Sleep disorders due to many reasons are now common phenomena across the world including Sri Lanka. While no real study has been done on this subject so far, sleep professionals are unanimous in their conviction that healthy sleep is a must for both physical and mental health.
The Sunday Observer spoke to Consultant Respiratory Physician, District General Hospital and District Chest Clinic, Trincomalee, Dr Upul Pathirana who has had long experience in this speciality for his views on a subject that has still to be properly understood, studied, and given priority attention by health officials to raise more awareness among the public . As he says, while sleep disorders are treatable and curable with early diagnosis and treatment they can severely undermine the health of persons with these conditions if left untreated.
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Q: What is World Sleep Day and why is there a need for a special day to be set aside for it?
A. It has been recognised that good sleep hygiene is pivotal for you to keep awake during the day. If you have excessive daytime sleepiness, the performances such as education, workplace, driving as well as your physical health can have negative consequences. To address these issues related to sleep, the specialty of sleep medicine was developed by professionals all over the world. Thousands of professionals in sleep medicine coming from a number of sleep organizations collaborated to form the World Sleep Society (WSS) in 2016.
World Sleep Day is held the Friday before the Spring Vernal Equinox of each year and this year it is on March 18. For World Sleep Day 2022, the theme and slogan is Quality Sleep, Sound Mind, Happy World. The professionals around the world organise activities for their local communities to highlight that sleep is a foundational pillar in human health. The Sri Lanka College of Pulmonologists will launch a website on March 18, 2022 at Hotel Kingsbury followed by a press conference and a symposium for doctors to upgrade their knowledge on sleep medicine.
My line up in this article is to best guess some queries in the back of your mind and come up with some answers and remedies for sleep related breathing disorders; how does quality sleep help maintain mental health? How might better sleep help people focus during the day? Or how might fatigue weigh us down physically, mentally, and emotionally?
Q: What are the common issues linked to sleeping?
A. People can come out with excessive daytime sleepiness (EDS) despite adequate duration of sleep or insomnia. And also, problematic snoring might be the first presentation to the physician. Sleepwalking and vivid dreams are some uncommon matters during sleep.
Q: Why are people sleepy during the day?
A. Once we have a good sleep overnight, we are supposed to be fresh and awake throughout the day. Perhaps, you may need a coffee or shower to refresh after waking in the morning, or you might fall into sleep unintentionally during daytime. The set of causes of EDS are broad; this could be simply poor sleep hygiene, or some other medical disorders. Sleep related breathing disorders (SRBD) are a group of disorders resulting in EDS and an array of events leading to health and non-health related complications in the short and long run. Obstructive sleep apnoea (OSA) is one of the most common and serious categories of SRBD.
Q: What is Obstructive sleep apnoea?
A. OSA has 3 components; 1. Obstruction: there is an obstruction in the airway 2. Sleep: it happens when you’re asleep 3. Apnoea: it means you stop breathing for a short time.
Q: How does it happen?
A. When we sleep, all the muscles relax except the muscles for breathing and some eyelid muscles. In healthy persons, the air flows freely to their lungs. If you have OSA, your throat closes completely and the flow of air stops, so you stop breathing for a short time, which is called obstructive apnoea. When the closure of your throat is partial, it is named obstructive hypopnea. The oxygen level in your blood drops during each apnoea or hypopnea.
Your brain will initiate breathing again with a gasp or grunt and some movement. You relax again and this is going on like cycles with repeated arousals even though you are not aware, making you sleepy during the day. If it’s not treated, it can have a big impact on your health and life. We know lots of people go undiagnosed. But the good news is there’s effective treatment.
Q: Who is more likely to have OSA?
Certainly, there are identified risk factors to develop OSA. You are at risk when you are overweight or obese and your neck is large (collar size more than 17). And also, a small airway, a set-back lower jaw or a small lower jaw, large tonsils, a large tongue or nasal blockage are some of other factors which make you vulnerable to OSA.
Q: How do we know whether we have OSA?
A. The symptoms might be during sleep or when you are awake; and your bed partner describes some symptoms such as loud snoring and apnoea events. You wake up several times or go to the washroom than usual at night. The mouth and throat feel dry in the morning and you are unrefreshed despite adequate sleep time. You might wake up with a headache and it is difficult to concentrate during work due to EDS and your mood is liable. Sometimes, you may not experience any EDS, instead you are tired and fatigued.
