Obstructive Sleep Apnoea

Obstructive Sleep Apnoea is real. Often misconstruction as just snoring, the sleep disorder can raise the risk of heart disease and other serious health issues. A person suffering from obstructive sleep Apnea is unable to get deep sleep as the upper airway gets blocked

 It occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed.

Its a the most  common sleep related  breathing disorder. Since the life threatening medical condition is often mistaken for  just a snoring disorder. It is a major cause of divorce and road traffic accidents. 

Introduction

Obstructive sleep Apnea occurs when one's breathing repeatedly stops and starts while one is asleep. Episodes of not breathing can last a few seconds to a few minutes. It may happen 5-30 times or even more in an hour.

In most cases breathing stops when the airway collapses., blocking the flow of air into  and out of lungs. In a rare form, the episodes result from a problem with how the  brain controls breathing. Sleep apnea can be managed with proper treatment. How ever when left undetected  and not treated, it raises the risk of heart disease and other serious breath problems.

While the health condition can go undetected for several years, there are several ways in which the disease can affect one. OSA can affect people of all ages, including babies and children, and seen mostly over the age of 50.

Obstructive Sleep Apnoea, It is called obstructive because our upper respiratory airway is choked. Its muscles are so relaxed that it blocks the air passage. It causes the obstruction in the upper airway when you sleep and the problem starts. Typical history that patient passed off while sleeping due to  oxygen drops in oxygen level.

When one sleeps at night , the oxygen level is reduced due to the reduced airway passage. As the  body is deprived of oxygen,  brain is also deprived of oxygen. The main complication is one becomes weak, lethargic, put on weight, the person becomes more weak and the vicious cycle goes on. There are neuro - psychiatric illness. Heart is also affected, causing high Blood pressure, heart attack, Metabolic problem like increase in blood sugar. . Eye is affected having glaucoma, or dry eyes.  Obesity can manifest which itself can cause number of problems. If one drives vehicle in lethargic  this condition chances of accidents are there.

After using C-Pap Machine people become active, weight also decreases. One has to use it at night. In serious patient  it is also used in day time. You can monitor the machine also if it is working or not.

                                  

Central Sleep Apnoea 

Risk Factor

• Males are more susceptible to Obstructive Sleep Apnoea. Female can also be affected.
• This problem increases with the age.
• Family history also contributes to this problem.

Causes

●  Obesity
●  Asthma
●  Smoking
●  Alcohol
●  High Blood Pressure
●  Diabetic
●  Small size of neck
●  Double chin
●  Obesity / overweight
●  Enlarged tonsils can cause obstruction.
●  Any E.N.T problem
●  If a person is lethargic
●  Insomnia, unable to sleep at night feels restless and suffocation at night

●  Down's Syndrome

Signs & Symptoms.

●  Snoring loudly at night affecting quantity and quality of sleep.

●   When the obstruction is severe, the oxygen supply to the various body organs is affected leading to Apnea.(stoppage of breathing).
●  Because of lack of oxygen they suffer from variety of  neuropsychiatric symptoms such as 

   -  Day time sleepiness,

    -  Irritablity and lack of concentration.
●  Early morning headaches
●  Dry mouth upon waking up
●  Sudden awakening with sensation of choking
●  Restlessness in sleep
●  Loss of memory and lack of ability to function due to which critical thinking can be impaired.
●  Feels lethargic  whole day, even after full night sleep.  Due to this accidents may occur.

●  There is a problem while getting up in the morning.
●  Sometimes person has to get up at night number of times.
●  They feel sleepy in sitting posture.
●  Feel suffocated while sleeping at night., patient try to sit at night..
●  There is sweating at night.
●  Patient feels depressed and have anxiety.
●  Blood pressure can be high.
●  Acidity and flatulence can be there.
●  Frequency of micturation is there at night..
●  Frequent sore throat infections
●  Obesity
●  Depression or anxiety. 
●  Large tonsils , a small jaw, a large overbite, a recessed chin, or a large neck are also at risk. Structural abnormality reducing the  diameter of the upper airways, such as nasal obstruction, a low hanging soft palate.

Overbite

Smaller Jaw

A recessed chin

Common Effects

●  A lack of sleep can leave you mentally foggy it will also make it hard to solve problems or think clearly.
●  It can weaken your immune system, leaving you more vulnerable to any kind of infections.
●  Fatigue, disorientation, drowsiness, difficulty staying awake during day.

History

●  A typical history that a person died in his / her sleep.

Diagnosis

Difficult to diagnose, Patient come to the doctor when the condition is deteriorated.

Physical Clinical

●  Polysomnography /  Sleep Study : One have to sleep with mask on (along with the machine) minimum for 5-6 hours. And the report comes on the next day. Oxygen level will be monitored, respiratory rate will be checked. Heart beat will be monitored. Brain wave will be checked. No need for admission in the hospital. This test can be done at home. It cost around Rs 3000- Rs 5000.
●  E.N.T Check up : A  must.

Lifestyle

●   Eating a light dinner.

●    Losing weight

●   Not smoking

●   Avoid alcohol

Walk

Yoga

Meditation

Gym

Diet 

Take care of diet. 

Treatment

• Medication improving sleeping habit.
• Continuous positive air positive, which uses a small devise and a face mask to provide a steady stream of air to keep your throat open.
• Dental devices that either hold the lower jaw in place so it doesn't block air flow or hold the tongue in place to keep it from blocking airway. 
• Sleep at the back.
• C-Pap Machine : One has to sleep with the C-Pap Machine . It improves the condition of gasses inside the body. It opens the airway passages. Cost of machine is Rs 40,000,50,000. After using C-Pap Machine people become active, weight also decreases.One has to use it at night. In serious patient  it is also used in day time. You can monitor the machine also if it is working or not.

●   Control the addiction :  alcohol, and smoking.
●   Control the weight.
●   Pharmacological Treatment by medicines.
●   In diabetes control the sugar
●   Control Blood pressure.
●   Surgery is also one of the option (Uvulopalatopharyngoplasty) . Plastic surgery of airways.

Myths

●  Snoring is a sign of healthy sleep

One of the most common myths, snoring is a sign of healthy sleep, is a big misconception.  Snoring is caused by obstruction to the airway when we are asleep and can actually result in multiple health risk.

●  If you don't snore you are not at risk of sleep Apnea.

On the contrary, not everybody who has a sleep Apnea, snores. Up to 20% of sleep Apnea patients do not snore. Patient therefore should be mindful of other  symptoms such as morning headaches and labored breathing.

●  Sleep Apnea affects only men.

Women are equally at risk of sleep Apnea. They undergo more hormonal changes then men due to their menstrual cycle. Fertility cycle and menopause. Also a women's snoring may often go unnoticed, as it is not as loud as that of most men.

●  If you are not overweight, you are not at risk.

Even though obesity is a risk factor, it does not always mean that people who are not  overweight are not at risk. Facial and neck anatomy may also play a role . People with large tonsils , a small jaw, a large overbite, a recessed chin, or a large neck are also at risk.

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