Obstructive Sleep Apnea

What is reason to see a sleep specialist?

As sleep specialist is called somnologist and he deals with sleep disorders. The reason to see a sleep specialist to help diagnose 86 known sleep disorders which can be majorly categorised into 3 major types, Insomnia, Hypersomnia, Parasomnia. 

  1. Insomnia: Hard for you to fall asleep (initiation Insomnia) or stay asleep though the night (maintenance Insomnia)
  2. Hyper-somnia (feeling tired or feel very sleepy during the day, even if you have had enough sleep): which could be due to sleep related breathing disorders like sleep apnoea (intermittent stoppage of breathing in sleep) which can be obstructive sleep apnea (OSA) and its treatment (sleep apnea treatment with CPAP or without CPAP), Central Sleep apnoea and sleep related hypoventilation (obesity hypoventilation syndrome), circadian rhythm disorders and  hypersomnia of central origin like Narcolepsy
  3. Para-somnia (abnormal movement and behaviour in Sleep): Sleep walking, Sleep talking, Sleep terrors, Nightmares, REM (excessive vivid dream) related behaviour disorder, sleep enuresis (bed wetting), sleep related movement disorders (like Restless leg syndrome, a tingling or prickly sensation in the legs), head banging, and grinding your teeth (bruxism)
What does a sleep specialist do?

A sleep specialist takes a detailed sleep history and diagnose the sleep problem you may suffering from and then orders a sleep test called polysomnography which can be done at a sleep centre near you called sleep lab (level 1 sleep study) or at comfort of your home-Level-2 or Level 3 sleep study (sleep apnea test at home) and then treats sleep disorders with either medications or machines/surgery (eg. sleep apnea treatment at home, Sleep apnea treatment with CPAP, Sleep apnea treatment without CPAP, Sleep apnea surgery)

How much it cost to see a sleep specialist?

Sleep specialist a super specialist and consultation may range from 1000 to 5000 rupees depending on which part of India you are consulting.

What is cost of a sleep test?

The cost of sleep test (polysomnography) depends on level and type of sleep study.

Sleep Diagnostic studies: needed to diagnose sleep disorders

The cost of sleep test (polysomnography) depends on level and type of sleep study.

Sleep Diagnostic studies: needed to diagnose sleep disorders

  • Level- 1 sleep study:

It has 33 channels recording.

It is done at a sleep centre/sleep lab by a qualified sleep technician and is reported by a qualified sleep specialist.

It costs between Rs 12000 to Rs 25000 depending upon quality of sleep centre/sleep study machine and expertise of sleep specialist.

This is indicated

  1. Suspected OSA with insomnia combined
  2. Suspected OSA with Heart/Lung disease with/without low oxygen levels
  3. Obesity Hypoventilation Syndromes
  4. REM related sleep disorders
  5. Narcolepsy
  • Level-2 sleep study:

It has 25 channels recording.

It is done at a sleep centre/sleep lab or can be done at home with or without a sleep technician and is reported by a qualified sleep specialist.

It costs between Rs 8000 to Rs 10000 depending upon quality of sleep centre and expertise of sleep specialist.

This is indicated in

  1. Suspected OSA without comorbidities when patient is not willing for sleep centre study and/or there is a financial issue with sleep centre study.
  • Level 3 sleep study: Home sleep study/Sleep study at home

It has 5 channels recording.

It is done only at home without a sleep technician but the data is seen and reported by a qualified sleep specialist.

It costs between Rs 2500 to Rs 5000 depending upon quality of sleep centre/sleep study machine and expertise of sleep specialist.

This is indicated in

  1. Suspected OSA with very high pre-test probability of OSA and/or there is a financial issue with sleep centre study.

Sleep Therapeutic studies: needed to treat sleep apnoea

  • Sleep Titration study:

It is a level 1 sleep study with 33 channels recording but also with CPAP/BiPAP manual titration

It is done at a sleep centre/sleep lab by a qualified sleep technician and is reported by a qualified sleep specialist.

It costs between Rs 12000 to 25000 depending upon quality of sleep centre or sleep study machine and expertise of sleep specialist.

  • Split night study

It is a combination of diagnostic and titration study combined in same single night

It is a Level 1 sleep study with 33 channels recording but also with CPAP/Bipap manual titration

It is done at sleep centre/ sleep lab a qualified sleep technician and is reported by a qualified sleep specialist.

It costs between Rs 15000 to 25000 depending upon quality of sleep centre/sleep study machine and expertise of sleep specialist.

  • AutoTitration study

It has no recordings but it is done with an Automatic CPAP machine trial at home for atleast3 nights.

It is done at home without any technician and the autoCPAP automatically generated report is finally validated by a qualified sleep specialist.

This may cost around Rs 1000 to 3000

PLEASE BEWARE:  SPLIT NIGHT SLEEP STUDIES AT HOME SHOULD NEVER BE DONE AS IN HOME SLEEP STUDIES YOU CANNOT TITRATE A PATIENT SITTING AT BED SIDE AND DOING AN AUTOTITRATION IN HALF NIGHT WILL NOT GIVE VALID RESULT AS RECOMMENDED AUTOTITRATION IS FOR 3 DAYS ATLEAST.

