Things, I might have missed – Part 1

Things, I might have missed – Part 2
July 14, 2019

SLEEP Disorders (Sleep Apnea)

Introduction to Sleep Apnea

Even a decade back, there was hardly any awareness about this disorder. Today, on search, you will get millions of articles & information ona special type of sleep disorder, ‘Sleep Apnea’

Why I am reading this article ?
Either you are diagnosed as having‘sleep apnea’. Or, you got some strange cluster of symptoms and wondering whether you are suffering fromthis diseases. And, whatever may be the scenario, this might be the 50th article that you are reading on this topic!!Yet, still remain clueless on ‘what next’!!
But, is this a serious ailment at all? Can Sleep Apnea kill me !!??
There are evidences that long-term sleep-disordered breathing can have important health consequences. It may increase the incidence of high blood pressure (hypertension), diabetes, and heart problems. In short, yes, untreated sleep apnea will graduallymake your life miserable by developing multiple complications and also can kill youin one go during the sleep !!

But, nothing to get worry that much, as specific therapy and management can bring your life back to normal track.
One should understand, Sleep Apnea can bother life many way, mealy not by just killing !!Here are some health problems you might face if you have Sleep Apnea:

1. High blood pressure. If you already have it, sleep apnea can make it worse. When you wake up often during the night, your body gets stressed. Also, the level of oxygen in your blood drops when you can’t breathe well.

2. Heart disease. People with Obstructive Sleep Apnea are more likely to have heart attacks.The causes may be low oxygen or the stress of waking up often. Sleep apnea disrupts how your body takes in oxygen, which makes it hard for your brain to control how blood flows in your arteries and the brain itself.

3. Type 2 diabetes. Sleep apnea is common among people with this condition -- 80% or more of diabetics may have OSA.

4. Weight gain. Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. When you’re overweight, you can have fatty deposits in your neck that block breathing at night. The good news? Treatment for OSA can make you feel better, with more energy for exercise and other activities. This can help you lose weight, which can help your sleep apnea.

5. Adult asthma. Science hasn’t proven a link to OSA, but people who get sleep apnea treatment may find they have fewer asthma attacks.

6. Acid reflux. There’s no proof that sleep apnea causes this kind of heartburn, but many people say it’s a problem. Treating reflux seems to improve apnea symptoms for some people, and treating OSA helps symptoms of reflux, sleep doctors say.

7. Car accidents. When you feel groggy, you raise your risk of falling asleep at the wheel. People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents.

Okay,but do I really have Sleep Apnea?
Hold !! Don’t jump in to any conclusion. Rather go ahead step by step.

First, let me introduce our friend Varun here.

Varun is in his late 40s and a busy Insurance agent. His wife, Lily is a school teacher and a lovely homemaker. Varun is one of the top
performing agent of LIC in his region and keep really busy with his clients round the clock. Even a year back, Varun was very health and energetic. In spite of all his work pressure and related mental stress, he used to spend some time at the pool each evening. But, since last couple of months the scenario is getting changed fast and Varun got no idea , what’s happening !! His overall energy level got reduced. He always started feeling excessivelysleepy during daytime. Even after a tight sleep atnight, he doesn’t feel fresh in the morning. He is losing appetite yet putting on weight. Lilly is complaining about his loud snore with intermediate choking sound throughout the night, which was not that much prominent earlier. Due to lack of energy and extreme fatigue Varun stopped going for swimming even. He started making silly mistakes in his work regularly and being highly forgetful. Incidentally, Varun started feeling less or no sexual urge which started putting his relationship with Lilly under huge stress. Varun was a diabetic patient and since last couple of months the sugar level has increased very high.

Initially he considered increased work pressure being the reasonand never bothered to visit a doctor. Unfortunately, symptoms aggravated further and Lily forced him to visit their house physician.

After listening the whole episode, the doctor asked couple of specific questions to Varun:

  1. Do you suffer from morning headache frequently?
  2. Even after a quantifiable hours of sleep at night, do you feel dull and tired in the morning, as if, you have not slept for long time?
  3. Did your wife ever complain about your high snore with intermediate breathlessness?
  4. Do you feel lack of energy throughout the day?
  5. Have you ever fall asleep while driving?
Surprisingly, in all first four question, Varun’s response was a big ‘yes’. Regarding the 5th one, though he never fall asleep while driving, but many a times he fall asleep while watchinghis favourite exciting IPL cricket matchon TV and even sometimes the remote fall down from his hand .

