How to deal with Sleep Apnoea, a disorder that hits 7-9 pct of middle-aged Indians

The recent death of renowned singer and composer Bappi Lahiri caused by Obstructive Sleep Apnoea and chest infection initiated conversations about the medical condition that is prevalent among roughly 7 to 9 percent of the middle-aged population in India, according to a study published in the US National Library of Medicine.

Several region-specific studies have indicated the presence of sleep apnoea symptoms among Indians. According to a survey, ‘A study to estimate prevalence and risk factors of Obstructive Sleep Apnoea Syndrome in a semi-urban Indian population', published in the National Library of Medicine, middle-aged individuals, especially men, in India are at greater risk of developing symptoms of sleep apnoea and conditions such as obesity and hypertension further add to the vulnerability.

While excessive snoring is one of the earliest symptoms of the sleep disorder, many in India are generally unaware of the dangers of habitual snoring and rarely consult a physician for the disorder. Mid-day Online reached out to Dr Preyas Vaidya, consultant pulmonologist and sleep medicine expert at Hiranandani Hospital, to understand the causes, symptoms and severity of sleep apnoea.

What is sleep apnoea? Are there various types of it?

Sleep apnoea is a potentially serious sleep disorder in which breathing repeatedly stops and starts along with a drop in blood oxygen levels. If you snore loudly and feel tired even after a full night's sleep, you might have Sleep Apnoea. There are three forms of Sleep Apnoea: Central, Obstructive, and Complex.

The most common of these is Obstructive Sleep Apnoea (OSA). Central Sleep Apnoea occurs when your brain doesn't send proper signals to the muscles that control breathing. Finally, Complex Sleep Apnoea Syndrome, also known as ‘treatment-emergent Central Sleep Apnoea', occurs when someone has Obstructive and Central Sleep Apnoea.

What are the common causes?

OSA is caused due to a collapse of the upper airway, which leads to restricted breathing due to obstruction. Central Sleep Apnoea happens when the brain fails to send a signal to breathe. The most common Obstructive Sleep Apnoea is expected to occur in nearly eight per cent of the population.

In adults, the most common cause of OSA is excess weight and obesity, which is associated with the soft tissue of the mouth and throat. When throat and tongue muscles are more relaxed during sleep, this soft tissue can cause a blockage in the airway.

How can one identify that they are suffering from the disorder? Please elaborate on the symptoms.

Snoring, choking and restricted breathing during sleep, waking up tired or unrefreshed, excessive daytime sleepiness, and nocturia (waking up to pass urine) are common signs of the disorder.

Loud snoring can indicate a potentially serious problem, but not everyone who has sleep apnoea snores. OSA is also a concern with certain medications and general anaesthesia. People with sleep apnoea are more likely to have complications after major surgery because they are prone to breathing problems, especially when sedated and lying on their backs.

An evaluation in the form of an overnight Polysomnography (sleep study) helps with diagnosis of the type of sleep apnoea along with a grading of its severity.

At what stage is medical attention necessary, and why is early diagnosis important?

Medical attention is required when a person snores with increased daytime sleepiness or fatigue. Further, OSA is a predisposing factor for hypertension, diabetes mellitus, increased cholesterol, heart problems, including heart attacks and brain stroke. Early treatment improves outcomes in terms of quality and quantity of life.

Your doctor may evaluate your signs, symptoms, and sleep history, which you can provide with help from someone who shares your bed or your household, if possible. If you have OSA, your doctor might refer you to an ear, nose and throat (ENT) doctor to rule out blockage in your nose or throat. An evaluation by a heart doctor (Cardiologist) or a doctor specialising in the nervous system (Neurologist) might be necessary to look for causes of Central Sleep Apnoea.

Once an early diagnosis is made with the diagnostic sleep study, a Titration Sleep Study (treatment) is done with a PAP device to confirm the efficacy. A Positive Airway Pressure (PAP) device along with lifestyle changes is the gold standard treatment currently. The PAP device delivers air pressure and works as a splint for the collapsing airway. Early intervention can help to reverse and control the effects of sleep apnoea to a greater extent.

Who is more vulnerable to sleep apnoea and at what age?

OSA can be hereditary or genetic as it depends on the body type and fat distribution, and there are very few cases of the same. Increased weight or obesity is the most typical reason. However, non-obese individuals may also be suffering from the disorder. The incidence of sleep apnoea increases with age as well.

Further, men are two to three times more likely to have sleep apnoea than women. However, women also face the risk during the menopause phase and if they are overweight. Additionally, smokers are three times more likely to have OSA than people who have never smoked.

Can lifestyle and dietary changes ensure safety from the disorder?

Lifestyle changes are an adjunct to PAP therapy and help reduce the severity. Having a healthy lifestyle consisting of a good diet and physical activity is extremely important. Regular exercise can reduce the symptoms of Obstructive Sleep Apnoea (OSA) even without weight loss. Try to get 30 minutes or more of moderate activity, such as a brisk walk, most days of the week. However, the changes are only temporary as one may develop the symptoms of OSA once weight is regained.

Another good tip is to sleep on your side or abdomen rather than your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. Also, be aware of the symptoms and get yourself evaluated as early as possible if you have signs of OSA.

Can sleep apnoea be fatal and in what conditions?

There are a lot of issues associated with Sleep Apnoea namely Arrhythmias (beating of heart out of rhythm), increased blood pressure, heart attacks and stroke. These are all emergent situations. Sleep Apnea has also been found to increase mortality in people suffering from it.