World Sleep Day tomorrow

The Sleep Assembly of the Sri Lanka College of Pulmonologists will launch sleepbetter.lk web page tomorrow (18) to coincide with the World Sleep Day.

Dr. Chandimani Undugodage, Consultant Respiratory Physician and Senior Lecturer Faculty of Medical Sciences, University of Sri Jayawardenepura says Obstructive Sleep Apnoea (OSA) makes people vulnerable to diabetes, high blood pressure, heart attacks or strokes.

Addressing the media at Ramada on Tuesday (15), Dr. Undugodage said that snoring at night, sleeping during daytime and being overweight could be symptoms of one having OSA.

What is OSA?

Obstructive sleep Apnoea is a condition where you stop breathing during sleep. This occurs as a result of temporary closure of the upper airway that carry air to the lungs. Obesity is commonest risk factor for development of OSA.

What happens in OSA?

The airway that carries air to the lungs passes through the throat or the upper airway. When a person gains weight there is a lot of fat deposited in the neck, which makes the upper airway narrow.

When a person is awake, the airway is kept open by the muscles of the throat. But when he goes to sleep all the muscles relax and the already narrow airway becomes even narrower. When air passes in and out through this narrow airway it makes a noise, which is what snoring is. As the person goes into deep sleep, the muscles of the throat relax further and the airway becomes narrower; at one point the airway completely closes; then there is no movement of air in to the lungs and the person completely stops breathing. This is known as an “apnoea”

When this happens there is no air/oxygen going in to the lungs; which results in low levels of oxygen in the blood, brain and other organs. When the brain senses that the person is not breathing, it immediately brings the person from deep sleep to light sleep, or completely wakes that person up. Then the airway opens out and the person starts to breathe again. In those with OSA this happens over and over again in the night. Which leads many awakenings, with very little uninterrupted deep sleep. In the morning the person wakes up feeling unrefreshed and is sleepy during the day. This can result in loss of productivity during the day. Especially by falling asleep during work, at meetings and even while driving leading to road traffic accidents.

An episode of obstructive apnoea where the throat closes during sleep is comparable to strangulation. Imagine if someone strangles you, what will happen? You will panic, your heart rate will go up, blood pressure will go up and you would be under a lot of stress. A similar situation occurs during an apnoea in OSA. It produces a stressful situation in the body. There is release of stress hormones in to the blood. This leads to elevated blood pressure and blood sugar. With time this leads is development of diabetes and high blood pressure (hypertension). There is also a higher risk of getting a heart attack, stroke, abnormal heart rhythms (arrhythmias) and dying suddenly while asleep (sudden cardiac death). OSA patients can also suffer from impotence. With time they become forgetful and there can be changes in their personality

When should you suspect OSA?

How is OSA diagnosed?

If you think you have OSA, you have to talk to your doctor. He or she will refer you to a specialist. A comprehensive sleep assessment will be done to look for other sleep related disorders. An overnight sleep study will be done to look for OSA. This is a simple test where your breathing, air flow, oxygen levels and heart rate are monitored and recorded. Once the data is looked at whether you have OSA or not can be determined.

How is OSA treated?

As OSA is about the closure of the throat during sleep, the treatment is aimed at keeping the throat open. The two main ways of treatment that is available in Sri Lanka are treatment with Continuous Positive Airway Pressure ventilation (CPAP) and surgery. CPAP – this is a small machine with a mask. The person wears the mask when going to sleep. The machine produces a jet of air which splints the airway open, without letting it close. Snoring stops immediately and the person wakes up refreshed in the morning

Surgery – surgical therapy is aimed at making the airway larger and thereby stopping the airway from closing. There are many types of surgeries available.

In addition weight reduction by diet and exercise is advised.