, so please read it carefully.

Do not drive when you feel sleepy. That applies to everyone, always.

If you have sleep apnoea and are excessively sleepy, you must tell the DVLA,
and you must not drive until your symptoms are controlled. You can be
prosecuted if you do not. Once you are established on treatment and no longer
sleepy, most people return to driving normally.

If you drive for a living, tell us, because the rules for bus, coach and lorry
licences are stricter and we can prioritise your assessment.

We will tell you what applies to you and will support your licence
application. Insurers need to know as well.

Other things that help

Losing weight, if you are overweight, can substantially reduce sleep apnoea and
in some people resolves it. It is the only treatment that alters the underlying
problem rather than holding the airway open.

Avoid alcohol in the evening; it relaxes the throat muscles.

Avoid sleeping tablets and sedatives unless they have been prescribed for you
knowing you have sleep apnoea.

Sleeping on your side rather than your back helps some people, particularly
those whose apnoea is mild or mainly happens on their back.

Stop smoking, which contributes to airway irritation and swelling.

Further information: Sleep Apnoea Trust, www.sleep-apnoea-trust.org.