The physician advised for some blood test along with atest, called Polysomnography Sleep Study.
I come to know that, Sleep test can be done both in hospital/sleep lab and even at my own home. Which one is better?
Well, Sleep Test or polysomnography is an overnight test to evaluate multiple physiological parameters of the body during sleep. Parameters such as Eye movement, Leg movement, Chest Movement, EEG, EOG, EMG, Oxygen Saturation in blood ( SPO2 ), Snoring, Sleep Position etc. are recorded.

The process is very simple. Couple of wires ( The number of wire varies with the desired number of parameter to be recorded) to be fixed with different body parts with clip or probe. A data recording device is also connected with these wires. This is a small device and to be fixed on the patient’s chest with a normal strap. The patient just needs to switch on the device to start recording before going to bed for sleeping.

Now, practically, it is quite unlikely that one can have a normal sleep with all these devices and wires attached to his body. And, it will be more challenging if he is asked to sleep in a hospital room or at a Sleep Lab, instead of his own homely comfort.

Due to this reason, most of the physicians these days recommend a home sleep test.

Varun got his overnight Sleep Test report. What are the most important parameter to check?
Pauses in breathing up to 5 times per hour in adults is considered normal. If breathing disruptions happens more than five times in an hour, due to physical obstruction in the upper respiratory tract, then the patient is considered to have Sleep Apnea. The supply of Oxygen to brain & body reduced due to narrowing of air pathways. The following categories are used to classify sleep apnea based on the apnea-hypopnea index (AHI):

  • Mild: 5-15 events per hour
  • Moderate: 15-30 events per hour
  • Severe: More than 30 events per hour
For our friend Varun, the AHI was detected as 45. Which is quite severeas per the category list.
Along with the number of Apnea ( breath sensation), It is also important to evaluate the degree of oxygen deprivation that occurs with these events. When oxygen levels fall below 90%, this is called hypoxemia. Chronic oxygen deprivation may lead to both short-term and long-term effects. During the sleep study, Varun’s Oxygen saturation falls to 67%, which is very alarming.

Now, the physical examination, blood report and the sleep parameters confirms Varun to have Obstructive Sleep Apnea. The doctor advised him to start using a CPAP machine during his sleep at night. Learn more about LIVING WITH CPAP.
Let’s see, who got high chance to develop Sleep Apnea ?
You are much more likely to have sleep apnea if you are overweight or obese. However, sleep apnea can occur in slim people too. Common risk factors for sleep apnea include:

  • Excess weight: Your risk for sleep apnea is higher if you are overweight with a body mass index (BMI) of 25 or more or obese with a BMI of 30 or higher.
  • Large neck size: Your risk for sleep apnea is higher if you have a neck size of 17 inches or more for men, or 16 inches or more for women. A large neck has more soft tissue that can block your airway during sleep.
  • Middle age: Sleep apnea can occur at any age. However, it is more common between young adulthood and middle age.
  • Male gender: Sleep apnea is more common in men than in women. For women the risk of sleep apnea increases with menopause.
  • Hypertension: High blood pressure is extremely common in people who have sleep apnea.
  • Family history: Sleep apnea is a heritable condition. This means that you have a higher risk of sleep apnea if a family member also has it. Other common family factors - such as physical activity and eating habits - also may play a role.
So, when should I consult a Doctor:

In a simple way, if you experience most of these symptoms mentioned below, book appointment with your doctor without wasting much time.

  • Loud or frequent snoring
  • Silent pauses in breathing during sleep
  • Choking or gasping sounds during sleep
  • Daytime sleepiness or fatigue
  • Unrefreshing sleep
  • Insomnia
  • Morning headaches
  • Nocturia (waking during the night to go to the bathroom)
  • Difficulty concentrating
  • Memory loss
  • Decreased sexual desire
  • Irritability
Which DOCTOR should I consult with for Sleep related issues ?
Somnologists are trained for treating sleep disorders. In India, such patients are being seen mostly by Pulmonologist (Chest Specialist) and ENT specialists. Many a times Cardiologist and Neurologists are also treat these ailment.

Well, as of now we have seen how Varun was diagnosed as having a disease called Sleep Apnea. We have also understood how fatal this disease can be. And, who got high chances to develop these disease. As you know, Varun was advised to use CPAP machine along with some life style modifications. He started using CPAP during his sleep every night. Though he faced some initial challenges, but now he is doing perfectly well. We will discuss Varun’s journey thru his ‘Sleep Apnea management’ in part two of this blog.

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