“If you make noise, doctor uncle will give you an injection, ok.” This is a usual threat mothers make to keep children quiet when parents come to him for consultation. To partially correct the image of a “needle happy maniac doctor uncle” who loves giving small children painful injections, I normally bribe the accompanying child with chocolates. But I never expected bribing would lead to a miracle of this scale.

The woman did make a passing mention that her husband snores a lot, but in a busy cardiology outpatient department, chest pain and breathing difficulties get priority over such trivial issues. I examined her husband, in his mid-fifties, an executive in a private company, successful enough to sport a little flab around the tummy, coupled with perks like high blood pressure, and a hint of high blood sugar. I prescribed tablets for his blood pressure and diet for his sugar. Their daughter, a six-year-old kid, happily enjoyed the chocolate, trying to tickle the tummy of the “laughing Buddha” on my table, notwithstanding the mother’s warning that ‘doctor uncle’ might go for the injection at the slightest provocation.

In the next one year, he visited me four times with worsening blood pressure and sugar. I scolded him for not following the diet regimen, warned him of dire consequences like insulin injection and increased his medicine dosage. He silently accepted all that but each time insisted that he was becoming weak and tired. By the end of the year, his weight had gone up, as had the number of pills, while his self-esteem and agility came crashing down. Finally, he was sent out of his company on the pretext that he was sleeping off during board meetings.

As I was trying to figure out what complicated medical illness he was suffering from, his small daughter accepted the chocolate bribe as usual, and was going on blabbering like any six-year old. “How do you sleep now,” I asked the patient, with a purpose of deciding whether I should send him for a psychiatric consultation, the last remedy in the magic box of a physician unable to make a diagnosis. “I sleep well,” he said.

“Doctor uncle, doctor uncle, I will tell you how papa sleeps.” Despite her mother trying to stop her, she went on. “Papa snores like brrrrbrrrrbrrrr and then suddenly stops breathing….and the again brrrr, brrrrr, brrrrr…..like a lion.”

And then it struck me like a bolt. That was a classical description of obstructive sleep apnoea (OSA).

Normally as we sleep our brain relaxes, and most of our ‘non-essential’ services go to sleep. Except the respiratory muscles and diaphragm, which maintain the mechanism of breathing. The throat muscles relax. Normally, it doesn’t matter. But sometimes, often in the obese, the relaxed throat muscles fall back and clog the airway and then the problem starts. As air gushes through the narrow airway, the muscles vibrate and snoring starts. With more obstruction, breathing slows down, and finally the brrrrbrrrr stops, totally. As breathing stops, the blood oxygen level drops. When the levels of oxygen fall below a critical level, it jolts us out of our sleep; making us transiently alert and breathing becomes somewhat normal. Transiently. The whole cycle goes on repeating, without the knowledge of the sufferer of the disease. He thinks he sleeps well. Night after night, till he sleeps off during the meetings. That’s OSA.

The treatment for such a mysterious disease is pretty simple. A small ‘gas mask’-like device, CPAP (Continuous Positive Airway Pressure), which is worn at night over the nose, prevents the airway from closing down during sleep. Absolutely simple and safe. Once sleep is corrected, it reduces associated problems like elevated blood pressure and blood sugar, to a great extent. The daytime sleepiness and fatigue vanish.

A sleep study confirmed the diagnosis. The CPAP made sure he got back his job, and his daughter, a double dose of chocolates.

I named this article OSA, the standard medical terminology. My son, always in a hurry, started reading the first few letters of this article and commented… oh new disease called OSAMA. Only then did I realise that OSA is similar to the dreaded terrorist. Deadly, mysterious, residing very close, but without our knowledge.

Next time you find your spouse snoring, make sure there is no such terrorist lurking in the background.

(The writer is Head, Dept of Cardiology, PRS Hospital, Thiruvananthapuram. His email is tinynair@gmail.com)

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