IT WAS the same storyevery night. Soon after 42-year-old Vithoba RajaramKumbhar fell into deepslumber at his Dombivli
home, his wife would nudgehim every now and then — asignal to stop snoring.
“My children even imitatemy snoring,” confessesKumbhar, who works as an X-ray technician at ENT surgeonDr Ashim Desai’s clinic. Lastyear, fed up, he took Dr Desai’sadvice to go for a sleep studyto find out what was wrong.
Dr Desai connectedKumbhar to a polysomno-graph (PSG).Electroencephalography(EEG) was carried out tomeasure his brain waves anddecipher his depth of sleepand type of sleep, while theECG and oximetry tests weredone to determine his oxygenlevels.
While Kumbhar slept, themachine noted his snoringpattern. And no, it didn’t hurta bit.
Once he was diagnosedwith snoring without signifi-cant apnea Dr Desai advisedhim to go for a surgery, whichwould correct his blockageand allow air to flow freely,putting an end to his snoring.
Five hours after the OutPatient Department (OPD)surgery, Kumbhar resumedwork. “Today, 75 per cent ofmy snoring has been healed. Isleep much better at nightcompared to earlier, when Iwould get broken or disturbedsleep,” says Kumbhar.
Kumbhar’s problem is notunique — far from it actually.Around 10 per cent of India’spopulation, over 12 millionpeople, suffer from sleep dis-orders, according to citydoctors. “Indians have a ten-dency to ignore going to adoctor and snoring is not evenconsidered a disorder,” says
Desai, a senior ENT consultantwith Nova Specialty Surgery(NSS), which has tied up withEurosleep, a network of ENTclinics from Norway, and hasjust launched one of its fiveSleep Disorders ManagementCentres at Tardeo.
“If you take less than fiveminutes to fall asleep, or morethan 15, there is trouble inparadise. The Nova centreaims to provide an end-to-endsolution for all kinds of sleepdisorders,” says Dr Desai.
Dr Mahesh Reddy, execu-tive director, Nova MedicalCentres, says, “Sleep disorderis a huge and unrecognisedproblem in India. Our focus ison niche conditions that needproper attention. We have fivecentres as of now in India.”
What is sleep apnea?Obstructive Sleep Apnea(OSA) is the commonest SleepRelated Breathing Disorder(SRBD). This is a sleep disor-der characterised by abnormalpauses in breathing orinstances of abnormally lowbreathing during sleep. Eachpause in breathing, called anapnea, can last from at least10 seconds to minutes, andmay occur five to 30 times ormore an hour. Similarly, eachabnormally low breathingevent is called a hypopnea.
This occurs when the softtissue in the back of yourthroat relaxes during sleep,causing a blockage of the air-way as well as loud snoring.Untreated sleep apnea resultsin daytime sleepiness, slowreflexes, poor concentration,and an increased risk of acci-dents. Sleep apnea can alsolead to health problems overtime including diabetes, heartdisease, stroke, high bloodpressure and weight gain.
Apart from using the stan-dard polysomnograph, NSShas invested in five of Euro
Sleep’s ApneaGraph machinesto assess sleep-related breath-ing disorders, snoring beingthe most common complaint.The apneagraph identifies thesite of obstruction duringsleep, deverity of SRBD anddetection of central respirato-ry events. “Obesity and latenights can aggravate a block-age, which is also caused dueto presence of a tumour or adenoids,” explains DrDesai.
Continuous positive airwaypressure (CPAP) and Bilevelpositive airway pressure(BIPAP) machines costingbetween Rs 25,000 to Rs 1lakh are prescribed in caseswhere surgery is not possible.
The road aheadWith the Indian medical fra-ternity now recognising thisdisorder as a serious issue,awareness is seeping down tothe masses. While treatmentsare available globally for thepast 20 years, minimal inva-sive surgeries are beingconducted in India for the pastfive to six years.
