By Evangeline Majawat
If you want to know how sleep or more appropriately the lack of sleep affects couples, just speak to the amiable Dr. Azida Zainal Anuar. After all, this ENT (ear, nose and throat) surgeon has seen and heard it all. “It is not uncommon for wives to drag their husbands to see me,” she says.
The normal complaint is the husband’s loud, unbearable snoring that disrupts the wife’s sleep. “I have had patients whose wives threatened to sleep apart or who demanded a divorce if the snoring is not treated!” laughs Dr. Azida. While snoring is often dismissed as a minor sleep problem, it is usually a symptom of a common, potentially debilitating sleep disorder, called sleep apnoea.
What is Sleep Apnoea?
Sleep apnoea is a condition when people stop breathing intermittently when they are asleep. Sufferers end up gasping or choking for air. In general, there are two main types of sleep apnoea. Obstructive sleep apnoea (OSA) happens when there is a physical block in the throat or nasal airways. This the most common form of sleep apnoea. The other type is called central sleep apnoea. Unlike OSA, central sleep apnoea is rare. It occurs when there is no respiratory effort because the brain fails to send the right signals to the muscles. This is due to unstable respiratory sensors.
If you are overweight or obese and have associated nasal conditions such as a deviated or bent septum or nasal polyps, you run a higher risk of contracting sleep apnoea. The risks also increase once you hit 60 and above or have abnormalities such as a small jaw positioned backwards or a big tongue.
Men are more prone to suffer from sleep apnoea compared to women and according to Dr. Azida, studies show that middle aged men have a 25 per cent chance of developing the condition compared to middle aged women who run a 9 per cent risk.
Race could be a factor too based on a research by the Wayne State University. In an article entitled “The Influence of Race on the Severity of Sleep Disordered Breathing”, published in the April 15 issue of the Journal of Clinical Sleep Medicine, it was stated that the severity of sleep apnoea is higher in African-American men in certain age groups even if they are within a healthy weight range. However, no differences were seen in African-American women compared to their Caucasian counterparts.
Children are not spared from this condition. Kids with large tonsils or adenoids have a higher chance of suffering from this disorder. Adenoids are the patch of tissues behind the throat that helps with immunity function. “Some children with allergies or who are always having the sniffles or recurrent tonsillitis will tend to have bigger adenoids or tonsils, which can cause blockages of the airways,” Dr. Azida explains. “It happens in toddlers and older children too.” Babies do not suffer from sleep apnoea because their tonsils and adenoids are still underdeveloped.
You Know You Have Sleep Apnoea When…
Snoring is a widespread symptom but Dr. Azida cautions that not all snorers suffer from sleep apnoea. Another telltale sign is when you or your spouse wake up gasping for air. “In severe cases, these people wake up feeling like they are dying! Their heart is beating fast and they feel frightened,” she says. Dr. Azida also lists a dry mouth, sore throat and morning headaches as symptoms. In men, it can even cause impotence. Lethargy and sleepiness is obvious too.
“The symptoms are multi factorial and not specific but when we group them all together and study the brain activity, we can tell whether it is sleep apnoea or not. Child sleep apnoea sufferers also snore and display sleepiness during the day but the symptoms can be learning difficulties and behavioural problems,” adds Dr. Azida.
If left untreated, sleep apnoea sufferers could develop cardiovascular problems as prolonged decreased oxygen intake strains the heart. The drop in oxygen saturation triggers biochemical processes that can cause arrhythmia or abnormal heart rate, heart attack, high blood pressure, stroke and even diabetes. Sleep apnoea is also known to worsen attention deficit hyperactivity disorder (ADHD) especially among children.
Fixing The Problem
Sleep experts like Dr. Azida carry out tests either in the hospital or in the patient’s home before they come to a conclusion. Patients can choose to loan a diagnostic machine overnight, which they will strap to their body before they go to bed. The machine records air pressure and flow, oxygen levels and pulse rate. More advanced home-based diagnostic tools monitor the sleep stages and even the patient’s sleeping positions.
Sleep clinics or hospitals offer deeper insights as the data collected is more comprehensive and includes brain activity and eye movements. The doctors study the data to obtain the apnoea-hypopnea index (AHI), which indicates the existence or severity of sleep apnoea.
A healthy person displays an AHI of less than five. An AHI between five to 14.9 means mild and the range of 15 to 29.9 is moderate. A person with an AHI of 30 and above is considered to be a severe case. “The thing with sleep apnoea is that it won’t just go away. It can be fatal if left untreated,” Dr. Azida stresses. “Because of the risks and complications, it’s important to try to diagnose it early.”
Treatment is two-pronged with surgery coming in as the third and last option. The 3 methodologies are:
Lifestyle or behaviourial changes
A 10 per cent weight loss for those who are overweight can reduce AHI. Quitting smoking and drinking and actually getting the optimal hours of sleep will make a big difference.
The Continuous Positive Airway Pressure (CPAP) is currently the gold standard treatment. It is a ventilation therapy. The patient wears a mask to sleep and the device pushes air into the patient’s airways. It is the most effective treatment to date.
This is the most drastic approach. It is also painful and recovery takes about two to three weeks depending on how extensive the surgery was.
Doctors must repeat the diagnostic tests again after treatment is prescribed. “The repeat tests will reveal the treatment’s effectiveness. We also need to take another look at the AHI. It doesn’t mean you’re cured just because you stop gasping for air or that your wife said you stopped snoring,” says Dr. Azida. She advises that anyone can reduce the risk of developing sleep apnoea by maintaining a Body Mass Index of less than 25 per cent, avoiding alcohol, sleeping pills and smoking.
Having problems sleeping?
Here are five common sleep disorders that prevent us from getting a good night’s rest. Make sure you make a trip to the doctor’s if you suspect that you suffer from one of the following.
The inability to fall asleep or sleep well. This could be caused by various medical or mental health problems.
It is a chronic sleep disorder that is characterised by excessive daytime sleepiness and a tendency to fall asleep during the day.
Also known as somnambulism. This disorder is characterised by walking or other physical activities carried out during sleep. A sleepwalker may appear to be awake and may engage in complex task. It is more common in children.
4. Sleep Apnoea
The most common reason for referral to sleep centres. It refers to the condition when one’s airways are partially or fully blocked when asleep.
5. Teeth Grinding
Nocturnal teeth grinding or sleep bruxism is the medical term for clenching or grinding teeth during sleep. Occasional bruxism may not be harmful but when it occurs regularly, it may be associated with moderate to severe dental damage, facial pain and disturbed sleep.
Sources: National Sleep Foundation of America and University of Maryland Medical Centre