You go to bed, doze off on time, and even have a good night’s slumber, but still you wake up tired. Your partner, roommate or a family member points out that you snore while sleeping. Sometimes you can sleep, but at other times, no matter how hard you try, you are just not able to disconnect from the world, close your eyes, and fall asleep. You wake up in the middle of the night gasping for breath or with a parched mouth. Many times, you also wake up with a headache. You feel excessively sleepy or drowsy during the day. Not to mention, you have trouble paying attention, focusing, or concentrating while you are up.
If this sounds like you, chances are you might be suffering from a ‘dangerous’ sleep disorder called sleep apnea, says Dr Manav Manchanda, director and head of respiratory, critical care and sleep medicine at Asian Hospital, Faridabad. “When you have sleep apnea, a dangerous sleep disorder, your breathing ceases and resumes during the night,” he explains.
The issue doesn’t just disrupt sleep – it has a spillover effect on your daily functioning and routine; it also has some serious health repercussions, if left untreated. “It can lead to more significant issues including high blood pressure or heart problems, diabetes, as well as loud snoring and fatigue throughout the day,” says Dr Manchanda.
Studies have also shown that people who experience sleep apnea may be more likely to have memory or thinking problems. According to a study released by the American Academy of Neurology in March this year, sleep apnea was positively associated with memory and thinking problems. Among the participants who had symptoms of sleep apnea, 33% reported memory or thinking problems. The study also looked at other factors that could affect memory and thinking problems, such as age, race, gender, and education, and found that people who reported sleep apnea symptoms were about 50% more likely to also report having memory or thinking problems compared to people who did not have the symptoms.
Another study published in the medical journal JAMA Network in December last year said people with obstructive sleep apnea (OSA), who slept less than seven hours per night, had a higher risk of death compared to those with longer sleep. According to a study published in the journal Sleep in April this year, sleep apnea and low oxygen levels while sleeping are associated with epilepsy in older adults (after 60 years of age), known as late-onset epilepsy.
Doctors say the problem of OSA is quite common in India. At least 104 million Indians suffer from OSA, with around 47 million individuals suffering from moderate or severe forms of the condition. This is just the tip of the iceberg as a lot of those living with this condition go undiagnosed and untreated, say doctors. Additionally, people who are obese are at a higher risk. “This high prevalence indicates a growing concern, particularly given the rising rates of obesity in the country. It also underscores the need for greater awareness and intervention to address this widespread issue,” says Dr Vikas Mittal, pulmonologist at CK Birla Hospital in Delhi.
Doctors say it is more prevalent among men than women and tends to affect older men more than younger people. However, Dr Sanjiv Badhwar, consultant and head of ENT Services at Kokilaben Dhirubhai Ambani Hospital in Mumbai, says cases are also being reported among young children.
Dr Sanjay Sachdeva, vice chairman, ENT at Max Super Speciality Hospital, Saket, observes that the condition is quite prevalent in metros because of the sedentary lifestyle that most people lead there. “The disease load on our society is quite intense and renders a lot of responsibility on our shoulders to comply with,” he adds.
Know your condition
In sleep apnea, breathing repeatedly stops and starts during sleep. “Either the brain miscontrols the breathing (central apnea) or the airway becomes blocked (obstructive sleep apnea),” says Dr Manchanda of Asian Hospitals.
The fact that many people abruptly get awakened is explained by consequent oxygen shortage which sets off a survival mechanism that somewhat breaks their sleep so that they can start breathing again. “The reflex keeps you alive, but it throws off your sleep schedule. This might lead to other problems, such as stressing your heart, which could be fatal, and prevents you from getting a good night’s sleep,” adds Dr Manchanda of Asian Hospitals.
It is characterised by repeated collapse of upper airways during sleep and accompanied by reduction in oxygen saturations, waking up from sleep and disturbed sleep. “In technical terms, stopping of breathing for at least 10 seconds is called apnea,” says Dr Badhwar of Kokilaben Dhirubhai Ambani Hospital.
An apnea is a temporary pause in breathing when oxygen level dips critically. The airway becomes narrower while sleeping, leading to drops in oxygen levels, says Dr Akshay Budhraja, senior consultant and HOD of respiratory and sleep medicine at Aakash Healthcare in Delhi.
While this is temporary, it can happen multiple times throughout the night when a person’s breathing stops for anywhere from two seconds to a few minutes each time.
“When this happens, their oxygen level drops and the person wakes up briefly to start breathing again but this cycle repeats throughout the night. As a result, they can’t get a good night’s sleep and often feel drowsy in the morning,” says Dr Neetu Jain, senior consultant of pulmonology at PSRI Hospital in Delhi.
