Are you sleeping when you should be Awake?

Article written by
Dr Manojendra Narayan Bhattacharyya
DLO (Cal), DOHNS (England), MRCS (Edinburgh),
MRCS (ENT Head & Neck Surgery),
Consultant ENT Head & Neck Surgeon

Prevent Sleep Apnea ::

What do you mean by sleep disorder?
When the sleep is “not in order” or abnormal it is called sleep disorder. It has a range , starting from simple snoring to a condition where the oxygen intake in the lungs falls to a great extent even when the patient is awake (called Obesity Hypoventilation Syndrome).

Why does it occur?
Mostly sleep disorders occur due to some incomplete obstruction in the upper airway passage (from nose up to the voice box or larynx). In some cases this occurs due to abnormal control of breathing by brain, which thankfully is not that common.

SIMPLE SNORING ->UPPER AIRWAY RESISTANCE -> HYPOPNEA -> OBSTRUCTIVE SLEEP APNOEA ->OBESITY HYPOVENT ILATION SYNDROME

Thus it starts with simple upper air passage obstruction during sleep, but as the severity increases it happens to progress to conditions called Hypopnea then to Apnea, where the breathing completely stops for some time resulting in the oxygen level in our blood to go down significantly due to momentary complete obstruction of air passage. These events happen several times during one episode of sleep.

What do you mean by Apnea and Sleep Apnea?
The condition of stoppage of breathing is called APNEA, and as it occurs during sleep it is termed as SLEEP APNEA.

Why are we so concerned about Sleep disorders?
The answer is very simple but alarming. It occurs at all age groups (from children to aged), and can lead to the following problems as — high blood pressure, diabetes, hormonal disruption, depression, heart problems (abnormal heart beat, heart failure), stroke, memory problems, increased daytime sleepiness leading to poor performance at work/school or increased road traffic accidents and death in sleep (called silent death). Additionally in children, it very frequently leads to decreased hearing because of some fluid like substance accumulating behind the ear drum. People suffering from this disorder are more than 30%, and the number is increasing. With advanced research and scientific knowledge, this condition is better understood by the doctors today and hence, thankfully can be treated completely.

What happens when a patient comes to the clinic?
A thorough history of the events in presence of sleep partner is desirable, following which various examinations in the clinic are performed. Depending on the outcome of history and clinical examination, an investigation called sleep study may be recommended.

What is Sleep study?
This is a study performed during sleep. It is completely painless and non invasive and is done at patients home during his/her sleep. Several parameters are measured during overnight sleep of a person, like, change in oxygen level (how frequent and how much), ECG changes, nature of sound produced with position during sleep, EEG changes et cetera. Collectively the test quantifies the severity of the disorder.

What happens next?
Depending on the history, clinical examination and the required investigations, a treatment plan is framed; apart from some lifestyle changes like – height appropriate weight reduction, stoppage of smoking, avoidance of alcohol before sleep, avoidance of few group of medications (if the patient is on them routinely) et cetera, surgical or non surgical measures are advised which would address to his/her type of disorder.

What happens in Non surgical option of management?
In non-surgical measure :
• Medications like those for rhinitis are prescribed
• Mandibular advancement splint prescribed
• CPAP (Continuous Positive Airway Pressure) machine advised.

What do you mean by surgical measure of Sleep disorder management?
In surgical measures, the main idea is to relieve patients from the obstruction, thus surgically the area of obstruction is located and widened. LASER is one of the useful tools for this procedure, which is available at Peerless Hospital Kolkata. Makes the surgery much faster, precise and blood tests. The common procedures performed for Sleep disorder management are as follows (depends on the individual patient need) :

• Endoscopic removal of intra nasal mass.
• Septoplasty/Turbinoplasty
• Adeno-tonsillar removal
• LASER assisted Uvulo-Palatoplasty
• Hypopharyngeal mass removal
• Laser/Coablation debulking of tongue base.
• Laryngeal inlet procedures
• Jaw protrusion techniques
• Various other surgical options

Where can we go to get the benefit of treatment for this disorder?
The department of ENT Head and Neck Surgery at our hospital have doctors who are well trained in addressing this disorder and are doing it successfully for several years.
Don’t ignore this condition, as it is “A SILENT KILLER”