India's first sleep management centre opens in Mumbai

It was the same story every night Soon after 42yearold Vithoba Rajaram Kumbhar fell into deep slumber at his Dombivli home his wife would nudge him every now and then mdash a signal to stop snoring ldquoMy children even imitate my snoringrdquo confesses Kumbhar who works as an Xray technician at ENT surgeon Dr Ashim Desairsquos clinic Last year fed up he took Dr Desairsquos 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 didnrsquot hurt a bitOnce 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 Dr Ashim Desai explains the working of the Apneagraph which tests the site of obstruction during sleep PicDatta Kumbhar Five hours after the Out Patient Department OPD surgery Kumbhar resumed work ldquoToday 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 sleeprdquo says Kumbhar Kumbharrsquos problem is not unique mdash far from it actually Around 10 per cent of Indiarsquos population over 12 million people suffer from sleep disorders according to city doctors ldquoIndians have a tendency to ignore going to a doctor and snoring is not even considered a disorderrdquo 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 ldquoIf 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 endtoend solution for all kinds of sleep disordersrdquo says Dr Desai Dr Mahesh Reddy executive director Nova Medical Centres says ldquoSleep 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 Indiardquo 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 Sleeprsquos ApneaGraph machines to assess sleeprelated 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 ldquoObesity and late nights can aggravate a blockage which is also caused due to presence of a tumour or adenoidsrdquo explains Dr Desai Continuous positive airway pressure CPAP and Bilevel positive airway pressure BIPAP machines costing between Rs 25000 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 ldquoWhile 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 overlookedrdquo 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 ldquoEighty 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 deathrdquo 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 ldquoThe treatment thanks to technological wonders is very simple mdash locate how severe it is and where is the problemrdquo he says Unbiased approach 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 ldquoWe 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 fashionrdquo 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 52yearold housewife who has spent the last five years frequently waking up breathless in the middle of the night Last week she visited Dr Devnanirsquos clinic where she learnt about sleep apnea for the first time ldquoA complete sleep study using a polysomnograph was conducted where a thin wire was inserted through my noserdquo says Dhanwani who had ignored her snoring due to lack of knowledge that it was treatable ldquoMy snoring was so severe that it had becoming difficult to share a room with anyone I was conscious of even falling off asleep anywhererdquo 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 nightrsquos sleep ldquoI wish I had not been lazy and feared treatment for five years I could have caught up on a lot of sleeprdquo smiles Dhanwani Like her there is hope now for thousands of other Indians who suffer from sleeping disorders but didnrsquot know till now how to get it treated Bedtime tales show your child a doctor if You spend too much time helping your child fall asleep your child wakes up repeatedly at night your child39s mood and behavior are affected by poor sleep You lose sleep as a result of your child39s nightmare pattern Your child39s poor sleep causes your relationship with your child to suffer Illustration Amit Bandre 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 Medical therapy 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 u00a0