How to get a sleep study?

You may search for sleep specialist near me, sleep centre near me, sleep lab near me, or sleep apnoea specialist and sleep treatment, sleep apnoea treatment at home and you will find a right sleep specialist who will guide you and then schedule the type of sleep study you need as per your sleep problem.

What can a sleep study diagnose?

It can diagnose Sleep Apnoea-Central sleep apnoea or obstructive sleep apnea, obesity hypoventilation syndrome, REM behavioural sleep disorder and Narcolepsy and some cases of Insomnia.

It measures electrical activity of your eyes, brain and chin muscle tone which helps us diagnose which stage of sleep you are sleeping. There 4 stages of sleep, stage 1, stage 2, stage 3 and REM sleep.

It measures the flow of air through the nose and mouth and breathing effort by chest and abdomen movement which helps us diagnose sleep apnoea by giving us index of no of times per hour we stop breathing (apnoea) or have depressed breathing (hypoapnoea) which is represented by an INDEX called Apnoea/Hypoapnea Index (AHI). AHI (stoppage of breathing per hour) of 5 is normal, 5-15 is mild sleep apnoea and 15-30 is moderate sleep apnoea and> 30 is severe sleep apnea.

It measures snore intensity with snore microphone

It measures heart rate through ECG and BP also.

It measures leg movements.

It measures oxygen levels- spo2 levels.

What is the risk of having a sleep disorder or sleep deprivation or poor sleep?

Sleep disorders cause more than just sleepiness. Poor quality sleep can have a negative impact on your energy, emotional balance, productivity, and health. Sleeping well is essential to your physical health and emotional well-being. Unfortunately, even minimal sleep loss can take a toll on your mood, energy, efficiency, and ability to handle stress. Ignoring sleep problems and disorders can lead to poor health, accidents, impaired job performance, and relationship stress. If you want to feel your best, stay healthy, and perform up to your potential, sleep is a necessity, not a luxury.

What is Narcolepsy?

Narcolepsy is a chronic sleep disorder, or Dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia. Narcoleptics, when falling asleep, generally experience the REM stage of sleep within 10 minutes; whereas most people do not experience REM sleep until an hour or so later. Another one of the many problems that some narcoleptics experience is cataplexy, a sudden muscular weakness brought on by strong emotions (though many people experience cataplexy without having an emotional trigger). Narcolepsy is a neurological sleep disorder. It is not caused by mental illness or psychological problems. It is most likely affected by a number of genetic abnormalities that affect specific biologic factors in the brain, combined with an environmental trigger during the brain’s development, such as a virus. The main characteristic of narcolepsy is Excessive Daytime Sleepiness (EDS), even after adequate night time sleep. The classic symptoms of the disorder, often referred to as the “tetrad of narcolepsy,” are cataplexy, sleep paralysis, hypnagogic hallucinations, and excessive daytime sleepiness. Other symptoms include automatic behaviours.

What is Sleep Apnea?

We sleep for 8 hours which is one-third of 24 hours, this amounts to us sleeping 1/3 of our lifetime. There are 84 known sleep disorders and sleep apnea is the second most common sleep disorder after insomnia. Sleep Apnea is a serious sleep disorder which results in changing patterns of sleep especially causing excessive sleepiness. Sleep apnoea leads to continuous start and stop of breathing cycle during sleep. There are three types of sleep apnea: obstructive, central, and mixed. Obstructive sleep apnea (OSA), the most common, is caused by a blockage of the airway during sleep.

What is the cause of Sleep Apnea ?

Sleep apnea is also known as Obstructive Sleep Apnea (OSA) in which there is OBSTRUCTION in the upper airway during SLEEP causing APNEA which is stoppage of breathing. There is a loss of muscle tone during sleep which causes the airway muscles becom floppy and the tongue to fall back. This leads to narrowing of the upper airway during sleep in everybody, but this can cause obstruction of the airway in some people especially those with a thick neck like obese people. Excessive respiratory efforts to overcome airway obstruction and a fall in oxygen level due to this obstruction awakens you from your sleep transiently. As you wake up transiently from sleep, the airway opens to make you comfortable, and you fall asleep again. But as soon as you sleep the cycle repeats and the whole night is disturbed, making you feel sleepy, tired, and fatigued the next day causing a lack of concentration and irritability. In extreme situations, this can lead to automobile accidents in case you have sleep apnea, and you drive.

What are the risks of Sleep Apnea?

During sleep apnea, as your oxygen falls and sleep is disturbed, there is a worsening of the control of your blood pressure and diabetes. People with sleep apnea also tend to gain weight as they feel hungrier due to increased secretion of the hunger hormone, Ghrelin and lack of the satiety hormone, leptin. This creates a vicious cycle of obesity causing sleep apnea and sleep apnea worsening obesity.

