Fri | Sep 22, 2017

Are you dying to sleep? (Part 1)

Published:Monday | October 5, 2015 | 10:00 AM

When it comes to matters of health, disorders of sleep have become extremely important.

Not too long ago, if someone complained of difficulty falling asleep and/or staying asleep (insomnia), we would think of stress-related problems, medication side effects or just bad sleeping habits. We would make suggestions to ameliorate the sleeping problem, prescribe medications and, if all that fails, refer patients to psychologists or psychiatrists. However, now, we must also seriously consider obstructive sleep apnoea (OSA).

There needs to be a much greater awareness of OSA because it is associated with numerous serious medical conditions, and I strongly believe that it is far more common than we realise.

We know that OSA is more prevalent in people with African genes, middle-age men who are overweight, lead a sedentary lifestyle and drink alcohol (especially beer). But now we know that, although that is true, many people of various body types, of any race and age, with diverse activity levels and from both genders suffer from OSA.

In sleep apnoea, there is a temporary cessation of breathing. There are two types of sleep apnoea - central (breathing suspension caused by something or some things affecting the brain) and obstructive sleep apnoea (caused by airway problems that manifest during sleep). Central sleep apnoea can be very difficult to treat, but is far less common than the easier-to-treat OSA.

Daytime sleepiness, unrewarding sleep, fatigue, no vitality, difficulty concentrating, falling asleep during tasks (even while driving), morning headaches, problems with memory, bad moods, irritability, and other symptoms may be caused by OSA.

 

Duppy stories

 

Some patients may complain of waking up in a panic - gasping for air, choking or breath-holding. Some wake up with a rapid heartbeat and complain of nightmares.

OSA can cause some people to wake up but find themselves unable to move, so they say, "Duppy hold mi down." Patients even express trepidation about going to bed. Some wake up very early and boast that they only need a few hours of sleep at nights, then they rise and get all kinds of work done.

Some go to the gym at ungodly hours in the morning because they feel full of energy even after a brief sleep. There is an explanation for that - OSA produces a temporary adrenaline surge.

Obstructive sleep apnoea is caused by a prolonged interruption of breathing due to total (upper) airway collapse. Hypopnoea is a severe reduction in airflow caused by partial collapse of the (upper) airway.

If OSA sounds very serious, it's because it is.

Loud snoring with prolonged periods of silence, followed by a loud gasp or a snort and transient restlessness/partial wakefulness (during which the sleeper may groan, mumble a bit, shift position and then fall back asleep), is often a giveaway. But some people don't snore much, and some don't snore at all, even when they have severe OSA and/or serious hypopnoea. And the converse is not always true - snoring is not a sure sign of OSA.

 

No breath

 

Many people stop breathing for a few, very brief moments during sleep; that is considered within the range of normalcy. But frequent and/or prolonged periods of apnoea, or hypopnoea, end up causing serious harm over a period of time, especially if they go unnoticed, undiagnosed or untreated.

OSA caused such severe cardiopulmonary damage to a relative of mine that it killed her. It has been linked to a long list of medical conditions that, at a glance, would never seem even remotely related to OSA.

During OSA, the body 'struggles' to breathe against a closed airway. OSA causes a depletion of oxygen and a build-up of carbon dioxide in the blood, essential organs and tissues. Subconscious alarms go off. As far as the body is concerned, it is about to die, so there is a surge of adrenaline (the fight or flight hormone) and the person becomes partially or fully awake.

Next week: The link to REM and NREM sleep problems and more physical and psychological manifestations of OSA.

- Garth A. Rattray is a medical doctor. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.