No yawning matter

No yawning matter

Though it is an "official" disease recognised by the medical profession, it still seems to be a "secret ailment" about which relatively little is known. This ailment has a name - obstructive sleep apnoea (OSA).

It is quiet, comfortable ... and absolutely lethal. You could have it, and not know about it until it is too late.

Many people regard it as a minor inconvenience, but it is a major cause of heart attacks, high blood pressure, lung disease, kidney failure, strokes, diabetes, brain damage, and work-related accidents.

OSA is a common illness that afflicts millions of people all over the world, often without their realising it.

When OSA is described as a common disease, this is simply because it is extremely widespread and more prevalent than people are aware of - especially in affluent and urbanised societies.

The word "apnoea" itself comes from the Greek term for "stop breathing" or "cessation of breath". People who suffer from OSA actually stop breathing repeatedly during their sleep.

However, what scares people who discover that they have this ailment is that each actual cessation of breath lasts a second or less - so the person does not wake up, and often seems to sleep soundly through the night.

Victims of this quiet killer are quite comfortable with their sleeping pattern, and this complicates awareness of the illness.

Tell-tale symptoms

One of the most obvious symptoms of OSA is loud and prolonged snoring.

There are lots of jokes about snorers, but the root cause of snoring is no laughing matter because it can kill. If your loved ones tell you that you snore very loudly and often, do them a favour by seeing a physician immediately.

University Malaya's Prof Dr Liam Chong Kin (right) says that people with untreated OSA tend to feel sleepy during the day no matter how long they sleep, have night-time awakenings with choking or gasping for air, wake up not feeling refreshed in the morning, have trouble concentrating and may be forgetful, may wake up with dry mouth, often have morning headaches, and may need to pass urine many times at night.

"When people with OSA fall asleep, the muscles of the upper airway relax and tend to collapse and block the upper airway," he explains.

"Breathing then stops. Some people with OSA wake up suddenly gasping for breath. More often, they will experience partial awakenings from sleep and restart breathing without realising that they have awakened.

"The repeated wakening during the night robs them of a refreshing sleep, causing them to feel sleepy the whole day. They often snore loudly to the extent of disturbing other people, especially their bed partners."

An industry analyst adds that along with the snoring, OSA is also suspected as being the main cause of hangovers - the terrible headaches caused by oxygen deprivation, which is the deadliest side effect of OSA.

Sounds familiar?

Sounds familiar? See a doctor

Michael Yap, a successful businessman from Sabah, used to feel groggy by late morning, but shrugged it off thinking he needed more sleep.

When he began falling asleep at the wheel, he realised there was something seriously wrong and consulted a doctor.

He started using a continuous positive airway pressure (CPAP) machine in 2005, and bought a second unit in 2010. As a frequent traveller, he finds a total transformation in his daily energy levels and alertness.

Q.L. Wong is a 36-year-old sales manager who was well-known for his loud and excessive snoring.

"In campus, I was called 'motorboat' because my snoring drove my room mates crazy. We all thought it was funny, but later in life, when I got engaged, I realised that this would be a major problem for my spouse, so I consulted my family doctor.

"The discovery that I had OSA was both shattering and a relief," he recalls. "It was shattering because the consequences I suffered unknowingly seem awful, but it was a great relief to know that I had a certified illness that could be treated effectively."

R. Mohammed had totally different symptoms.

"Several years after I began working, I began experiencing splitting headaches when I woke up in the morning. I assumed it was migraines and sought treatment for it, but the problem persisted.

"I also felt tired, short-tempered and miserable. My colleagues teased me that I was the first person they knew with a 'non-alcoholic hangover'. When I was diagnosed with OSA, the specialists recommended that I use a CPAP machine when I sleep. My symptoms disappeared very quickly after that."


Causes and cures

Causes and cures

"CPAP stands for continuous positive airway pressure," explains Low Meng Imm, sales manager of Goodlabs Medical (M) Sdn Bhd, technical partners of the Global Doctors Sleep Laboratory in Mont Kiara, Kuala Lumpur.

"Our machines work quietly as the patient sleeps, adjusting the pressure as the patient's requirements change during the night. The air pressure prevents airway collapse, allowing you to breathe freely while you sleep.

"Unlike surgery, this whole process is non-invasive, painless and effective. The use of a CPAP machine is the preferred treatment for OSA by many doctors these days."

She adds: "OSA is the result of a collapsed airway because of muscles relaxing during sleep. This in itself is caused by a variety of factors such as obesity, alcohol intake, smoking, sedatives, asthma or other respiratory issues. Whatever the cause, OSA is really more widespread and serious than most people realise.

"We recommend prompt consultation with your family physician, panel doctor or a respiratory specialist, who will then set up an overnight diagnostic sleep test. Subsequently, an appointment with our medical technicians will ensure you have a CPAP machine that is comfortable, convenient and easy to use."

Like most people, Wong found the idea of sleeping with a mask and tubing extremely disturbing.

"The whole concept seemed intimidating to me. How would my new wife react to sleeping with a man who wears this medical equipment to bed? However, I soon realised my fears were unfounded.

"Like wives all over the world, she much prefers a man who wears this equipment, to a fellow who snores loudly and deafens her while making the whole bed vibrate through the night!" he chuckles.

"When either spouse uses a CPAP machine, the other spouse has improved sleep as well! It makes for a happier, healthier marriage, actually."

Choices and options

Choices and options

Prof Dr Liam agrees that OSA is easily treatable with various options.

"Some people only have OSA when they are sleeping on their back, and it disappears when they roll over to their side. Weight reduction in people who are overweight or obese helps, although that may take a long time to achieve, and it is often difficult to maintain the reduced weight.

"Alcohol can aggravate or cause OSA, and occasionally, we will see people who only have OSA when they have been drinking heavily. Avoidance of alcohol can sometimes help to lessen the problem," he explains.

"There is sometimes a role for dental appliances. People with milder OSA or those who are non-obese tend to be the ones who would benefit from the use of dental appliances.

"There is a role for surgery to remove enlarged tonsils and adenoids if these are the cause of OSA, especially in children. Otherwise, the surgical approach has a very limited role in the treatment of OSA.

"People with OSA can be treated in several ways, but the most effective is CPAP therapy," states Prof Dr Liam.

"CPAP treatment involves the use of a small appliance, which is basically a specialised air compressor that is placed beside the bed. It blows air through a hose that is attached to a tightly fitted mask that covers the nose, or the nose and the mouth. The pressure can be automatically or manually adjusted to keep the upper airway open during sleep so that breathing does not stop."

"Anyone can have this disease. Individuals with low muscle tone and soft tissues around the airway are typical patients, and people with rhinitis, deviated septums, narrow nostrils and structural features that give rise to a narrowed airway are at high risk, too, he says.

"Every race is susceptible, although elderly folk are more likely to have OSA than young people, but I am seeing more men in their late thirties showing the classic symptoms of OSA. Men are more likely to suffer sleep apnoea than women and children, but again, obesity and changes in lifestyle are crossing these barriers."

Prof Dr Liam sums up things succinctly: "Ultimately, people should remember that like many illnesses, early intervention is the best remedy. If you have any OSA symptoms, the sooner you have a medical check-up, the better."

OSA in a nutshell

 OSA in a nutshell

Key symptoms:
- Loud and prolonged snoring
- Severe headaches upon waking-up
- Frequent daytime drowsiness or tiredness

Other symptoms:
- Gasping or choking during sleep
- Uncharacteristic impatience and bad temper
- Uncharacteristic depression or lethargy
- Frequent urination at night


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