Having a good sleep is challenging for those with sleep apnea. It occurs when the muscles in the back of the throats relax, or the airways are obstructed, leading to the low blood oxygen level and the repeatedly brief awakening at night. This is the most common sleep disorder in Hong Kong. According to the Hong Kong Asthma Society, approximately 4% of males and 2% of females suffer from the disorder, with a majority of middle-aged men from 30 to 60 years old.
Types of Sleep Apnea
Sleep apnea can be categorised into three types:
- Obstructive sleep apnea: This is the most common type, with over 90% of patients. It happens when your airways narrow or become blocked. The causes are numerous, including severe allergic rhinitis, blockage of the airway by the tongue, uvula, turbinate or tonsil hypertrophy.
- Central sleep apnea: This type happens when your brain does not send the right signals to the muscles that control your breathing. Those with heart disease, stroke and brain injury are prone to this type of sleep apnea.
- Complex sleep apnea syndrome: This is a combination of central sleep apnea and obstructive sleep apnea.
Symptoms of Sleep Apnea
All types of sleep apnea have similar symptoms, including:
- Loud snoring with intermittent pauses
- Difficulties in concentration
- Memory problems
- Tiredness after sleep
- Insomnia or difficulty staying asleep at night
- Excessive daytime sleepiness
- Headaches upon waking up
- Mood changes, such as depression and irritability
- Decreased sexual desire or even erectile dysfunction
However, snorers do not necessarily have sleep apnea if they can still breathe while sleeping, as per Dr Chan Kin Ming Kevin of Chiron Medical. Simple snorers (or primary snorers), with 5 times of snoring per hour, are considered normal or acceptable. The times of snoring per hour indicates the levels of sleep apnea, which can be graded as mild (5 to 15 times), moderate (16 to 30 times) and severe (over 30 times).
High-risk Groups of Sleep Apnea
Everyone has the chance of having sleep apnea, but the below groups are considered to have higher risks:
- Ageing: Sleep apnea occurs significantly more often in older adults. On average, one in ten seventy-year-old has this disorder.
- Middle-aged males: It is prevalent among men in their 40s and 50s. Their risk is about two to eight times that of women.
- Obesity: 70% of patients are obese. Conditions worsen along with obesity.
- People with small jaws and short necks
- People with heart disease, stroke and diabetes
- Premature babies
Critical Illnesses Caused by Sleep Apnea
People with sleep apnea are hard to get into a deep sleep, resulting in persistent daytime tiredness, leading to accidents at work or when driving. Low oxygen level in the blood, or even hypoxia, may harm vital organs and cause the critical illnesses below. In some severe cases, patients pass away due to hypoxia.
- Cardiovascular diseases
- Hypertension
- Stroke
- Heart failure
- Coronary heart disease
- Impaired lung function
- Pulmonary hypertension
- Polycythemia
How to Perform a Sleep Apnea Self-Assessment?
You could refer to the Epworth Sleepiness Scale (ESS) to evaluate your sleepiness level and understand if you are prone to sleep apnea preliminarily.
(0 - would never doze; 1 - slight chance of dozing; 2 - moderate chance of dozing; 3 - high chance of dozing)
| Activities |
Chance of dozing (0-3) |
|
| 1 |
Sitting and reading |
|
| 2 |
Watching TV |
|
| 3 |
Sitting, inactive in a public space |
|
| 4 |
As a passenger in a car for an hour without a break |
|
| 5 |
Lying down to rest in the afternoon when circumstances permit |
|
| 6 |
Sitting and talking to someone |
|
| 7 |
Sitting quietly after lunch without alcohol |
|
| 8 |
In a car, while stopped for a few minutes in the traffic |
You could get to know your level of daytime sleepiness after adding the scores of the questions above.
- 0 - 7 points: Normal daytime sleepiness
- 8 - 11 points: Higher normal daytime sleepiness
- 12 - 15 points: Excessive daytime sleepiness
- 16 - 24 points: Severe excessive daytime sleepiness
People with sleep apnea generally score more than 16 points. However, ESS is only a preliminary assessment. Please consult your doctor for further enquiries and diagnosis incorporated with your medical history.
Diagnosis of Sleep Apnea
Generally, polysomnography is used to diagnose sleep apnea through collecting data while you sleep, such as your heart, lung and brain activity, breathing patterns, eyeball movements, and snoring volume.
Sleep apnea tests can be conducted in public and private hospitals and at home, with specific equipment provided by sleep test suppliers. The test fees at public hospitals are lower, but the waiting time is lengthy. For most private hospitals, sleep tests are referred to sleep test suppliers responsible for hooking up the equipment for you at the wards.
With the same testing machines, home sleep testing costs are relatively lower, exempting the inpatient fees.
| Fees at public hospitals |
Fees at private hospitals |
|
| Inpatient (One night) |
$120 (Inpatient; general beds) |
HK$6,000 - 9,000 |
| Home sleep tests |
$1,000 - 2,000 |
HK$3,000 - 5,000 |
Sources: CPAP Pal. Charges are subjected to the specification of the hospital beds.
Costs of Different Treatments for Sleep Apnea
Once you are diagnosed with sleep apnea after the tests, your doctor will recommend suitable treatments for you according to your conditions. The following are the common treatments for sleep apnea. We list out the average costs below for your reference.
| Treatments | Uses |
Fees for references |
| Continuous positive airway pressure (CPAP) machine |
With this treatment, the air breathed pressure is continuous, constant and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open and allow air to be inhaled into your lungs. This is currently the safest and most efficient treatment. |
$6,000 - $15,000 |
| Mouthpiece |
Mouthpieces enable you to breathe with your mouth open by applying on the upper and lower jaws and holding the tongue in a different position. |
$480 |
| Side sleeping headband |
These sleep accessories are auxiliary treatments to help patients sleep on the side rather than on their back, aiming to lower the obstruction of airways caused by the tongue and uvula. |
$100 - $400 |
| Side sleeping pillow |
$1,000 - $3,000 |
In some cases, surgery may be necessary to resect the obstruction in the airways. However, performing surgery is relatively rare and only for severe cases.
Sleep Apnea Lifestyle Remedies
Apart from the treatments above, you could consider home remedies to improve your quality of sleep.
- Exercise regularly and maintain a healthy weight: People with obesity are sleep apnea high-risk groups. Maintaining a healthy weight can keep your airways clear and reduce sleep apnea symptoms.
- Avoid smoking and alcohol: Cigarettes and alcohol contribute to inflammation and swelling in your airways which can worsen your snoring and sleep apnea.
- Alter your sleep position: Sleeping on the side can help your breathing return to normal since it may lower the chance of airway obstruction, compared with sleeping on your back.
- Try yoga: Yoga can increase your energy level, strengthen your heart, raise your respiratory strength and encourage oxygen flow.
Sources:
© Cigna Healthcare 2023
Information provided in this article is intended for health and fitness purposes only and is not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment or prevention of disease (see Terms & Conditions for details). Any health-related information found in this article is available only for your interest and should not be treated as medical advice. Users should seek any medical advice from a physician, especially before self-diagnosing any ailment or embarking on any new lifestyle or exercise regime. Any information contained in this article may not be suitable, accurate, complete or reliable. Cigna Healthcare accepts no responsibility for the content or accuracy of information contained on external websites or resources, or for the security and safety of using them. "Cigna Healthcare" and the "Tree of Life" logo are registered trademarks of Cigna Intellectual Property, Inc. in the United States and elsewhere, licensed for use. All products and services are provided by or through operating subsidiaries, and not by The Cigna Group.