Q: What are the dangers if someone has untreated OSA?
A. Patients with OSA are at increased risk for a number of adverse outcomes. OSA can affect your executive function with increased likelihood of errors. And also, it changes your mood and makes you irritable, inappropriately affecting interpersonal relationships. You are prone to several other complications such as heart attack, rhythm changes in heart, stroke, hypertension, liver diseases, sexual dysfunction and many more.
Q: Does OSA affect one’s driving skills?
A. Yes. Sleep apnea causes impairment in performance and is associated with an increased risk of motor vehicle crashes compared with the general population of drivers. Motor vehicle accidents are two to three times more common among patients with OSA than without OSA.
Q: How is OSA diagnosed?
A. You can talk to a health care professional if you display symptoms of OSA or your bed partner concerns about apnea during sleep. Then you will be directed to a respiratory or sleep clinic. You may go through the Epworth Sleepiness Scale (ESS) test on Google search before going to the doctor. Bear in mind that all the patients with OSA are not sleepy, therefore; negative ESS does not exclude the diagnosis.
Q: What happens at a sleep clinic?
A. Doctor asks certain questions about symptoms and your medical history. He carries out physical examinations to assess risk factors and complications of OSA.
You will be asked to go ahead with a sleep study, which is available in most of the respiratory medicine units in Sri Lanka.
Q: What is a sleep study?
A. A simple sleep study could be carried out at your home where the health care provider lends you the sleep study kit or otherwise you should stay overnight in the hospital. The test simply measures oxygen level in your blood, heart rate, and airflow through your nose and chest expansion throughout your sleep. It is not only making the diagnosis but also assessing how bad your OSA by counting the number of apnoea events. However, a normal test does not exclude OSA and if the doctor strongly feels that you have OSA, he may ask you to have some complex sleep studies.
Q: What would you recommend if I have OSA?
A. We recommend all to have good sleep hygiene. Good sleep hygiene refers to activities you can follow which help get you the best possible night’s sleep. These include, Lifestyle changes.
- Refrain from drinking alcoholic beverages and caffeinated beverages within at least 2 hours and 6 hours re of going to sleep.
- Get as much exposure to natural light during the day that you can.
- Exercise regularly but try to avoid moderate levels of exercise at least 4 hours prior to bedtime. Avoid consuming large amounts of liquids prior to bedtime.
- Avoid smoking as bedtime approaches or quit altogether.
Sleep environment
lUse your bedroom only for sleep and intimate activities; for example, do not watch TV in bed. Minimize light, noise and extremes in temperature in the bedroom. Ensure your bed and pillows are comfortable.
3. Follow a regular sleep routine. Go to bed at approximately the same time each day.
- Wake up at approximately the same time each day.
- Save your worries for the daytime. Select a relaxing bedtime (pre-sleep) ritual, for example listen to calming music or 10 minutes of reading
Q: Do you have any treatment for patients with OSA?
A. Of course. We treat OSA with Continuous Positive Airway Therapy (CPAP) and it’s the mainstay of treatment strategy for most of the patients. CPAP is a simple machine that blows air through a mask you wear at night. It’s designed to hold your airway open while you’re asleep. It sends air at a pressure into your upper airway to stop it collapsing or narrowing.
Q: What other options are available if somebody is not improving with CPAP?
A. Yes, they have several other options like dental devices to keep the airway open. And also, you will be assessed to see whether there is any surgically correctable reason to cause sleep apnoea.
Q: Can loss of excessive weight help those with sleep apnoea?
A. We recommend exercise and weight reduction for all patients with OSA. While rarely leading to complete cure of the problem, weight reduction has a number of positive aspects such as improving overall health, reducing excessive daytime sleepiness, reducing blood pressure and apnoea index, and many more.
Q:If a reader wants more information what is the number to contact? Is there a website?
A. The Sri Lanka College of Pulmonologists have developed a webpage called “Sleep Better” for the general public and we will launch this on World Sleep Day on March 18 at Hotel Kingsbury. There is a contact number on the website so that you can send any questions.
Q: What is the take home message for patients suspected as having OSA?
A. If you want a sound mind and happy world, a quality sleep is a must. The testing facility with sleep studies is available in a number of hospitals. You can consult a Respiratory Physician and he will offer the testing after clinical assessment. The illness is treatable and untreated OSA has complications.