'I feel like I have a new brain'

Sleep apnoea, a common condition which disturbs a good night's rest, is simple enough to treat

Imagine waking up once a minute, gasping for breath, before falling back to sleep, only to wake up again, and again, and again.

It might sound exaggerated but for those suffering from acute sleep apnoea it is a nightly ordeal they go through.

Many do not even realise their rest is being interrupted so drastically and wonder why after eight hours of sleep they still feel tired. Sometimes they even nod off during the day.

"It is a common condition and can affect up to four per cent of populations," said British respiratory expert Himender Makker, who was recently in Malta for a conference on respiratory problems organised by the Medical Association of Malta.

But although doctors know sleep apnoea is a common condition, it remains under-diagnosed.

The reason could stem from patients' embarrassment to go to see a doctor. "The condition normally presents with very loud snoring and people are embarrassed to come forward with that symptom, even thinking snoring is normal," he said.

However, while snoring is quite common, severe snoring - sometimes going up to 100 decibels - is not.

Sufferers tend to feel tired but this could also be the symptom of many conditions, and is often shrugged off by doctors.

But the repercussions could be serious, especially if apnoea sufferers fall asleep during the day. In September 1999 a woman was killed after she was run over by a car driven by a sleep apnoea sufferer in Għajn Tuffieħa. The man was not aware of the condition despite the telltale symptoms of snoring, waking up feeling tired and dozing off during the day.

Dr Makker explained that patients' respiratory tract repeatedly obstructs during sleep; they choke and stop breathing for between 10 seconds and a minute.

"In the midst of their loud snoring, they become absolutely silent because they are not breathing at all and the level of oxygen to the brain drops. To breathe again they wake up - sometimes every minute - and the net effect is that despite sleeping for seven to eight hours every night, they wake up feeling extremely tired and sleepy," he said.

Moreover, the repeated drop in oxygen levels puts a strain on the heart and these patients tend to suffer from high blood pressure and blood problems.

In another reason to drop extra weight, sleep apnoea is often associated with obesity. Dr Makker said around half the patients suffering from the condition are obese.

"Obesity definitely has a lot to do with sleep apnoea," he said, adding that weight loss would not only help in preventing sleep apnoea but also cure other problems, like diabetes, high cholesterol and high blood pressure.

However, the tiredness associated with sleep apnoea deprives sufferers of the drive to exercise and eat a healthy diet.

"By treating sleep apnoea, they become more alert and they can be encouraged to lose weight," he said.

The most effective treatment is wearing an oxygen mask with slightly raised pressure to open the airways throughout the night.

"It is a very effective and dramatic treatment and patients wake up saying they had the best night's sleep ever and they feel years younger. One patient woke up saying he felt as if he had a brain transplant. These patients would have had bad quality sleep for many years and would have forgotten what a good night's sleep feels like," Dr Makker said.

He said although sleep apnoea was initially believed to be more common in countries with a high prevalence of obesity, recent studies from Japan and China, where obesity is still not such a major problem, have also shown a high occurrence, possibly related to facial bone structure.