FAQ
What is Sleep apnea?
Sleep Apnea is a disease wherein sleep-related breathing disturbance causes health effects due to low oxygen levels and the disruption of sleep results in excessive daytime sleepiness interfering in an individual's day to day life and profession.
When the person is sleeping, the upper part of the airway which connects the mouth to the windpipe consists of pharynx and hypo-pharynx. In these areas, the muscle tends to be very floppy due to lack of firm support of cartilage or bone. During the deep sleep, the tone in these muscles reduces and they collapse during breathing causing loud snoring, reduced airflow during breathing, and if complete closure, it prevents air from entering the lungs. These episodes happen throughout the night multiple times which causes poor quality of sleep due to fragmentation, frequent disruption and repeated awakening, either physically or in the form of abnormal jerking movements, choking episode, gasping for breath and nightmares. The end result is the person wakes up in the morning not feeling refreshed and having excessive daytime sleep in episodes throughout the day leading to poor concentration and interference in the professional sphere.
What causes Sleep Apnea?
It is a lifestyle disease intimately related to being overweight and obese. Hence individuals having a weight which is above his or her ideal weight have a greater tendency of having obstructive sleep apnea. The excess fatty tissue in obese persons tends to get deposited around the upper part of the airways( pharynx and hypopharynx) reducing their diameter. Those with body mass index (BMI) > 30 are considered to be at higher risk of obstructive sleep apnea. The prevalence of sleep apnea in India is about 5% in males and 2.5% in females in various surveys.
Other risk factors for sleep apnea include:
- Allergic nose problems( rhinitis)
- Family history of sleep apnea
- Thyroid gland dysfunction(Hypothyroidism)
- Pituitary gland dysfunction ( Acromegaly)
- Tonsil or adenoid enlargement in young children
- Facial abnormality- small mal-position of the lower jaw
What are the warning signs of sleep apnea?
- Snoring – loud snoring which disturbs spouse is the most common symptom
- Witnessed Apneas – spouse nudges the patient for “stopped” breathing
- Waking up with a gasping episode due to air hunger
- Waking up with a choking episode or bout of cough
Many subtle symptoms which most people ignore could suggest sleep apnea:
- Waking up at night two-three times to use the washroom
- Poor concentration and loss of memory
- Excessive daytime sleepiness interfering in daily activities( driving accidents)
- Impairment of professional performance
- Impaired libido and erectile dysfunction
- Resistant Hypertension: Poorly BP control despite using three or more medicines
- Poor Diabetes control despite medications and diet control
If you have Snoring with any of the above symptoms, its best to approach your doctor and get an assessment done to rule out Sleep Apnea.
What tests are performed to diagnose sleep apnea?
The diagnostic test is an overnight sleep study in a sleep laboratory. Sleep laboratory is just like a bedroom where patient sleep comfortably just like they sleep at home. This sleep study test is technically called Polysomnography and is designed to assess the sleep, breathing pattern and oxygen saturation levels in the laboratory under observation by a trained technician who monitors these parameters in real-time.
For what parameters does a doctor look for during the sleep apnea test?
The sleep study equipment records various parameters including sleep stages, breathing pattern, respiratory efforts, leg movements, snoring and oxygenation during the overnight sleep period:
- Brain waves pattern in sleep- electroencephalography (EEG)
- The activity of the eyes and the chin muscles ( EOG)
- The activity of chin Muscle activity (EMG)
- Airflow through the nose and mouth
- Respiratory movements of the chest and abdomen
- Electrocardiography for the heart beating rhythm (ECG)
- Pulse oximetry for oxygen saturations
- Leg movements during sleep
All these parameters are recorded at night and analyzed by the Specialist with the score which will tell that how many times in the night your breathing airflow had stopped for more than 10 seconds (called Apnea) and how many times the breathing airflow had reduced and caused a significant drop in the oxygen level and /or caused the EEG pattern of arousal (called hypopnea). The total apnea-hypopnea index (AHI) is measured per hour and AHI > 5 per hour is abnormal and suggestive of Sleep Apnea.
Obstructive Sleep Apnea is very common, almost in 85% of cases and less often it could be central Sleep Apnea, in 15% cases.
What is central sleep apnea?
In this type of sleep apnea, respiratory centre in the brain does not generate any signals to the respiratory muscles leading to episodes of Apnea or hypopneas. It is usually found in people with brain disease (after stroke/brain infections) or heart diseases (with heart failure).
Can people consult a doctor from home and do a sleep study at home?
If anyone in your family has warning signs of sleep apnea, then we at Sakra World Hospitals offer video consultation services where you can discuss the problems with Specialist doctors. If the symptoms are suggestive of Sleep Apnea and there are no other diseases like chronic lung disease, stroke or heart disease, a limited sleep study can be done at your home to make a diagnosis of Sleep apnea. This is not the ideal type of sleep study but in persons with high probability can be useful for diagnosis of sleep apnea.
How can sleep apnea be prevented?
- Maintaining a healthy lifestyle is the most important preventive measure
- Exercise regularly 30-40 minutes per day
- Maintain healthy food habits
- If you are obese, then reduce weight to ideal body weight gradually
- Avoid alcohol and smoking tobacco
How is sleep apnea treated?
Sleep apnea which is causing sleep disturbance, frequent awakening, witnessed apnea episodes and daytime sleepiness needs urgent treatment. The treatment of choice is using a device called Continuous positive airway pressure (CPAP). The CPAP machine delivers air under positive pressure through tubing to a mask. The mask is applied to the patient using velcro straps to cover the nose (nasal mask) or covers the face and nose (full face mask- if nose blockage). Air under positive pressure prevents the collapse of the upper airways and improves the sleeping pattern and oxygen saturation. It is very important to explain that the CPAP device has to be used regularly during sleep by the patients. Apart from this, they need to maintain the ideal body weight and develop the habit to sleep on either side to avoid lying flat on the back (supine).
What happens if sleep apnea is not treated?
Unrecognized or untreated sleep apnea is a major health problem. It predisposes to the development of Hypertension, Diabetes, heart attack, brain stroke, abnormal heart rhythms and also increases the risk of sudden death.
What is the role of medicines in treating sleep apnea?
Unfortunately, there are no medications for treating sleep apnea as it results from upper air passage closure during deep sleep. CPAP is the treatment of choice and is life-saving if used regularly during sleep.
