Tired of Losing Sleep

You’re fast asleep when you suddenly wake up gasping for breath. The next day, despite sleeping for eight full hours, you feel lethargic and find yourself yawning through meetings and trying to slap yourself awake while driving. For people who suffer from Obstructive Sleep Apnea (OSA), such scenarios are a familiar daily affair.

Fortunately, medical treatment can offer patients help and relief. Dr Jim Teo cited one of his patients as an example. The construction supervisor in his 50s was obese and diagnosed with severe OSA. He had an Apnea-Hypopnea Index (AHI) of 50 which meant he would stop/decrease breathing 50 times per hour of sleep. “For years, he had been trying to keep himself awake at work with a number of near misses at the construction site,” said Dr Teo.

Dr Teo advised his patient to use a Continuous Positive Airway Pressure (CPAP) machine every night. Basically the machine works to increase air pressure in the user’s throat which in turn keeps the upper airway open and prevents it from collapsing. Since starting the therapy, his patient has been enjoying better sleep. “He is amazed at the new-found energy he has during the day!” quipped Dr Teo.

What is Obstructive Sleep Apnea? 
Sleep apnea is the abnormal cessation of breathing or respiration during sleep. This can last from a few seconds to as long as a minute. Obstructive Sleep Apnea is caused by a temporary blockage of the airway in the throat during sleep when overall muscle tone is decreased and tends to worsen as one ages or puts on weight.

What are the symptoms of Obstructive Sleep Apnea?             
Daytime sleepiness is a typical complaint. Patients describe themselves as having persistent fatigue, tiredness and low energy in spite of sleeping six to eight hours every night.  Some fall asleep while sitting in a moving vehicle, in the middle of a seminar, while driving a car or attending a religious service.  It is estimated that the risk of a person suffering from OSA being involved in a road traffic accident while driving is three times higher than a person without the condition.

Spouses of patients often complain about having to endure their partners’ noisy breathing, loud snoring, gasping, snorting or interruptions in breathing in their sleep. I have patients whose wives drag them to my clinic, worried that their husbands might stop breathing and die suddenly during sleep. One thought her husband was having an asthma attack at night but it turned out to be OSA.

Who does Obstructive Sleep Apnea tend to affect? 
OSA can affect up to 10% of the population although it is likely many sufferers continue to remain undiagnosed due to a lack of awareness and misconceptions about the condition. Many think that snoring is normal and it is just a sign that you are tired from the day’s work.  Others assume that OSA only affects very obese people but this is not true. I’ve seen many OSA patients who are not obese or who are only slightly overweight.

In 2008, a retrospective study in a Singapore hospital involving over 500 patients suspected of OSA was published. It concluded that OSA is predominant in middle-aged, overweight Singapore males and much less common in females who tend to be older. The majority of patients have moderate to severe OSA, which significantly disturbs normal sleep architecture.

From my experience, the typical OSA patient is a middle-aged male, obese, with a thick neck. However I’ve also treated children and young adults in their 30s with OSA. Other risk factors include craniofacial abnormalities like a receding chin and soft tissue abnormalities like tonsil enlargement or adenoid enlargement. Enlarged tonsils and adenoids are common causes of OSA in children.

How serious is OSA? What are the consequences of not seeking treatment? 
The most obvious consequence is daytime sleepiness which will interfere with normal daily activities. Patients tend to have decreased concentration, fall asleep easily and are prone to accidental injuries.

Because of the repeated apnea (temporary cessation of breathing) in OSA, there is lack of oxygen in the blood during sleep. Over a period of many years, it increases the risk of hypertension, heart and lung failure, heart attack, stroke and abnormal heart rhythm. Some studies suggest that OSA patients also face higher surgery complications and higher risk of Type 2 diabetes and high cholesterol.

Untreated OSA can be very serious. One of my patients who had undiagnosed OSA for 10 years developed chronic heart failure and became dependent on oxygen tank at home.

Can OSA lead to death in your sleep? 
Yes, the risk of dying from a heart attack during sleep is higher in OSA patients.

What can patients do to improve their condition? 
Losing weight is definitely useful. Sleep apnea frequency decreases with significant weight loss and physical exercise. Do avoid alcohol and sleeping pills too. Sometimes changing the sleeping posture also helps. One of my patients got his OSA ‘cured’ by always sleeping on one side.

Doctors may also prescribe the use of Continuous Positive Airway Pressure machines or oral appliances to open the airway during sleep. Surgery is rarely indicated.

Dr Jim Teo is based at Mount Alvernia Medical Centre Block A #05-02, Tel: 6256 9923.

Do you have Obstructive Sleep Apnea?

Symptoms in Adults:

• Daytime sleepiness or fatigue
• Dry mouth or sore throat upon awakening
• Headaches in the morning
• Trouble concentrating, forgetfulness, depression, or irritability
• Restlessness during sleep
• Sexual dysfunction
• Snoring
• Sudden awakenings with a sensation of gasping or choking
• Difficulty getting up in the morning

Symptoms in Children:         

• Bedwetting
• Choking or drooling
• Inward movement of the ribcage when inhaling
• Learning and behavioral disorders
• Poor school performance
• Sluggishness or sleepiness (often misinterpreted as laziness in the classroom)
• Snoring
• Teeth grinding
• Restlessness in bed
• Pauses in breathing
• Unusual sleeping positions such as sleeping on the hands and knees, or with the neck hyperextended

Doctor’s note: Symptoms are less obvious in children and require careful observation. Parents should consult a sleep specialist if they suspect that their child has Obstructive Sleep Apnea.

– Source: My Alvernia Issue #6