Doctor Reza - The Specialist in Treatment of Obstructive Sleep Apnea

Did you know that Sleep Apnea causes:

  • Accidents, especially road accidents
  • High blood pressure
  • Heart failure and stroke?

The consequences, of not taking immediate action, are severe.

Whether it is you or your partner who is suffering, get sleep apnea diagnosed and treated as early as possible.

Obstructive Sleep Apnea (OSA)

In U.K., I worked with Prof. John Stradling who is a world authority on sleep apnea. There I got a chance to diagnose and treat Sleep Apnea patients. This was before most doctors in Kolkata had even heard about obstructive sleep apnea. Since my return to India, I have successfully imbibed my learning and experience in my treatment of OSA patients, in Kolkata.

Defining Obstructive Sleep Apnea (OSA)

While sleeping, if you breathe slowly or stop breathing for brief periods, then you maybe suffering from Obstructive Sleep Apnea or OSA. This process of slow, or stopping breathing, for short periods while sleeping in the night can happen a number of times. You may not understand that your extreme sleepiness during the day is due to poor sleep patterns in the night. All you may know is that you are waking up with a lingering feeling of tiredness every morning, in need of more sleep.

Usually, while you are in deep sleep, your muscles and throat relax. However, if you have OSA, then:

  • The upper airway at the back of your tongue gets blocked when you fully relax your throat muscles
  • Your usual breathing pattern will slow down totally or stop at this point. This occurrence is called an apnea
  • As your upper respiratory tract will be obstructed, you will constantly try to breathe against it till your blood oxygen level start dropping
  • Your brain will, now, try to make your muscle tone revert to normal so that the upper airway opens for you to breathe again. The brain will, therefore, wake you up from your deep sleep
  • This aroused state does not last longer than 10 or more seconds. You will go back to a relaxed deep sleep where your muscles will relax again. This cycle will go on throughout the night, and through all nights. It maybe repeated a 100 times every night, if you have a very severe state of OSA.
The type of people most affected by OSA

You will be most at risk of suffering from Sleep Apnea, if you are:

  • An overweight middle-aged male who snores
  • Females are less affected. Their peculiar hormones and throat structures protect them till menopause.

    It does not affect only the middle-aged or over-weight. Anyone with one or all the problems listed below can have OSA:

    • Back of the throat and the upper airway are narrow
    • A blocked nose
    • A small jaw
    • Enlarged tongue
    • Big tonsils
    • Big dangly uvula.
Elements that Worsen Sleep Apnea

Many a times, to sleep undisturbed, you may resort to consuming –

  • Alcohol
  • Sleeping pills
  • Tranquilisers.

These have an adverse effect on OSA as they relax your upper airway muscles more. Alcohol, specially, lengthens the episode of apnea as the brain takes more time to respond. It will result in worsening your mild snoring and mild apnea.

Understand Your Symptoms of and Complications due to Obstructive Sleep Apnea

Though it is difficult for you to be aware of obstructive breathing due to apnea, you or your partner can understand from the related symptoms whether you have OSA, like:

  • Snoring loudly
  • Breathing strenuously and noisily
  • Acute breathlessness
  • Waking up for brief periods after struggling for breath
  • Feel that you have not had a refreshing sleep when you wake up in the morning
  • Morning headaches
  • Cannot concentrate during the day
  • Feel sleepy throughout the day
  • Cannot remember properly
  • Feel depressed and moody
  • Become impotent (males)
  • Lose interest in sex.

A lot of times symptoms worsen while you are in deep sleep and lying on your back.

