Face mask can help combat mild cases of sleep condition

The CPAP machine

A night time face mask can improve energy levels and vitality in people who suffer from the condition sleep apnoea.

This is the finding from a new study of over 200 patients, published in the journal The Lancet Respiratory Medicine, led by Imperial College London.

We are seeing increasing cases of sleep apnoea, and in a wide range of patients. Professor Mary Morrell Study author

The research, conducted at 11 NHS sleep centres across the UK including the Royal Brompton & Harefield NHS Foundation Trust, is one of the first to investigate the use of the treatment for mild cases of sleep apnoea. The mask – called a CPAP machine - is currently only recommended for people whose sleep apnoea is moderate to severe.

Sleep apnoea affects over one billion adults globally, and causes the airways to become too narrow during sleep, causing people to briefly stop breathing many times throughout the night.  It can also trigger loud snoring, and cause frequent awakening from sleep, and subsequent daytime sleepiness.

Severe cases of sleep apnoea are thought to affect up to 1.5 million in the UK, with some estimates suggesting up to eight million people in the UK may have a mild form of the condition.

Mask keeps you breathing 

One treatment is a mask that fits over the nose or mouth called a continuous positive airway pressure (CPAP) machine, which gently pushes air into the mouth and throat, keeping the airways open.

Although previous trials have found a CPAP machine to improve symptoms of moderate to severe cases of the condition, this is the first large trial to find that mild cases of sleep apnoea can also be treated with this technology.

Mary Morrell, Professor of Sleep and Respiratory Physiology at the National Heart and Lung Institute at Imperial, and lead author of the research, said: “We are seeing increasing cases of sleep apnoea, and in a wide range of patients. Although the condition was previously thought to mainly affect overweight men, we now know it also strikes post-menopausal women, the elderly, and even children."

Professor Morrell, who is also honorary researcher at the Royal Brompton Hospital, added: "Around 60 per cent of all cases of sleep apnoea are classed as mild, but until now we didn’t know whether a CPAP would be helpful to these patients.”

In the study, 115 patients were asked to use the CPAP for three months, while 118 received standard care for mild sleep apnoea, which includes advice on improving sleep and avoiding anything that can exacerbate the condition, such as drinking alcohol before bed.

Tackling daytime sleepiness

The research revealed those who used the CPAP machine had an improvement of 10 points on a so-called vitality scale, compared to those who received standard care.

Currently the NHS doesn’t routinely offer CPAP machines to cases of mild sleep apnoea, but our research suggests this treatment should now be considered Dr Julia Kelly Study author

The vitality scale assesses a range of factors such as sleep quality, energy levels and daytime sleepiness. The researchers also saw improvements in a number of additional factors among the patients who used the CPAP, including fatigue, depression, and social and emotional functioning.

The researchers explain they have not yet conducted an economic analysis of the cost to the NHS of treating mild cases of sleep apnoea with a CPAP machine. In previous studies they have shown that, if used correctly, the machines are cost-effective (using the criteria for cost-effectiveness defined by the National Institute for Health and Care Excellence)  

Dr Julia Kelly, first author of the paper, said: “Currently the NHS doesn’t routinely offer CPAP machines to cases of mild sleep apnoea, but our research suggests this treatment should now be considered.”

The research was funded by ResMed, who manufacture CPAP machines, but the funder had no involvement in the trial methods or data analysis.

"I was falling asleep in the classroom"

Patricia Ware, 62, from Southall, tried a CPAP machine after being diagnosed with sleep apnoea at age 60. She explains:

“My energy levels had been low for a while, but I started to consider whether I should see my GP when my husband told me I was snoring very loudly. At one stage I even woke myself up through snoring.

“I finally decided to make an appointment when I started nodding off at work. I was working at a school at the time, and during the day colleagues told me that I’d fallen asleep. I was horrified as I didn’t remember drifting off.

My doctor sent me for tests at Harefield Hospital, and the medical team asked if I wanted to take part in a trial using a CPAP machine.  At first it felt slightly strange – and involved wearing a mask that just fitted over my nose.

However it was soon discovered I was a mouth-breather, and so I was given a mask that covered my nose and mouth.  After initial adjustments I found the machine very comfortable, and now don’t even notice I’m wearing it.

After a year and a half of using the machine I now feel like the old me – I have my energy levels back, and am now working as a steward at a football training ground, and have not fallen asleep at work since.”

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"Continuous positive airway pressure versus standard care for
the treatment of people with mild obstructive sleep apnoea
(MERGE): a multicentre, randomised controlled trial" is published in the journal The Lancet Respiratory Medicine.