Obstructive Sleep Apnoea: Care Staff Guide to Spotting and Supporting

Obstructive sleep apnoea, often shortened to OSA, is one of those conditions that care staff are well placed to notice, because they see people at night, at mealtimes and during the quiet parts of the day when tiredness shows. Left untreated it can affect mood, concentration and heart health, yet many people have never been assessed. This guide, based on NHS information, explains what OSA is, how to spot it, how it is treated and how to support someone who uses a CPAP machine.

What is obstructive sleep apnoea?

The NHS describes obstructive sleep apnoea as a condition in which breathing repeatedly stops and starts during sleep. This happens when the walls of the throat relax and narrow, so that airflow is briefly blocked. Each pause disturbs sleep, even though the person may not remember waking, so they can spend a full night in bed and still feel exhausted.

Signs and symptoms

People often do not realise they have OSA, and the first clue may come from a partner, family member or night-time care worker. The NHS lists the symptoms as:

• pauses in breathing while asleep, sometimes with gasping, snorting or choking
• loud snoring
• waking frequently during the night
• feeling very tired during the day
• difficulty concentrating
• mood changes or mood swings
• headaches in the morning

In care settings, daytime sleepiness and poor concentration are easily put down to age, boredom, medication or low mood. In a person with dementia, they may be mistaken for the condition progressing. If a person dozes during meals or activities, snores loudly or seems to stop breathing at night, record what you observe and pass it to the senior on shift so it can be raised with the GP.

Who is at risk?

The NHS names several risk factors for obstructive sleep apnoea:

• obesity
• a large neck
• older age
• a family history of the condition
• alcohol
• smoking
• large tonsils
• sleeping on the back
• COPD (chronic obstructive pulmonary disease)

Some of these are not changeable, but others, such as alcohol and smoking, can be discussed sensitively as part of person-centred care.

Why treatment matters

The NHS warns that untreated OSA can lead to high blood pressure, stroke, type 2 diabetes, heart disease, depression and accidents caused by tiredness. For older people and people with other conditions, the effect of poor sleep on thinking, mood and safety can be significant. Our guide to depression screening in older adults is a useful reminder that persistent low mood and tiredness should always be explored rather than assumed to be inevitable.

How is it diagnosed?

A GP can refer a person to a sleep clinic. The NHS explains that diagnosis usually involves monitoring breathing during sleep, often at home with a small device. Results are reported using the apnoea-hypopnoea index, or AHI, which counts breathing pauses and partial blockages per hour. The NHS gives these severity bands: mild is 5 to 14, moderate is 15 to 30, and severe is over 30.

Treatment options

Treatment depends on severity and the person's circumstances. The NHS lists:

• Lifestyle changes, including losing weight, taking exercise, stopping smoking, drinking less alcohol, sleeping on the side and avoiding sleeping pills unless a doctor advises them.
• CPAP (continuous positive airway pressure), where a mask delivers air under gentle pressure to keep the airway open. The NHS says CPAP is provided free on the NHS.
• A mandibular advancement device, a mouthpiece that moves the lower jaw forward.
• Surgery in selected cases.
• Hypoglossal nerve stimulation, another option the NHS mentions for some people.

The comment about sleeping pills is worth noting: sedatives can relax throat muscles and make breathing pauses worse. Never withdraw a prescribed medicine without clinical advice, but if a person with suspected or diagnosed OSA is on a sedative, make sure the prescriber knows. Our guide to insomnia, sleep disorders and Z-drugs covers sleep medicines in more depth, and a regular medicines review is the right route.

Supporting someone who uses CPAP

CPAP works only if it is used, and many people find the mask awkward at first. Care staff can make a real difference by:

• helping the person put on the mask correctly and checking that it fits without leaking or causing sore skin
• making sure the machine is clean, plugged in and the tubing is not a trip hazard
• keeping the equipment with the person on admission, hospital stays and trips away
• offering reassurance and encouraging them to keep trying, rather than assuming they have refused
• reporting discomfort, dry mouth, nasal problems or skin pressure to the sleep clinic or GP, because adjustments are often possible
• following the manufacturer's and clinic's cleaning instructions

If a person declines treatment, respect their capacity and choices while making sure they have information about the risks, and document the conversation.

Night-time observations and falls

Night staff are often first to witness breathing pauses. Record what you see, including how long pauses seem to last, whether the person wakes gasping, and whether snoring is new. Do not shake or startle someone unnecessarily, but check on them and escalate immediately if you are worried about breathing or cannot rouse them. Tiredness and broken sleep also increase confusion and the risk of falls, so it is worth linking sleep problems into the person's falls prevention plan.

Driving and the DVLA

The NHS says that people with OSA may need to tell the DVLA and must not drive if they are excessively sleepy, until their condition is under control. Staff who support people to drive or arrange transport should be aware of this and signpost to the GP or sleep clinic if there is any doubt.

Frequently asked questions

Is snoring always sleep apnoea?

No. Snoring is common, but the NHS lists loud snoring together with pauses in breathing, gasping and daytime tiredness as signs that should be checked.

Can obstructive sleep apnoea be cured?

For some people, lifestyle changes such as weight loss can reduce symptoms. CPAP and other treatments keep the airway open while they are in use, and sleep clinics can advise on which option suits the individual.

Who should I tell if I suspect it?

Share your observations with your manager or senior and the person's GP, who can refer to a sleep clinic.

Keep building your knowledge

Spotting under-recognised conditions early improves health, safety and quality of life. Explore the health and social care learning available through Learnsignal CPD to keep your knowledge current.

This article is general information for care staff, based on NHS guidance, and does not replace the advice of a person's own clinicians.