The real challenge, says DrSeemab Shaikh, founder mem-ber and president of IndianAssociation of Surgeons forSleep Apnea (IASSA), isspreading awareness that snor-ing is a sleep disorder. “Whilesnoring is the biggest indicatorof sleep apnea, not all cases ofsnoring may actually be due tosleep apnea. Culturally, Indiansbelieve snoring is not a disease,which is why it is overlooked.”
When there is an obstruc-tion in our breathing, the fall inthe oxygen levels results in lowsupply to the heart and brain,increasing the chances of astroke or hypertension. “Eightyto 90 per cent deaths that arecaused during sleep are due tosleep apnea, but there are nostatistics to prove this, as thereis no scientific method to deter-
mine OSA as the cause ofdeath,” says Shaikh, addingthat the tendency to avoid see-ing a doctor and the fear oftreatment is a reason for thelack of more cases being diag-nosed. “The treatment, thanksto technological wonders, isvery simple — locate howsevere it is, and where is theproblem,” he says.
Unbiased approachAccording to Dr PreetiDevnani, who runs SleepDisorders Clinic in Khar andconsults at Jaslok Hospital,while awareness of sleep dis-orders is steadily growing, itstreatment needs to percolateto the primary care level. “Wehave no data on sleep apnea.Thankfully, India is in theprocess of getting a set of rulesand guidelines, which willemphasise on optimising thestandard of care with avail-
able resources in an unbiasedfashion,” says Dr Devnani.
While 20 to 30 per cent ofthe sleep disorder cases arediagnosed as insomnia, a lot ofcases are related to work tim-ings, also known as thecircadian rhythm disorder.While sleep apnea affects twoper cent male and an equal per-centage of the female populace,women are more likely todevelop apnea only after theyreach menopause, since thehormones balance their muscletone well, before that.
Take the example ofSheetal Dhanwani (namechanged on request), a 52-year-old housewife who hasspent the last five years fre-quently waking up breathlessin the middle of the night. Lastweek, she visited Dr Devnani’sclinic where she learnt aboutsleep apnea for the first time.“A complete sleep study usinga polysomnograph was con-ducted where a thin wire wasinserted through my nose,”says Dhanwani, who hadignored her snoring due tolack of knowledge that it was treatable.
“My snoring was so severethat it had becoming difficultto share a room with anyone. Iwas conscious of even fallingoff asleep anywhere,” saysDhanwani, who has been rec-ommended the use of a PAPmask which helps apneapatients breathe easy. Thedevice will now give her agood night’s sleep, “I wish Ihad not been lazy and fearedtreatment for five years. Icould have caught up on a lotof sleep,” smiles Dhanwani.Like her, there is hope now forthousands of other Indianswho suffer from sleeping dis-orders but didn’t know tillnow, how to get it [email protected]
MY CHILDREN USEDTO IMITATE MYSNORING. FIVE HOURSAFTER THE OPERATION, I RESUME WORKED.NOW I HARDLY SNOREVITHOBA KUMBHAR
who underwent the OSA surgery
10 YEARS AGO, WEWOULD GET A PATIENTWITH SLEEP-RELATEDPROBLEMS ONCE AWEEK. NOW, I ATTENDFOUR PATIENTS IN A DAY DR MANVIR BHATIA
Director, Neurology and Sleep Centre, New Delhi
BEDTIME TALESSHOW YOUR CHILD ADOCTOR IFYOU spend too much timehelping your child fall asleep YOUR child wakes up repeatedlyat nightYOUR child's mood andbehavior are affected by poorsleepYOU lose sleep as a result ofyour child's nightmare pattern YOUR child's poor sleep causesyour relationship with your childto suffer
OBSTRUCTIVE SLEEPAPNEAThis is similar to how a strawflattens and collapses if you
pinch one end closed whilesucking from the other end.With the airway blocked, nobreathing occurs and oxygenlevels drop Your brain then wakes you up torestore your breathing. Thesebrief and repeated arousalscause your sleep to beunrefreshing
MEDICAL THERAPY Positive Airway Pressure (PAP)devices are the standard methodof treating OSA.It keeps the airway open byproviding a steady stream of airthrough a mask that you wear asyou sleep IL
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