It was the same story every night. Soon after 42-year-old Vithoba Rajaram Kumbhar fell into deep slumber at his Dombivli home, his wife would nudge him every now and then — a signal to stop snoring.
“My children even imitate my snoring,” confesses Kumbhar, who works as an X-ray technician at ENT surgeon Dr Ashim Desai’s clinic. Last year, fed up, he took Dr Desai’s advice to go for a sleep study to find out what was wrong.
Dr Desai connected Kumbhar to a polysomnograph (PSG). Electroencephalography (EEG) was carried out to measure his brain waves and decipher his depth of sleep and type of sleep, while the ECG and oximetry tests were done to determine his oxygen levels.
While Kumbhar slept, the machine noted his snoring pattern. And no, it didn’t hurt a bit.Once he was diagnosed with snoring without significant apnea Dr Desai advised him to go for a surgery, which would correct his blockage and allow air to flow freely, putting an end to his snoring.
Five hours after the Out Patient Department (OPD) surgery, Kumbhar resumed work. “Today, 75 per cent of my snoring has been healed. I sleep much better at night compared to earlier, when I would get broken or disturbed sleep,” says Kumbhar.
Kumbhar’s problem is not unique — far from it actually. Around 10 per cent of India’s population, over 12 million people, suffer from sleep disorders, according to city doctors. “Indians have a tendency to ignore going to a doctor and snoring is not even considered a disorder,” says Desai, a senior ENT consultant with Nova Specialty Surgery (NSS), which has tied up with Eurosleep, a network of ENT clinics from Norway, and has just launched one of its five Sleep Disorders Management Centres at Tardeo.
“If you take less than five minutes to fall asleep, or more than 15, there is trouble in paradise. The Nova centre aims to provide an end-to-end solution for all kinds of sleep disorders,” says Dr Desai.
Dr Mahesh Reddy, executive director, Nova Medical Centres, says, “Sleep disorder is a huge and unrecognised problem in India. Our focus is on niche conditions that need proper attention. We have five centres as of now in India.”
What is sleep apnea?
Obstructive Sleep Apnea (OSA) is the commonest Sleep Related Breathing Disorder (SRBD). This is a sleep disorder characterised by abnormal pauses in breathing or instances of abnormally low breathing during sleep. Each pause in breathing, called an apnea, can last from at least 10 seconds to minutes, and may occur five to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea.
This occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway as well as loud snoring. Untreated sleep apnea results in daytime sleepiness, slow reflexes, poor concentration, and an increased risk of accidents. Sleep apnea can also lead to health problems over time including diabetes, heart disease, stroke, high blood pressure and weight gain.
Apart from using the standard polysomnograph, NSS has invested in five of Euro Sleep’s ApneaGraph machines to assess sleep-related breathing disorders, snoring being the most common complaint. The apneagraph identifies the site of obstruction during sleep, deverity of SRBD and detection of central respiratory events. “Obesity and late nights can aggravate a blockage, which is also caused due to presence of a tumour or adenoids,” explains Dr Desai.
Continuous positive airway pressure (CPAP) and Bilevel positive airway pressure (BIPAP) machines costing between Rs 25,000 to Rs 1 lakh are prescribed in cases where surgery is not possible.
The road ahead
With the Indian medical fraternity now recognising this disorder as a serious issue, awareness is seeping down to the masses. While treatments are available globally for the past 20 years, minimal invasive surgeries are being conducted in India for the past five to six years.
The real challenge, says Dr Seemab Shaikh, founder member and president of Indian Association of Surgeons for Sleep Apnea (IASSA), is spreading awareness that snoring is a sleep disorder. “While snoring is the biggest indicator of sleep apnea, not all cases of snoring may actually be due to sleep apnea. Culturally, Indians believe snoring is not a disease, which is why it is overlooked.”
When there is an obstruction in our breathing, the fall in the oxygen levels results in low supply to the heart and brain, increasing the chances of a stroke or hypertension. “Eighty to 90 per cent deaths that are caused during sleep are due to sleep apnea, but there are no statistics to prove this, as there is no scientific method to determine OSA as the cause of death,” says Shaikh, adding that the tendency to avoid seeing a doctor and the fear of treatment is a reason for the lack of more cases being diagnosed. “The treatment, thanks to technological wonders, is very simple — locate how severe it is, and where is the problem,” he says.
According to Dr Preeti Devnani, who runs Sleep Disorders Clinic in Khar and consults at Jaslok Hospital, while awareness of sleep disorders is steadily growing, its treatment needs to percolate to the primary care level. “We have no data on sleep apnea. Thankfully, India is in the process of getting a set of rules and guidelines, which will emphasise on optimising the standard of care with available resources in an unbiased fashion,” says Dr Devnani.
While 20 to 30 per cent of the sleep disorder cases are diagnosed as insomnia, a lot of cases are related to work timings, also known as the circadian rhythm disorder. While sleep apnea affects two per cent male and an equal percentage of the female populace, women are more likely to develop apnea only after they reach menopause, since the hormones balance their muscle tone well, before that.
Take the example of Sheetal Dhanwani (name changed on request), a 52-year-old housewife who has spent the last five years frequently waking up breathless in the middle of the night. Last week, she visited Dr Devnani’s clinic where she learnt about sleep apnea for the first time. “A complete sleep study using a polysomnograph was conducted where a thin wire was inserted through my nose,” says Dhanwani, who had ignored her snoring due to lack of knowledge that it was treatable.
“My snoring was so severe that it had becoming difficult to share a room with anyone. I was conscious of even falling off asleep anywhere,” says Dhanwani, who has been recommended the use of a PAP mask which helps apnea patients breathe easy. The device will now give her a good night’s sleep, “I wish I had not been lazy and feared treatment for five years. I could have caught up on a lot of sleep,” smiles Dhanwani. Like her, there is hope now for thousands of other Indians who suffer from sleeping disorders but didn’t know till now, how to get it treated.
show your child a doctor if
You spend too much time helping your child fall asleep
your child wakes up repeatedly at night
your child's mood and behavior are affected by poor sleep
You lose sleep as a result of your child's nightmare pattern
Your child's poor sleep causes your relationship with your child to suffer
Obstructive Sleep Apnea
This is similar to how a straw flattens and collapses if you pinch one end closed while sucking from the other end. With the airway blocked, no breathing occurs and oxygen levels drop
Your brain then wakes you up to restore your breathing. These brief and repeated arousals cause your sleep to be unrefreshing
Positive Airway Pressure (PAP) devices are the standard method of treating OSA.
It keeps the airway open by providing a steady stream of air through a mask that you wear as you sleep