Sleep medicine did not even exist until the Japanese decided to save marriages.
The story goes that about 25–30 years ago, a Japanese court granted divorce to a woman on grounds that her husband was snoring. The early work on sleep medicine therefore came from Japan and it was intended, even if not to save lives, to save relationships.
The lady’s husband probably was a ‘heroic snorer,’ reasons Mohan Kameswaran, senior ENT surgeon and managing director, Madras ENT Research Foundation. Nothing heroic in the romantic sense of the term; perhaps only in the auditory sense! Loud snoring, that is disruptive for others, is termed heroic snoring.
Snoring, however, is just not a standalone. In most cases, about 90 per cent snoring is indicative of a condition called sleep apnea. Obstruction to breathing during sleep is defined as apnea, and its cardinal symptom, heroic snoring. The prevalence in India is about 24 per cent of men (mostly over 40 years) and nine per cent of women.
Post the forties, the body’s muscle loses its tonality, especially among men with little physical activity. During sleep, when the muscles relax, the base of the tongue completely obstructs the airway, causing the breathing activity to ceases. About 30 such obstructions occur within a seven-hour sleep cycle. This has an effect on the cardio vascular, and central nervous systems, and can even lead to death, in the odd instance. Besides, it will cause fatigue, and dulling of the intellectual and emotional faculties of a person, Dr. Kameswaran says.
Growing obesity, changing lifestyle patters, overeating, a sedentary life, smoking, consumption of alcohol are causes, explains Vijay Krishnan P, of the Indian Association of Surgeons for Sleep Apnea (IASSA). The diagnosis and management of this condition is rapidly evolving and includes the patient using a CPAP machine to facilitate removal of obstructions to breathing, and surgery, he adds. In the long term, stepping up physical activity, giving up smoking and controlling alcohol consumption will have beneficial effects.
There is suspicion that Indians are genetically predisposed to sleep apnea, doctors say. Sleep apnea among children is also growing, Dr. Kameswaran says. In them, while the causes relate to tonsils or adenoids, and removal is the recommended option.
Sleep apnea is recognised as a disorder in the West, says Seemab Shaikh, of IASSA. “In some countries, those with sleep apnea will not be issued driving licences, or allowed to work with heavy machinery. That kind of awareness is lacking in India,” he adds.
It is towards building awareness, and to formulate guidelines for assessment and management of the condition that the first national conference on snoring and sleep apnea is to be held in Chennai between Friday and Sunday. International faculty, national faculty and ENT surgeons will participate in the event that will also feature live surgical demonstrations.