Obstructive Sleep Apnea

If your sleep is disturbed by loud snoring, choking sensations, gasping efforts for breathing and excessive daytime tiredness and sleepiness, you might be suffering from “Obstructive Sleep Apnea Syndrome (OSA)”.

OSA is a serious sleep related breathing disorder where a person stops breathing hundreds of times in one night during sleep. The period may last for 10 seconds to more than 2 minutes at a stretch and thus could be life threatening.

Sleep apnea—chronic sleep disorder—sufferers survive turmoil in bed day after day, but they remain oblivious to the fact. The struggle ensues in their slumber for catching their breath, which invariably disrupts their sleep and reflects in their cranky mood. Prolonged hours of sleep refuse to refresh them and they are tired all the time. Often, they catch up on their sleep by dozing off at the unlikeliest places—over dinner, during meetings and even behind wheels, which can jeopardise their lives.

High Prevalence: 30-40% of the population snores. A total of 4-6% of the population suffers from significant OSA. Thus in our country alone we might be having 4-6 crore sufferers of OSA. It is thus a major health problem.

What causes OSA?

• Short flabby neck
• Smaller or narrow lower jaw
• Receding chin
• Bulky palate
• Bulky tongue
• Maladjustment of upper and lower jaw

Obstructive sleep apnea is caused by a narrowing or collapse of throat tissues during sleep. Blood-oxygen levels plummet, and the body responds by sending out a flood of hormonal emergency signals. The sufferer wakes, sometimes 30 or more times an hour, his or her body in full “flight or fight” mode.

Aggravating Factors:
• Obesity
• Alcohol
• Smoking
• Use of Sedatives, Hypnotics and tranquilisers

What makes episodes of sleep apnea scary is that the sufferers are ignorant about their struggle to catch breath while they are asleep. Routine blood work is incapable of diagnosing this chronic sleep disorder. While daytime drowsiness is a significant symptom of sleep apnea, snoring, reduced attention span, dozing off at inappropriate times and high blood pressure are important indicators too. Moreover spouses of the patients may help in diagnosing the disorder, as they might have witnessed their significant other’s struggle to grab mouthful of oxygen.
Understandably, sleep apnea makes one sleep deprived and robs off the restorative properties of sleep. As if this was not enough, latest research studies have more bad news. Sleep apnea can lead to worse things — such as serious car wrecks, heart disease, diabetes, and pregnancy complications.
Importance of this condition also lies in that it can be easily diagnosed and effectively treated, thus reducing the risk factors of cardiac, and vascular disorders and above all improving the quality of life.
OSA can easily be diagnosed by an overnight sleep study which can be performed in a specialized sleep laboratory or at the home of the patient. The new modular diagnostic systems are geared up to perform the study any where.
Treatment Options :
The goal is to keep the airways open so that breathing happens non-stop during sleep. Following measures help–
1. Life style changes: Avoidance of alcohol, smoking and sleeping pills.
2. Reduction in weight

In Mild cases:
• Surgical procedures like Adeno-tonsillectomy in children is treatment of choice.
• In adults – Somnoplasty (Radio-frequency Ablation causing volumetric reduction of soft pate and tongue), surgeries like Laser assisted uvuloplasty are performed. These are more effective for snoring.
• In some cases dental devices like “Mandibular Advancement Appliances” are used to pull forward the lower jaw thus maintaining the patency of airways.

4. The Gold Standard of treatment of OSA is Nasal CPAP (Continuous Positive Airway Pressure) systems, which are computerized flow generators and act as pneumatic splints for maintaining the patency of airways during sleep. In this a mask is attached to nose, mouth or both which is connected to the machine through a hose pipe which gives the necessary pressure and prevents the stoppage of breath.
5. Types and costs of CPAP.: Today there are numerous types of machines which are available.
• Fixed pressure CPAP – Rs. 25000/- to Rs.60000/- with or without heated humidifier
• AutoCPAP(Changes the pressure automatically as per the requirement of the patient. – Rs. 60000/- Rs.100000/-
• BiPAP (Bilevel Positive Airway Pressure) fixed and automatic – Rs.80000/- – Rs.120000/-

Dr. Sanjay Manchanda
Senior Consultant
Department of Sleep Medicine
Sir Ganga Ram Hospital

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2. Good Night. Sleep Tight.
3. Six Signs of Sleep Deprivation
4. How Obesity Threatens Your Health
5. Sleep like a baby