How Well Do You Sleep?

How well do you sleep? It’s a crucial question to ask in modern times. Add to it queries like - Do you sleep soundly yet feel sluggish through the day? Do you wake up often during the night? And of course - Do you snore?

Well, if the answer to any of these questions is in the affirmative one could be suffering from a condition known as Obstructive Sleep Apnea or OSA.

Medical experts underline that OSA is the mother of all major cardiac and other morbidities in adults as well children. Recent studies have placed the prevalence of OSA at an average of 22% in men and 17% in women.

The magnitude of the problem can be gauged from what Professor Sandeep Bansal who heads the Sleep Lab Department of Otolaryngology and Head Neck Surgery at the Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh has to say.

On the occasion of World Sleep Day that falls on March 18, he said that while there can be multiple reasons for sleep apnea, being obese or overweight is the one of the main causes, and it is treatable. “We see around 30 new patients of OSA every month and undertake 15-20 sleep studies a month… It has been observed that obesity predisposes to OSA.”

It was the recent demise of one of Bollywood’s iconic music composers and singers Bappi Lahiri that had people asking, can a person succumb to death in their sleep? Experts say that the answer is yes if one is suffering from an undiagnosed sleep condition.

OSA is perhaps the most feared but untreated conditions in society. A poor quality of sleep at night is often sorted out by taking a pill. Thus, the cause often remains undiagnosed and untreated. But OSA is definitely not the sort of problem one can solve with a sleeping pill!

Dr Bansal explains what makes OSA different from other sleep disorders. “When we say a person is having difficulty to sleep at night, it could be due to two reasons: either the person is unable to fall asleep, or the person does fall asleep at night but wakes up several times due to breathlessness. The two conditions are very different from each other - the first one is a case of insomnia in which you’ll visit a psychiatrist, while the second one is a case of OSA.”

Experts add that OSA was identified as an independent risk factor for covid infections that resulted in hospitalization. Hence the importance of diagnosing OSA has grown all the more during this pandemic.

“OSA usually happens because of repetitive narrowing of the airway during sleep despite breathing efforts. The person will unknowingly stop breathing repeatedly throughout sleep. Once the airway is opened or the breathing signal is received, the person may snore, take a deep breath, or awaken completely with a sensation of gasping, smothering, or choking,” the experts shared.

Professor Naresh Panda who heads the ENT Department at the PGIMER said that untreated sleep apnea can lead to potentially serious health complications such as heart disease, blood pressure, diabetes and depression. It can also leave a person feeling drowsy, increasing the risk of accidents while driving or working and loss of concentration at work and subsequently poor productivity. So early recognition of the problem and getting it treated is of utmost importance.

They shared some fast facts on sleep apnea:

· Around 1 in 5 adults have mild symptoms of OSA while 1 in 15 have moderate to severe symptoms

· Approximately 1 billion people globally have this condition, but only 20 percent have been diagnosed and treated

· Menopausal and postmenopausal women have an increased risk of OSA

· Sleep apnea is an independent risk factor for hypertension (high blood pressure)

The problem has not spared even children, among whom the OSA rate is 1% to 3% on average, with obese and high risk children facing a 20-50% of falling prey to the malady. Experts say that enlargement of the tonsils and adenoids is the most common cause of OSA in children, and 85% of the children can be cured of their OSA by an adenotonsillectomy.

Signs and symptoms of sleep apnea among children might include snoring, pauses in breathing, restless sleep, snorting, coughing or choking, mouth breathing, bed wetting and sleep terrors.

According to experts, “During the day, children with sleep apnea might perform poorly in school, have difficulty paying attention, learning problems, behavioural problems, poor weight gain or even being hyperactive.

If you are diagnosed with OSA, it is the Apnea Hypopnea Index that determines which treatment is given. An AHI of less than 5 events per hour is considered normal, 5-15 is considered indicative of mild apnea, 16-30 moderate and more than 30 severe. An AHI exceeding 30 can be life threatening and immediate treatment is advised.

Dr Bansal said there can be medical as well as surgical treatment options in carefully selected patients, but lifestyle modifications like exercise and weight modification are the most useful adjunct in both treatment forms. CPAP or Continuous Positive Airway Pressure devices that use a hose connected to a mask or nosepiece to deliver constant and steady air pressure to help one breathe while sleeping should be the first line of treatment before surgery.

He explained that with improvement in understanding the disease pathology and with the use of drug-induced sleep endoscopy to evaluate the different levels of airway obstructions, ENT surgeons are able to offer much better surgical treatment plans for OSA patients, with a much better success rate among patients who are not able to tolerate CPAP or do not want to continue with CPAP for various reasons. The bottom line of course is that it is a highly specialized and challenging surgery which should be done only by a surgeon specially trained in these procedures.

Dr Bansal said that OSA affects an individual’s productivity and is being neglected in spite of the fact that its treatment can prevent many co-morbidities in future. Studies show that OSA can increase the chances of road accidents. This is because people with OSA do not get enough sleep and so can become drowsy while driving. Further, a drop in oxygen level while sleeping can cause the body to release adrenaline to such a level that it causes a sudden cardiac arrest. About 19% of people with severe sleep apnea have died as mentioned in recent studies.

“So, snoring is not a regular event and should not be ignored. If you know someone who is snorer or someone who finds it difficult to sleep at night due to sudden choking sensation in the neck, you must refer the person to a sleep surgeon for management of this condition. We have and are carrying out many research projects so as to improve the surgical treatment options for OSA,” he said.