Things were going just fine for Rajeev Chopra, a Delhi-based chartered accountant, except that he could not figure out why he woke up several times in the night feeling suffocated.
He would rush to the window for fresh air, and was normal in just a while. Not knowing he was suffering a disease, Rajeev learnt to live with this disturbed sleep and loud snoring, and an occasional tiff with his wife who often suspected him of having too much to drink!
Eventually on the afternoon of January 1, 1998, Rajeev was told he was suffering from sleep apnea, a sleep disorder characterised by abnormal pauses in breathing or abnormally low breathing during sleep. Each pause between breathing is called apnea, which can last from a few seconds to minutes, and can occur 5-30 times in an hour or more.
Rajeev was sleeping on a couch in his drawing room when his younger brother, a doctor, walked in and suspected sleep apnea. Rajeev underwent an overnight sleep test – polysomnogram – at a hospital that confirmed the diagnosis.
There are three types of sleep apnea and snoring is common to all. The condition can remain undetected for years during which the individual learns to live with sleepiness and fatigue during the day as a result of disturbed night sleep.
The blocked airways due to collapsing of muscles during sleep results in shortage of oxygen to the body and brain. In the most severe case it can lead to a heart failure, often associated with a silent heart attack. The threat of obstructive sleep apnea increases with obesity and diabetes.
Rajeev has been using Continuous Positive Airway Pressure (CPAP) therapy devices since then. “It has made my life absolutely normal. I use it in the night. I breathe easy and it helps me relax during the day,'' he said.
The device – similar to a mask - is manufactured by several companies in India and abroad but continues to be priced high putting it out of reach for an ordinary person.
“I would say sleep apnea is a rich man's disease because the device is so expensive. I sincerely feel the government should so something to bring down the price of the device so that even the poor can buy it,” he said. The life of the device is around 3-5 years and the third one, which Rajeev is using, cost him Rs 60,000.
Medical studies show that effects of sleep apnea may range from annoying to life-threatening. It can lead to heart failure while other problems include high blood pressure, irritability, sexual dysfunction, learning and memory problems and falling asleep at work or while driving.
Untreated sleep apnea can also take an emotional toll. Depression and feelings of despair are common. This can affect an otherwise healthy person's ability to deal with stressful situations, which has an overall impact on a person's overall ability to cope with life.
Dr. R.K. MANI, Director, Department of Pulmonology, Critical Care and Sleep Medicine, Artemis Health Institute, Gurgaon, answers frequently asked questions on sleep apnea.
How does one identify sleep apnea? Could you list a few symptoms?
Most of us do not think of snoring as something to be overly concerned about, unless our partner disrupts our sleep. But frequent, loud snoring may be a sign of sleep apnea, a common and potentially serious disorder in which breathing repeatedly stops and starts as you sleep.
At what stage of the disease do patients come for treatment?
Generally late, when the symptoms start to impact their daily life. This usually takes the form of excessive sleepiness, impaired work performance or breathing difficulties. Sometimes it is detected when the patient is hospitalised for an unrelated surgical or medical condition.
Is it a lifestyle disease, clinical disorder or a genetic condition?
It is a combination of all three. Obesity adds to the problem caused by genetic predisposition and clinical conditions such as facial deformities, alcoholism, and thyroid disease, among others.
Do children also have sleep apnea?
Yes. No age-group is exempt. In children this is often caused by enlarged adenoids or tonsils. However, the peak age of onset is after 40.
Is it life threatening? How does it impact people in their normal life?
It is a potentially life-threatening condition that requires immediate medical attention. The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, impotence, irregular heartbeat, high blood pressure and heart disease. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents, lost productivity and interpersonal relationship problems. The severity may be mild, moderate or severe.
Is the treatment easy and affordable?
If the problem is moderate to severe, or you’ve tried self-help strategies and lifestyle changes without success, it’s important to see a sleep doctor. A specialist can evaluate your symptoms and help you find an effective treatment. Treatment has come a long way in recent times, so take time to explore new options. Even if you were unhappy with earlier treatment, chances are you can find something that works.
Continuous Positive Airflow Pressure is the gold standard treatment for moderate to severe obstructive sleep apnea. In many cases, you’ll experience immediate symptom relief and a huge boost in your mental and physical energy. The CPAP device is a mask-like machine that provides a constant stream of air under gentle pressure which keeps your breathing passages open while you sleep. Most CPAP devices are the size of a tissue box. A wide range of models from manufacturers across the globe are readily available in the Indian markets. Your doctor would guide you for the appropriate model and adjustments to specifically suit your needs.
What should be done to raise awareness?
An education campaign for doctors enlightening them on sleep apnea is a viable solution. Also a large-scale consumer campaign to dispel myths, taboos and social stigmas and urging affected people to reach out for treatment and improve the quality of their lives. Also, the media can raise awareness levels and bring about sustainable change thereby reducing vulnerability to such conditions.
