William Shakespeare wrote ages ago, “O sleep, O gentle sleep, nature’s soft nurse, how am I frightened that thou no more will weigh my eyelids down and steep my senses in forgetfulness?” Sleep is truly the sweet and restoring balm. It soothes and restores us after a long day of work and play. A good night’s sleep is very important to our overall health and ability to function effectively throughout the day. Most of us have experienced trouble sleeping at one time or another. This is normal and usually temporary, due to stress or other outside factors. But if sleep problems are a regular occurrence and interfere with your daily life, you may be suffering from a sleep disorder. Sleep disorders cause more than just poor sleep. The lack of quality sleep can have a negative impact on your energy, emotional balance, and health.
There are many known sleep disorders but one that has come recently to the fore is “obstructive sleep apnea” (OSA). Apnea literally means “cessation of breath”. You may suspect of OSA when there is restless sleep, unexplained daytime sleepiness and loud snoring at night (with periods of silence followed by gasps). Less common symptoms are morning headaches; trouble concentrating; mood changes such as irritability, anxiety and depression; forgetfulness; increased heart rate and/or blood pressure; decreased sex drive; unexplained weight gain; increased urination ; frequent heartburn and heavy night sweats.
Symptoms may be present for years or even decades without identification, during which time the individual may become conditioned to daytime sleepiness and fatigue. Individuals who generally sleep alone are often unaware of the condition, without a regular bed-partner to notice and make them aware of their symptoms. As the muscle tone of the body ordinarily relaxes during sleep, and the airway at the throat is composed of walls of soft tissue which can collapse, it is not surprising that breathing can be obstructed during sleep. Although a very minor degree of OSA is considered to be within the bounds of normal sleep there is a small percentage of people who have chronic, severe OSA.
Diagnosis of OSA is often based on a combination of the patient’s history and tests like “poly-somnography” (“sleep study”). Poly-somnography is a comprehensive recording of the biophysiological changes that occur during sleep and the test can be performed in Goa. It is usually carried out at night, when most people sleep, though some labs can accommodate shift workers and do the test at other times of the day. Mechanical measures to treat OSA include “Continuous positive airway pressure” (CPAP) device, or, “bilevel positive airway pressure” (BiPAP) device. According to findings following meticulous pressure titration you will be recommended an oral appliance (OA) which can be secured by importing the gadget through a local agent. But, by far, CPAP is the standard treatment option for OSA and generally can reverse this condition as quickly as possible.
The most serious consequence of untreated OSA is to the heart. Persons with sleep apnea have a 30% higher risk of heart attack or death than those unaffected. When OSA is left untreated it may also lead to elevated blood-pressure and to cerebral stroke. In severe and prolonged cases, increased pulmonary pressures are transmitted to the right side of the heart. This can result in a form of heart failure known as “cor pulmonale”. OSA is more common among people with thick or large necks as well as in those who smoke and are morbidly obese. A larger than average tongue can also block the airway in many people as well as a deviated septum in the nose. In babies and small children OSA is caused by swollen tonsils.
More recently, prospective studies published in the Journal of Cardiovascular Electrophysiology have confirmed a high prevalence of sleep apnea in patients with a troublesome heart rhythm disorder called “Atrial Fibrillation (AF)”. Continuous electrocardiographic monitoring in 566 people undergoing poly-somnography found that AF occurred in 5% of those with severe sleep apnea and only 1% of those without sleep apnea. Further, it has been found that those who use CPAP to treat the malady show significant reduction in the onset and recurrence of the rhythm abnormality compared with nonusers.
But here is a word of caution. Everyone that suffers from insomnia does not have OSA. So, no need to panic! The number of people who suffer from severe OSA is luckily small. Unfortunately, greater availability of sleep centers all over the world has spurred a flurry of entrepreneurial activity that potentially fosters overdiagnosis and overtreatment of obstructive sleep apnea (OSA). The end result sadly is a business-driven “apnea mill” approach to diagnosing and treating sleep disorders with potentially unscrupulous and costly results.
The next time you are troubled with a sleep disorder don’t immediately jump to the conclusion that you suffer from OSA. Consult an honest physician or a psychiatrist who will not only diagnose your problem but will guide you as to the best management approach in your particular instance.
And as a parting advice to all those who are troubled with insomnia, let me quote Dale Carnegie, “If you can’t sleep, then get up and do something instead of lying there worrying. It’s the worry that gets you, not the lack of sleep.”
(Dr. Francisco Colaço is a seniormost consulting physician)
