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Snoring & Sleep Apnea Treatment in Singapore

As an experienced ENT specialist, Dr. Dennis Chua provides sleep apnea treatment in Singapore for patients experiencing chronic snoring due to obstructive sleep apnea. Sleep apnea is a condition that is caused by a blockage in your air passageways while you sleep. It can be serious in some cases and can lead to an increased risk of congestive heart failure, heart attacks, and stroke.
Some symptoms of sleep apnea to watch out for include loud snoring, gasping for air during sleep, dry mouth, fatigue, morning headaches, and daytime sleepiness. While older men are more likely to develop sleep apnea, anyone can have sleep apnea and require appropriate treatment to correct the condition.

Common Signs & Symptoms Of Obstructive Sleep Apnea

In Singapore, the prevalence of those with moderate to severe OSA is estimated to be around 30.5%. Furthermore, this condition can affect people of all ages, especially those over the age of 50 and those who are overweight. Therefore, it is essential to understand the common signs and symptoms of OSA so that those with the condition can seek appropriate treatment.

The common signs and symptoms of Obstructive Sleep Apnea include:

  • Awakening from sleep with a dry mouth
  • Difficulty paying attention while awake
  • Difficulty staying asleep (Insomnia)
  • Excessive daytime sleepiness (Hypersomia)
  • Gasping for air during sleep
  • Intervals where breathing stops during sleep (usually noticed by another person)
  • Irritability
  • Loud snoring
  • Morning headache

What Causes Obstructive Sleep Apnea

OSA can have various underlying causes. Some patients may even have more than one condition that causes OSA.

The causes of Obstructive Sleep Apnea can include, but are not limited to:

  • Anatomical variation of facial bones
  • Dental conditions such as large overbite
  • Enlarged adenoids and tonsils
  • Enlarged septal bone deviation and turbinates
  • Heavy tobacco and alcohol consumption
  • Nasal congestion
  • Obesity

Complications Arising From Obstructive Sleep Apnea

OSA can have negative consequences on the human body. Those with the condition may experience repeated episodes of oxygen lowering, changes in carbon dioxide levels, direct effects on the heart caused by pressure changes within the chest, and high levels of inflammatory markers.

If left untreated, these changes can lead to health problems such as cardiomyopathy, diabetes, heart attacks, heart failure, high blood pressure, and stroke. Untreated OSA can also affect a patient’s day-to-day functions, such as work or school performance. Therefore, it is essential to seek appropriate sleep apnea treatment early before the condition deteriorates.

How Is Obstructive Sleep Apnea Diagnosed?

Those who suspect they have Obstructive Sleep Apnea should consult an ENT specialist who can conduct a thorough clinical examination, a flexible nasoendoscopy, and an overnight sleep study (nocturnal polysomnography test) to ensure an accurate diagnosis. During this examination, the patient will be hooked to a piece of equipment that monitors activities in their brain, heart, and lungs. The device will also analyse the patient’s arm and leg movements, breathing patterns, and blood oxygen levels.

Sleep Apnea In Children

Dr. Dennis Chua is a knowledgeable ENT doctor who also manages paediatric ENT conditions like Obstructive Sleep Apnoea. OSA can occur in children as well. OSA in children has been recognised since the 1970s and since then the effects of paediatric OSA has been well-studied. Consequences of untreated obstructive sleep apnoea in Singapore include failure to thrive, enuresis (bed-wetting), attention-deficit disorder, behaviour problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnoea in children is adenotonsillar hypertrophy.

Adenotonsillar Hypertrophy for Sleep Apnea

Adenotonsillar Hypertrophy for Sleep Apnea

Clinical diagnosis of obstructive sleep apnoea in the clinic is reliable and may not warrant a sleep study if the cause of OSA is obviously from the adenotonsillar hypertrophy. According to the American Academy of Otolaryngology 2011 Clinical Practice Guideline, a sleep study will be necessary in children who have comorbidities such as obesity, Down’s Syndrome, neuromuscular diseases, sickle cell disease or mucopolysaccharidoses. Overall, less than 10 percent of children who suffer from OSA will need a sleep study before surgery. Sleep apnoea in children if left untreated can result in significant learning impairment and poorer academic performance. Many children with sleep apnoea may be “mouth-breathers' ' where they have to use their mouth to breathe at night. This is unnatural and over a long period of time can result in changes to facial skeleton, bite (occlusion) deformities.

