As the city gears to raise the game in tackling sleep disorders, the biggest hurdles remain low public awareness and dearth of trained polysomnographers.
The lack of awareness is not just among the public but extends to physicians, and this is one of the main reasons why many patients remain undiagnosed.
According to experts, patients tend to dismiss symptoms like snoring as something harmless. Many patients and families do not consider snoring as a complaint worth informing a doctor. “In our experience it’s most often the partner who brings patient to the clinic because he/she is bothered by patient’s snoring,” said Dr. G.Vishnukanth, Associate Professor, Department of Pulmonary Medicine, Jipmer. Symptoms like daytime sleepiness, easy fatiguability, are often attributed to excessive workload or poor food intake, when these might actually be due to underlying Obstructive Sleep Apnea (OSA). Lack of dedicated polysomnography labs is another reason why OSA is under-reported.
The most common reason why patient’s kin bring the patient to doctor is because of snoring, which affects the sleep of the partner. Rarely, the partner may notice that during sleep the patient stops breathing for a few seconds and resumes it with a loud inspiration (apneic episodes) and decide to bring him to doctor. Patients with diabetes, hypertension, high cholesterol, hypothyroidism can also have undiagnosed OSA. Some patients present to the Emergency Medical Department when OSA has led to respiratory failure.
Doctors advise that anyone with nocturnal sleep disturbances, snoring, excessive daytime sleepiness (while watching TV or driving) needs to consult a specialist, says S. Mathan Raj, consultant pulmonologist.
Another roadblock in the way of the specialty taking off is the shortage of trained doctors as well as technicians in performing Polysomnography (PSG). As sleep medicine is an upcoming field it should probably be considered as a super speciality rather than a sub-speciality, specialists said.
Sleep study
PSG is carried out in a dedicated sleep lab overnight. EEG leads are placed on the scalp and the patient’s EEG waves are recorded for the entire duration of sleep. Other parameters which are recorded are — eye movements, snoring, oxygen saturation, nasal flow, heart rate, respiratory rate, abdominal movements, limb movements.
Sleep studies can also be done at the homes of patients who either refuse a lab sleep or who cannot be shifted. Unlike sleep lab PSG, these home-based sleep studies do not measure all parameters.
A few centres in India offer fellowship courses and diploma courses in sleep medicine for doctors.
The duration of these may vary with each centre and may be for about 1-2 years.
Besides many national and international conferences happen with hands on workshop on PSG. Certificate courses are also available for a six-month duration for technicians with interest in performing PSG, specialists said.
