What is Sleep apnoea?

Smptoms-

Other  type  is-

• Central  sleep  apnoea  -in  which  the  Central  nervous  system is responsible .The  impulse  required  for  breathing  from the  Central nervous system  stops  temporarily. In  a normal individual the  brain  sends  signals  to  the  respiratory  muscles  so that  the  lungs  contract and  expand  during  respiration .
• In  central  sleep apnoea  these  signals  are  reduced  or  interrupted.
• Loud  snoring is  less  common  in  patients of  Central sleep apnoea  as  compared to patients  with  obstructive sleep apnoea.
• Complex  apnoeas  are  a  condition  that  occurs  in  a  patient of  obstructive sleep apnoea  in  whom  positive  pressure  ventilation  is  given.
• In  the  present  day  medical  science  it  is  not  completed understood  how  these  apnoeas  develop.
• They  usually  develop and  resolve  on  their  own.
• When  they  persist  they  require  specific  treatment.
• In any case  whether  there is physical obstruction to breathing airway  or due to  signally problem  from the  Central nervous system  as  in case of  Central  sleep  apnoea  the  breathing  stops  temporarily .
• It  resumes  again.
• This  occurs  repeatedly during sleep.
• When  the  Breathing  starts  again  there is  snoring, deep  breathing.
• The  individual  may  wake up completely  but  there  is  feeling  of  choking, gasping.
• The  individual  has  to  wake  frequently during  sleep and  go  for  urination.
• In the  morning  there is  headache  ,irritability  and  the  individual  may  suffer from  memory loss.

Complications  of  Sleep  apnoea-

• If  untreated  sleep  apnoea  can  lead to complications like –
• Heart disease
• Depression .
• Due  to  decreased  sleep during  night  time  ,the  individual  feels  drowsy  during  the  day time.
• He  is not able to concentrate on his work.
• If  he is  driving  a vehicle  then  it can  lead to  accidents.
• It can  lead  to  mishaps  at  the  place of work. .

Things  noticed  by  individual-

• Due  to  lack  of  sleep  during  night  they  get  fatigued easily
• insomnia
• Difficulty  in  concentration
• They have to wake  several  times  during  night
• As mouth  breathing ,snoring  is  present, they  wake  up with a dry  mouth  ,upper  respiratory  tract  infection.
• headache due  to  lack of sleep, acidity ,
• Irritability,
• decreased  libido  and  erectile  dysfunction.

Treatment  of  sleep apnoea –

• Aims  of  the  treatment  are to  reduce  the breathing  problems during  night  sleep  and  to  treat  the  underlying causes.
• The  line of  treatment  depends  on the underlying cause and  the  severity  of the  symptoms.
• If  there  is  snoring  due to  obstructive sleep apnoea, first  of  all  weight  reduction  is  advised.
• Dieting and  rigorous physical exercise should  be  done  as  per  the  advice  of  dietitian  and  MD General Medicine doctors .
• We  never  recommend too  much  rigorous  dieting  as  it  can  spoil  the health.
• Whether  the  individual  has obesity  or  not, he  should  follow  heart  healthy  diet.
• Minimum 6-7 hrs  sleep  out  of  24 hrs  is  recommended.
• Ear  to  bed  ,ear  to  rise  makes a man healthy wealthy and wise.
• Remaining  awake  for  too  much  late  hrs  in  night  is  not  good  for  health.
• Smoking, alcohol  should be  given up.
• To  avoid  sleeping  in the  prone  position.
• To  sleep  in  supine position  or  lateral  positions.
• Continuous  positive  airways  pressure (CPAP) -At  present  this is the  main line  of  treatment  for  sleep  apnoea  .
• This  by  providing  positive  pressure though air  administered will  help to  keep  the  airway  open.
• Constant  stream  of  positive  pressure  air  is  given  by  mask.  Moisture  is  added  to the  inspired  air  to  prevent  health  problems  of  dry  air.

