I am Dr. Sudipta Chandra. I am an ENT, sleep medicine and sleep surgery specialist. I treat all types of sleep disorders regularly, mainly obstructive sleep apnea and upper airway resistance syndromes and simple snoring cases – of all age groups starting from children to the elderly, in women and men. I am often asked about OSA and here I shall endeavor to answer some of those questions.
When is the problem detected?
The problem is usually detected by the partner. There are many symptoms and risks of Obstructive sleep apnea. The primary symptom is that the patient snores. Apart from that, if the patient breathes with open mouth, it could be sleep apnea. Mouth breathing is not a normal phenomenon. It means there is blockage in the nose and upper airway. Sometimes people don’t understand that they breathe with open mouth. They have recurring throat infection, voice change and oral ulcers due to mouth breathing. Sometimes, because they do not have adequate oxygen in the system, they feel sleepy, tired and fatigued the next day. So, daytime sleepiness and daytime fatigue are also symptoms. In addition, sometimes they experience breathlessness and have difficulty in breathing. They may also experience choking sensations at night.
When do you suggest HST?
HST is home sleep test. HST is done at your own home. It is a test done to detect the severity of upper airway obstruction, i.e. the voice box or the larynx. The airway becomes narrow in many cases due to multiple factors and the severity of the narrowing is checked by HST. It can be mild, moderate and severe. The test we sometimes do apart from HST is called Polysomnography or PSG. PSG is an extension of HST where we also check the effects of that airway obstruction on the other organs like heart, lungs and brain. Airway obstruction can, in some cases, lead to heart attacks, brain strokes and breathing difficulties. Our goal is to prevent these problems.
How is CPAP therapy useful for OSA patients?
If the problem is diagnosed as OSA in the HST or a PSG report, then it is classified into mild, moderate or severe obstructive sleep apnea. If it is mild we don’t prescribe machines or surgery. Simple lifestyle changes like medicines, if there is a medical problem, exercises and diet changes are sufficient. Sometimes avoidance of smoking and alcohol is also helpful. That is the mainstay of the treatment. From moderate to severe obstructive sleep apnea cases, we always first advise a machine called CPAP. CPAP is a Continuous Positive Airway Pressure machine. You have to use this machine every night for the rest of your life. The function of the machine is to pass air from the nose to the lungs through the narrow airway. Due to positive pressure it pushes the air through the nose till it effectively reaches the lungs. We initially give a trial for the machine. TriBeCa Care does the trials for us. They do the HST and PSG reports for us and if we need a CPAP trial, they do it. Then they send the machine to us. We check the reports and as per the protocol we advise what treatment we need. Most patients are happy with the machine because they are able to breathe better and live a better life. The patient has to try it and give us feedback. Their sleeping partner has to tell us if during the night, they sleep with closed mouth, if their snoring reduces and if their sleep is less restless. The patient can tell us if, during the day, they feel fresher, less sleepy, more active and less fatigued. These are the most important parameters. If the patient is happy with the machine and everything goes according to plan, the patient goes ahead and buys the machine and uses it for the rest of their lives. This is one option. If the patient doesn’t like the machine, either because there is no improvement with the machine or they don’t like the idea of using the machine all their lives, then we sometimes suggest surgery.
How is CPAP changing their lives?
The problem with obstructive sleep apnea is that the air entry to the lungs is considerably less. So, the patient does not have adequate air in the lungs. The lungs cannot make adequate oxygen for the body to work as it gets less air from the upper airway. Consequently, it has to pump more times to get more air. It has to produce more oxygen but is not able to do it. And for working overtime, it needs more blood supply from the heart. As a result, the heart also has to pump more times so that there is more blood supply to the lungs. The heart and the lungs are very sensitive organs. The heart is the most sensitive organ. Due to all the overwork, patients develop hypertension. And in time there can be other heart problems like arrhythmias, heart beat problems, heart blocks, heart attacks and sudden cardiac deaths. If both the heart and the lungs are stressed, the patient can have raised blood sugar levels or diabetes. If they have low oxygen saturation in the blood, then oxygen saturation in the brain decreases. The brain is a very oxygen sensitive organ. If the oxygen supply to the brain decreases, the patient can suffer from memory loss, heaviness of the head, and other problems including brain stroke and sometimes coma. These are the major problems. Apart from these, there are sexual disturbances due to not being able to breathe adequately. They can develop hypothyroid, obesity i.e. increased weight and many other complications. Some of these are psychological and stress problems. If the patients’ lungs can produce adequate oxygen for the next day, then their whole lifestyle changes. Their blood pressure reduces. In cases of very early detection, we can even reverse blood pressure. They’ll have less blood sugar. They’ll be able to lead a healthier and better life. They can effectively reduce weight now because for weight reduction, we need oxygen to burn fat along with exercises. Due to less oxygen in the body, the fat that could not be burnt can now be burnt. All these factors help the patient to get motivated to use the CPAP machine for the rest of their lives. It definitely helps and changes their lives. Earlier, the problem was that it was a big machine that was difficult to carry. Nowadays, many companies, like Resmed, have come up with a very small machine, which is not heavy or difficult to carry. With advances in technology, using the machine has become simpler.
Message for readers
The message for my readers is that obstructive sleep apnea is a disease and it is called the mother of all chronic diseases in the body. So, it can result in all organ problems. It should be treated. If it is treated, there is data supporting the fact that up to 45 to 50 per cent of cardiac and neurological cases and complications can be reduced. The treatment is not very difficult. You need to go to a sleep medicine and sleep surgery specialist. They’ll diagnose it or you can fill up TriBeCa Care’s Sleep Apnea questionnaire. And the CPAP machine is very easy to use and patient friendly. Obstructive sleep apnea usually gets corrected. And in case the problem persists, there are surgical options we can explore.
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