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Obstructive sleep apnoea — a snorer’s disease
Are you having a pause in breathing during sleep? If yes, you may be suffering from sleep apnoea. Complete or partial obstruction of the airway during sleep causes loud snoring, a fall in body oxygen and frequent arousals. As a result, the sufferer has unrestful sleep and excessive daytime sleepiness. Incidence of hypertension, heart attack and stroke is higher in such patients. These patients often have impotence and emotional problems, depression, mood changes, poor memory, irritability and impaired concentration.
What are the causes? Sleep apnoea is caused by repetitive airway obstruction during sleep as a result of the narrowing of the upper respiratory passages. Such patients are often overweight, with extra fats deposited in throat and / or with an increased size of the velum and tongue leading to decreased upper airway lumen. Decreased airway muscle tone during sleep and falling of the tongue backward in the lying posture further reduce airway opening, thereby hindering airflow.
Patients with a severe form of the disease may have such episodes hundreds of times in an hour. This sleep fragmentation causes sleep deprivation and hence excessive daytime sleepiness.
How to diagnose sleep apnoea? Even though sleep apnoea is as common as asthma and diabetes, it often remains undiagnosed. The studies suggest that middle-aged 2 per cent women and 4 per cent men have symptomatic obstructive sleep apnoea. Since it is associated with significant misery and mortality, the disease must be suspected in the patient who complains of snoring or daytime sleepiness to pick up such cases at the earliest.
All suspected cases must undergo the “polysomnography test’ [sleep study] to confirm the diagnosis. In this technique, multiple physiologic parameters are measured while the patient sleeps in a laboratory.
How does a typical case behave? Most patients are overweight and typically have a short, thick neck. Middle-aged men and post-menopausal women are at a higher risk for the disease. The patient is often brought to the doctor by a family member who is being disturbed by the patient’s loud snoring. The partner may describe episodes in which the patient stops breathing and then gives a loud gasp when aroused by the breathing cessation.
The snoring and breathing cessation episodes may be worse after the patient drinks alcohol or takes sleeping pills, because these decrease throat muscle tone. Frequently, the patient falls asleep during sedentary activities, such as watching television or movie. In severe disease, the patient may report falling asleep in embarrassing situations, such as during meals or when sitting in a car stopped at a traffic light. The patient also complains of being tired on awakening in the morning. The patient often has to nap during the day but typically wakes up unrefreshed.
What are the treatment choices? The options include Continuous Positive Airway Pressure [CPAP] treatment, wearing an oral appliance at night, surgery and lifestyle changes like smoking cessation and weight loss. However, CPAP is the most common, most effective treatment and is considered as gold standard for these patients. With CPAP, the patient wears a snugly fitting nasal mask attached to a fan that blows air into the nostrils to keep the airway open during sleep. Actually, it serves as “air splint” that keeps the airway from collapsing, thereby preventing breathing cessation.
DO YOU HAVE SLEEP APNOEA?
If you snore excessively and have any of the additional problems listed below, you may have sleep apnoea. Please consider discussing a sleep evaluation with your doctor
1. Do you snore loudly?
2. Does your bedroom partner complain about your snoring?
3. Does your snoring wakes you up at night?
4. Do you or your bedroom partner notice that you make gasping and choking noises during sleep?
5. Do you have a dry mouth, sore throat or headache in the morning?
6. Do you often fall asleep during the daytime when you want to stay awake?
7. Are you often tired during the day?
8. Do you have high blood pressure?
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