Surgery –

• This is done  to  stiffen the  excess  tissues, to remove  excess  tissues ,
• to  remove  enlarged  tonsils  if  any.
• Mandibular repositioning  device (MRD) –
• This is used in cases  of  mild  to moderate  sleep apnoea.
• This is  a mouthpiece  device  which holds  the  jaw  forward during sleep  .This  increases  the  space  behind  the  tongue .
• Thus  the  upper  airway remains  open and prevents  snoring  and  sleep  apnoea.

Side  effects of  MRD-

• If  an individual  is already  having temporomandibular disease then  it  gets  aggravated.
• Even  if  an  individual  is not  having  temporomandibular  diseases  then also  it  can cause  jaw  pain  and  dental  pain, due to  the  pressure  exerted by  it .

Medicines-

• These should be  taken  only after consultation with  qualified and experienced MD General Medicine doctors  or  with chest  physician.
• These  have  several  adverse  effects –
• Triazolam, Acetazolamide

Causes /Eitiology  of  sleep  apnoea –

• Lax  tissues and  muscles  of the  mouth  and  throat
• Chronic  rhinosinusitis or  deviated  nasal  septum  since  a  long  time -Whatever  it  may  be  -these  things  cause  nasal congestion and  nasal  congestion  is  contributing factor in sleep  apnoea.
• Obesity  causes  thickened  tissues, irregular tissues and  additional  fat  stores,  around  airway,enlarged tonsils -contributing to  obstructive sleep apnoea
• neurologic  disorders
• genetic factors
• heart, kidney  problems ,
• thyroid  disorders,
• preterm  infants .

Risk factors  association with sleep apnoea –

• Many  of  these are already  discussed  previously  in this  article -Old  age,
• Obesity,
• alcoholism,
• smoking,
• pregnancy,
• diabetes,
• large  neck,
• menopause,
• Down ‘s syndrome
• family history,
• recessed  chin,
• racial  origin.

Sleep  apnoea  is associated with  the  following  disorders –

• Patients  taking  frequent pain  relief medications.
• Excess  use  of  pain  relief  medications  should be avoided.
• All  medicines  should be taken only after consultation with qualified and experienced MD General Medicine doctors .\
• CNS  disorders  like  encephalitis
• high  altitudes travel
• medicines  taken  for  depression and  opioids
• heart  failure and  stroke .
• Complications of  sleep apnoea –
• Stoke
• Atrial fibrillation
• Type  2 diabetes
• Hypertension
• Glaucoma
• In  female patients if  there is  pregnancy  then  it  can  cause pregnancy  related  complications.
• Cardiac  problems  due  to reduced  blood supply
• Dementia
• Kidney problems
• Decreased  ability to  focus   cognitive  problems
• Respiratory  system problems  like  asthma
• As  soon  as  any  of  these  earliest  signs and  symptoms  of  sleep apnoea  are  noticed  then  immediate  consultation  with qualified and experienced MD General Medicine doctor should  be  sought  to  avoid  progress and  undue  complications.
• Sleep  studies and  Sleep  MRI
• In  case of  snoring  we  advise  sleep  MRI in  which  the  patient  is  asked  to  sleep in  sleep  laboratory.
• During  deep  sleep  a sleep  MRI  is  performed.
• Video  record of  this  sleep MRI  is  done  which  actually indicates  the  site  of  obstruction  in  cases of  obstructive sleep apnoea.
• In  any  case  of  snoring  first  weight  reduction is advised.
• Only  and  only  after  weight  reduction and  correction  of  associated  deviated  nasal  septum   sinus  problems, this  sleep  MRI is done .
• If  any  obstruction  is  detected  in sleep  MRI then  various  surgical  modalities  like  mandibular  advancement  techniques
• reduction  of  tongue mass  by  laser
• Surgery  for  vocal cords polyps, if  any  is  advised
• In the  sleep  laboratory  the  equipment  records  brain  waves,
• Eye  and  leg  movements
• SPO2
• ECG