Sleep Apnea .
Sleep is a natural physiological state of the body where our brain is inactive, muscles relaxed, and consciousness practically suspended. Sleep is an essential part of our routine and it helps the body 'regenerate and rejuvenate'. We spend one third of our life in sleep and we never bother about it.
Sleep is important as our body undergoes a lot of changes during that time. It allows the body to rest, relieves tiredness, and most importantly restores our cognitive (thinking) ability. During sleep there is active hormone production, which is essential for good metabolism and maintaining homeostasis or body balance. In addition, there is a decrease in the heart rate, heart function and drop in blood pressure.
The American Association of Sleep Medicine has given guidelines as to the amount of sleep you require to promote optimal health:
-Infants and children- 10 -16 hours
-Teenagers- 9-10 hours
-Adults- 7-9 hours
Unfortunately, sleep is a very underrated and under diagnosed problem. The consequences of sleep disorders involve multiple parts of the body including risk of stroke, heart attack, memory loss, depression to name a few. We do not have much data for our country, but the Western data shows that a significant number of their population is sleep deprived and has sleep disorders. Consequences of this include loss of productivity, road accidents, accidents at work place. In fact, the West has strict laws with sleep disorders and driving. One’s license is suspended till they comply with treatment.
The types of sleep disorders include:
Snoring, Obstructive Sleep Apnoea (OSA), Obesity Hypoventilation Syndrome (OHS), Central Sleep Apnoeas, Parasmonias (sleep walking, sleep talking, sleep paralysis, confusional arousals, nightmares), Restless Legs Syndrome, Insomnia to name a few.
The commonest and most important amongst these are sleep disordered breathing (OSA, OHS). The patient, more so the partner witnessing, would have complaints of excessive or loud snoring, choking or gasping sensations, intermittently stopping breathing, needing to go to pass urine at night, dry mouth, waking up unrefreshed, unable to concentrate at work, daytime sleepiness, and morning headaches.
As doctors, we would screen for this in patients who have the above symptoms or who have difficult to control hypertension, diabetics who require excessive medication, co-existent heart disease, abnormal heart rhythms, and the overweight and obese.
Common risk factors for this condition are: Obesity, Male gender, Post-menopausal women, increasing age, pregnancy, alcohol or sedative use, smoking, family history, genetic disorders.
Our lifestyle has a big role to play in the increasing prevalence of this condition. In todays 'fast food' era and instant technology where one can access work, play, and entertainment at the finger tip, we are moving into a society with a sedentary life style in addition to increased calorie intake with instant foods and beverages. We as a young nation are growing into an obese nation, which is a known risk factor for OSA. In addition, social media and online working results in poor sleep hygiene and quality leading to other sleep disorders such asinsomnia and addiction to the same. This results in poor sleep quantity and quality, both of which affect sleep and hence health.
How do we diagnose: The gold standard test for diagnosis is a sleep study or polysomnography. This is an overnight test that records brain activity, eye movements, heart rate, oxygen levels, body movement, and more and diagnoses the condition. It can be carried out at home or in the hospital depending on one’s symptoms and condition. Limited studies with less monitoring can also be done, again, depending on the patient’s complaints.
The treatment of sleep disordered breathing depends on it’s severity. A CPAP of BiPAP device is used to treat this condition. Here a mask is attached on the nose or face of the patient, which has tubing and machine, which blows air in and helps the patient sleep and breathe normally. In patients with mild disease lifestyle modification such as weight loss, exercise, smoking cessation, avoiding alcohol is advised. Sleep hygiene is advocated with patients who have difficulty falling asleep.