Sleep Apnea in Women

Women may have atypical signs and symptoms of sleep apnoea. Snoring or noisy breathing may not be a prominent feature of sleep apnoea in women. They could have non-specific symptoms such as:

  • Fatigue
  • Insomnia
  • Morning headache
  • Lack of energy
  • Depression
  • Incidence increases during menopause

Diagnosing Nasal Obstructions with Nasoendoscopy and Sleep Study

  • Evaluation via a nasoendoscope to assess the narrowest point in the nasal or oral passages.If there is significant obstruction, then a sleep study may be needed to confirm the diagnosis. A nasoendoscopy is a quick and relatively painless procedure that takes a few minutes to perform in the clinic. Dr. Dennis Chua is a skilful ENT specialist who uses a paediatric sized nasoendoscope to assess the air passages in a relatively painless manner.
  • Sleep study to diagnose and assess severity of condition. With advancing technology, a sleep study can now be performed in the comfort of your own home. Parameters such as number of episodes of obstruction per hour, oxygen level, stages of sleep and number of awakenings per night are monitored. This helps overcomes “first-night-effect” that can occur when a sleep study is performed in the hospital whereby a patient is unable to fall asleep in a foreign environment (hospital setting). Obstructive sleep apnoea only occurs during sleep and if you are unable to sleep well during the sleep study test, the accuracy is lower and you may need to repeat the test.

Snoring (Sleep Apnea) Treatment

Recommend diet and lifestyle modifications. Patients who are overweight or obese are recommended to undergo a weight loss programme to help relieve constriction of their airways. Losing weight can also help improve health and quality of life, thus reducing daytime sleepiness. Patients with OSA are also encouraged to sleep on their side or stomach rather than the back to prevent the tongue and soft palate from resting against the back of the throat, thus blocking the airway.

Medications may be prescribed to treat conditions such as allergic rhinitis or help manage the patient’s breathing. If the patient experiences congestion, they can consider using a saline nasal spray to help keep their nasal passages open.

Oral appliances are designed to keep the patient’s throat open by bringing the jaw forward. This can help relieve snoring and mild OSA.

A Continuous Positive Airway Pressure (CPAP) machine is more effective than oral appliances. As such, this form of sleep apnea treatment is often recommended for those with moderate to severe OSA. The device delivers air pressure through a mask while the patient sleeps, causing the upper airway passages to remain open, preventing apnea and snoring.

Surgery may be recommended for those with sleep apnea, but usually only after other treatments have failed or in select cases where the nasal or oral passages are narrow. Surgical options may include tissue removal, tissue shrinkage, jaw repositioning, implants, nerve stimulation, or tracheostomy.

Factors that Increase Susceptibility to Sinusitis

Sinusitis is more likely to affect individuals who:

  • Experience frequent colds, particularly young children.
  • Engage in cigarette smoking, either actively or passively.
  • Regularly use nasal decongestant sprays for an extended period (more than two to three days).
  • Have untreated hay fever or other allergies.
  • Possess structural abnormalities in the nose.
  • Have nasal polyps, which are swellings in the linings of the nose or sinuses.
  • Suffer from dental diseases, such as untreated tooth abscesses.

Commonly Asked Questions

Sleep apnea treatment is largely dependent on the underlying cause. Once identified, appropriate medication or lifestyle changes can be prescribed to help the patient.
An estimated 15% of Singaporeans suffer from sleep apnea.
Lifestyle changes can make a big difference to reducing snoring. Surgical options also exist to reduce the soft tissue structures at the back of your throat to stop snoring and sleep apnea.
A Continuous positive airway pressure (CPAP) machine has been found to be highly effective in helping patients who are chronic snorers. However other medical treatments also exist.
Loud snoring can be caused by a number of different issues. These issues can be mitigated either by medical or surgical treatment or lifestyle modifications.
Sleep apnea is a potentially serious disorder. If you find yourself have symptoms of sleep apnea you should consult with an ENT first for a proper diagnosis of your condition.
To treat sleep apnea, doctors will likely prescribe lifestyle changes before moving on to other options like oral appliances, CPAP machines, or upper airway surgery.

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