Causes and effects
Sleep apnea is essentially an interrupted breathing pattern during sleep. There are three types of sleep apnea – obstructive, central, and mixed. OSA is the most common form and occurs when the upper airway becomes blocked
during sleep. “This blockage is often due to a loss of muscle tone that causes the airway muscles to become floppy and the tongue to fall back, leading to airway narrowing. People with a thick neck, such as those who are obese, are more prone to this condition,” says Dr Mittal of CK Birla Hospital.
Causes of OSA are excess weight gain (obesity), reduced muscle tone, increased neck circumference, increased body mass and deposition of soft tissue and fat in upper airways, deviation of nasal bone causing nasal obstruction, large tonsils, bulky base of tongue, genetics, as well as smoking.
“Besides obstruction of the airway, conditions which reduce the muscle tone in the body, like thyroid dysfunction, can also cause apnea. Obesity is one of the major reasons for OSA,” underlines Dr Sachdeva of Max.
Alcohol consumption and the use of sedative medications, including sleeping pills, can worsen the condition, points out Dr Budhraja of Aakash Healthcare.
The health effects of sleep apnea are rooted in the extent to which one’s sleep remains disturbed. “The more regularly you have sleep disturbances, the more severe your issue is. Being sleep deprived causes fatigue during the day. You could feel agitated, moody, or depressed, and you might be less productive at work or school. You may have trouble focusing or be forgetful. Additionally, you run the risk of getting into accidents when driving or at work,” says Dr Manchanda of Asian Hospital.
Sleep apnea can also cause serious health issues. Doctors say it can lead to problems like uncontrolled diabetes and high blood pressure, and it may increase the risk of stroke and heart attacks. This condition, if prolonged, can not just impact one’s cognitive abilities but also makes them vulnerable towards cardiac events and many other health issues. “As the disease progresses, these patients start losing cognitive function, memory and concentration ability. These patients are more prone to having sudden cardiac events in the night. They are more susceptible to getting strokes, heart rate abnormalities and metabolic disorders like diabetes mellitus,” says Dr Sachdeva of Max.
Obesity not just causes sleep apnea, it is also associated with late night hunger pangs adding onto the cycle of weight gain. “Increased risk of obesity due to higher levels of the hunger hormone ghrelin and lower levels of the satiety hormone leptin,” explains Dr Mittal of CK Birla Hospital. The condition can create a vicious cycle where obesity worsens sleep apnea, and sleep apnea exacerbates obesity and other related health issues.
Cure or treatment?
Doctors are divided on whether sleep apnea can be cured completely. Some say it can be cured in specific cases, others say it can be managed. Making changes to lifestyle like losing weight, quitting smoking, and avoiding alcohol, however, have been underscored as mandatory to get better results and reduce the severity of sleep apnea, according to Dr Sachdeva of Max and Dr Mittal CK Birla Hospital.
Early diagnosis and treatment are essential to avoid the long-term health impacts of sleep apnea. Diagnosis of the condition is done with an overnight sleep study. Confirmation of diagnosis is done with sleep endoscopy, explains Dr Badhwarof Kokilaben Dhirubhai Ambani Hospital, Mumbai. With proper evaluation and diagnosis, treatments are quite satisfactory and rewarding, say doctors.
While pointing out that none of the treatment options is a cure but can help avoid apnea episodes or lessen their frequency or severity, Dr Manchanda of Asian Hospital lists outs these as treatment options:
- Conservative (non-medical) treatment
- Adaptive ventilation devices and positive airway pressure
- Mouthpieces, oral appliances or dental devices
- Stimulators of nerves
- Medical procedures
- Medication (only for central sleep apnea)
Positive airway pressure (PAP) devices can help alleviate most of the symptoms and are considered the gold standard for treating sleep apnea. They work by delivering continuous air pressure to keep the airway open during sleep.
Doctors explain that OSA can’t be cured but is treated with the use of machines at night like CPAP or BiPAP.
“After a sleep study to figure out the right pressure settings, you use the device at night. It helps keep your airway open while you sleep, making it easier to breathe,” says Dr Jain of PSRI Hospital.
Symptoms to watch out for
- Loud snoring (not everyone who snores has sleep apnea)
- Teeth grinding or clenching while sleeping
- Sleep-related breathing arrest episodes
- Feeling of suffocation, choking while asleep, gasping for breath
- Waking up with parched/dry mouth
- Waking up to frequently use washroom at night
- Headache in morning, not feeling refreshed, decreased energy
- Insomnia or trouble falling asleep
- Hypersomnia or excessive daytime drowsiness
- Fatigue, brain fog, feeling groggy
- Having trouble focusing when awake, reduced alertness
- Irritability, sensitivity to light and sound
- Arousal during sleep
- Mood changes
— Dr Neetu Jain, senior consultant, pulmonology, PSRI Hospital, Delhi