Special Steps to Assess Sleep Apnea

As your sleep disorder specialist, I will take the following steps if I suspect that you have sleep disorder due to Obstructive Sleep Apneoa:

  • Ask about your sleeping and waking habits
  • Ask your family or sleeping partner about the same
  • Arrange for an overnight sleep study to confirm the diagnosis and find out how severe your OSA is
  • Your breathing and quality of sleep will then be measured on a computer during the night
  • Small round electrodes will be secured to special points on your scalp, face, chest and legs
  • Special sensors will be placed on your upper lip to gauge airflow
  • Another device will be placed on your finger or the ear lobe. This will be to measure the level of oxygen in your blood
  • Your chest and stomach wall movements will be assessed
  • Though uncomfortable, the process will not disturb your sleep.
Guidelines to Improve OSA

My experience as a pulmonologist allows me to advise a patient (you) with Sleep Apnea, to follow some general guidelines to improve your symptoms of OSA and help nasal decongestion. Like,

  • Most importantly, lose excess weight
  • Avoid drinking liquor up to 2 hours before bedtime
  • Avoid sleeping tablets and sedatives
  • Stop smoking
  • Use nasal decongestant spray
  • Avoid sleeping on the back, as OSA is often positional
  • Use special pillows to give at least a temporary relief.
Specialised Treatment of OSA

There are mainly 2 ways to treat Obstructive Sleep Apnea cases. They are:

  • Non-surgical
  • Surgical.
Non-surgical Treatment
  1. Continuous Positive Airway Pressure (CPAP) to cure moderate or severe OSA:

    The most widely prescribed and effective treatment for OSA is by using a CPAP device.

    A CPAP device:
    • Will supply air at low pressure to the upper airways through a plastic tube attached to a close-fitting nose mask
    • You will wear it while you sleep
    • Will keep the upper airway open during deep sleep with positive air pressure
    • Will prevent disturbed sleep
    • Improve sleep quality
    • Reduce sleepiness during the day
    • Stop you from snoring.
    Effects of CPAP:

    If you have not had a ‘good night’s sleep in years’ due to OSA, then you will feel surprised by the improvement in your sleep habits and as a result your quality of life, after CPAP.

    You may feel uncomfortable with CPAP. However, your initial discomfort with the CPAP mask will be temporary. To make your experience easier and more tolerable, your sleep disorder specialist can take special steps, such as:

    • Warm the air or use special humidifier with the CPAP device as you may sneeze or have stuffy nose, especially during winter
    • Replace standard CPAP units with latest machines that adjust their pressure throughout the night
    • Study your sleep once more to decide the correct setting for CPAP pressure. You may get an unfamiliar feeling while exhaling, as if there is too much of pressure
    • In case of an air leak from the nasal mask, you may feel an irritation in the eyes
    • An air leak through the mouth can make your mouth feel dry. You may need a chinstrap to solve this problem.
  2. Other non-invasive care for special cases of OSA:

    As your sleep specialist, I may refer you to a dentist for mouth splints. This is for patients who do not tolerate CPAP at all.

    • The mouth splints hold the jaw forward in relation to the upper teeth
    • If you wear them during sleep, they can reduce the severity of snoring and apnea
    • However, if you have narrow maxilla, then it may need to be expanded with specially designed mouth plates. Snoring due to narrow maxilla is more common among children.
Surgical Treatment for OSA

If I, as your chest specialist feel that some of your upper respiratory tract troubles can be eased with surgery, then I may recommend the following operations:

  1. Removal of tonsils and adenoids – this usually has better results in children
  2. Nasal surgery –
    • To remove nasal polyps
    • Reduce swollen turbinates
    • Correct deviated nasal septum.
    This will better your nasal airflow and increase efficiency of nasal CPAP.
  3. Uvulopalatopharyngoplasty (UPPP) –
    • To remove excess tissue at the back of the throat which may contribute to upper airway obstruction during sleep
    • UPPP helps snoring in people without OSA
    • UPPP may not cure your OSA
    • Snoring will improve in most OSA patients
    • You may need to use nasal CPAP even after UPPP.
  4. Tracheostomy (currently, a rare surgery for OSA) –
    • To create a hole in the windpipe to remove upper respiratory tract obstruction.
  5. Corrective surgery for jaw or hard palate deformity –
    • Rare cases of OSA need these operations.
Remember:

Please do not buy a CPAP device from the Internet. It is a complicated piece of medical equipment which requires supervision and fine tuning. I have met too many patients who have bought from the Internet and regretted it.

  • Untreated OSA can cause heart attack, stroke, high blood pressure
  • If you have OSA the best and safest treatment is CPAP
  • If you are overweight and sleep apnea, try to lose weight.
** This site is for patient information only **