Don’t sleep over it – Sleep Apnea

It is a known fact that having a good amount and quality of sleep benefits the heart, weight, mind and body. It helps in energizing the whole system. However, unhealthy food habits and lack of physical activity are factors that can hamper sleep. One condition that a lot of people suffer from is Obstructive Sleep Apnea (OSA).

Sleep Apnea:

The word apnea means no breathing. The upper airway is held open by the tone of the muscles forming the airway walls. During deep sleep, the muscles reduce their tone and the upper airway gets narrower. A little narrowing leads to snoring, more narrowing leads to hypopnea (“less breathing “), while a complete blockage leads to apnea. If the blockage lasts sufficiently long, the oxygen in the person’s blood falls. The episode ceases when the person’s sleep gets disturbed from a deep to a light stage of sleep or by waking up completely (“arousal”).

The risk factors for sleep apnea include obesity, structural abnormalities in the upper airway, a familial history of sleep apnea, hormone disorders like hypothyroidism and polycystic ovary syndrome, smoking and alcohol abuse.

Symptoms of sleep apnea:

Symptoms of sleep apnea can be categorized into night time and daytime symptoms. Night time symptoms include heavy snoring, apneas (breathing stops for 10 seconds or more) witnessed by the bed partner, choking, frequent urination, sweating, erectile dysfunction, acid reflux and unrefreshing sleep.

Daytime symptoms include excessive daytime sleepiness, difficulty in concentration, memory loss, irritability, fatigue and depression.

Diagnosing Sleep apnea:

Adults who have symptoms of sleep apnea can screen themselves using a questionnaire which is popularly known by the acronym STOPBANG.  STOPBANG refers to

  • S- Snoring
  • T- Tiredness
  • O- Observed apneas
  • P- Blood pressure
  • B- BMI (Body Mass Index-Weight in kgs/ (height in meters) 2) >35 kg /m2
  • Age >50 years
  • Neck Circumference >16 inches and
  • Gender- Male

People who score 3 or more in this questionnaire should see a sleep medicine specialist and undergo a sleep study.

A sleep study is a non-invasive, overnight exam that allows doctors to monitor you while you sleep to see what’s happening in your brain and body. For this test, the patient goes to a sleep lab that is set up for overnight stay usually in a hospital or a sleep center or at home. A sleep study will also measure brain activity, oxygen levels in your blood (through a sensor), heart and breathing rates, snore, and body movements. These parameters assist the clinician in deciding the severity of the disease. Audios and videos on the mobile camera also provide a fair degree of information to the physician. The cardiac assessment may be needed in a small group of children with longstanding Obstructive Sleep Apnea. The key figure looked at is the apnea-hypopnea index. This represents the number of obstructions to breathing, complete or partial during sleep, and is used to decide the need for treatment.

Prevention of sleep apnea:

Precautionary measures like weight reduction, regular exercise, sleep hygiene (Do’s-Go to bed at the same time each day ,get up from the bed at the same time each day, keep the bedroom quiet when sleeping, keep the bedroom dark enough to facilitate sleep and Don’ts-Read or watch television in bed, exercise just before sleep ,have caffeine in the evening, staring at the mobile screen)  and prompt recognition and treatment of correctable causes for sleep apnea can help in correcting sleep apnea both in adults and children. Apart from the above avoidance of smoking/alcohol consumption among adults also can reduce the chances of being affected by the condition.

Treatment:

The treatment strategy of sleep apnea includes Continuous Positive Airway Pressure (Auto–CPAP) delivered through a face mask/nasal mask besides other precautionary measures.

If there is an abnormal growth such as tonsils or adenoids obstructing the airway, surgery to relieve the obstruction may be advised. If the patient is unwilling to use these measures, a device called Mandibular advancement device can be used to advance the lower jaw during sleep.

Dr. Ishan Ashok Capoor
Consultant – Pulmonology
Narayana Medical Centre, Langford Town
Bangalore

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