What are the symptoms of Sleep Apnea?

Symptoms of sleep apnea include loud chronic snoring, frequent pauses in breathing during sleep, gasping, snorting, or choking during sleep, unable to stay asleep, feeling unrefreshed after waking, morning headache, dry mouth after waking, and most importantly excessive day time sleepiness or tiredness or feeling of irritability

Loud snoring is the most common symptom of sleep apnea, however not everyone who snores loud suffers from sleep apnea.

What is the Treatment of Sleep Apnoea (OSA treatment)?

As there are sleep disorders there are sleep specialists too to diagnose and treat these disorders. A sleep test called polysomnography conducted under a sleep specialist care will help you make the diagnosis of sleep apnea. Sleep stdu can be done at sleep lab near me or it can be a sleep test at home (home sleep study). The good news is that there is sleep apnea treatment with multiple interventions which include dental devices and by the application of a sleep apnea machine called positive airway pressure device (CPAP/Bipap) which pushes air and relives the airway obstruction during sleep with air pressure through CPAP mask.  This is considered as the most effective and reliable way of sleep apnea treatment. However, there is sleep apnoea treatment withoust CPAP also like for mild sleep apnea cases, you may just make some lifestyle modifications such as losing weight can help cure sleep apnea in some patients and quitting alcohol. Sleep apnoea treatment without CPAP can also be done in with sleep apnea surgery like bariatric surgery for losing weight and upper airway sleep apnea surgeries can also offer a cure in selected patients but the gold standard treatment remains the sleep apnoea machine eg CPAP device. With obesity becoming an epidemic, sleep apnea cases are bound to increase, and awareness about this disease is a necessary to break the cycle and halt its ill effects.

सवाल खर्राटे की समस्या पर!
Questions of Snoring problem!

जब हम गहरी नींद में होते हैं तो खर्राटे गले में उत्पन्न होने वाली ध्वनि है। यह कोई बीमारी नहीं है, लेकिन ऑब्सट्रक्टिव स्लीप एपनिया जैसी बीमारी का संकेत हो सकता है, जो दिन में अत्यधिक नींद आने और अनियंत्रित रक्तचाप और शर्कर से जुड़ी है।

Snoring is sound produced in throat while we are in deep sleep. This is not a disease but can be sign of a disease like obstructive sleep apnoea which is associated with excessive day time sleepiness and uncontrollable blood pressure and sugars.

कुछ व्यक्तियों के गले के ऊतकों में कंपन के कारण खर्राटे आते हैं, जिनके ऊतकों में अत्यधिक वसा होती है, जिसके कारण उन व्यक्तियों में वायुमार्ग थोड़ा संकीर्ण हो जाता है। जब हम सोते हैं तो गले के ऊतक और मांसपेशियाँ शिथिल हो जाती हैं और कंपन करने लगती हैं।

Snoring occurs due to vibration of tissues in throat in some persons who have excessive fat in tissues which causes slightly narrower airway in these persons. The tissues and muscles in throat become lax and so vibrate when we sleep.

यदि किसी व्यक्ति को केवल खर्राटे आते हैं तो उसे कोई समस्या नहीं हो सकती है, लेकिन कुछ लोगों में खर्राटे लेने की समस्या से दिन में अत्यधिक नींद आने और गाड़ी चलाते समय दिन में सोने के कारण होने वाली दुर्घटनाओं या अनियंत्रित रक्तचाप और मधुमेह से हो सकती है।

 If person has only snoring then he may not have any problem but Snoring in some can be associated with non-refreshing sleep, excessive day time sleepiness and accidents due to sleep in day time while driving or uncontrollable blood pressure and diabetes.

खर्राटे और ऑब्सट्रक्टिव स्लीप एपनिया पुरुषों और वृद्ध लोगों में अधिक आम है, खासकर यदि वे मोटे हैं (बीएमआई >30 किग्रा/एम2) और यदि उनकी जीभ बड़ी और छोटी गर्दन है और यदि उनके कॉलर का आकार (गर्दन का घेरा) 17 इंच से अधिक है। यदि बच्चों के टॉन्सिल या एडेनोइड बढ़े हुए हों तो भी खर्राटे आ सकते हैं।

Snoring and obstructive sleep apnoea is more common in males and older people especially if they are obese (BMI >30 kg/m2) and if they have large tongue and short neck and if their collar size (neck circference) is greater than 17 inches. Snoring can also occur in children if they have enlarged tonsils or adenoids.

अगर आपको खर्राटे आते हैं तो सबसे पहले एक स्वस्थ जीवन शैली अपनाकर वजन कम करें। आपको शराब से बचना चाहिए और खुद को नींद से वंचित नहीं करना चाहिए और रोजाना कम से कम 6 से 8 घंटे सोना चाहिए। यदि आपको ताजगी रहित नींद आने लगे, दिन में अत्यधिक नींद आने लगे और गाड़ी चलाते समय दिन में सोने के कारण दुर्घटनाएं होने लगे या खर्राटों के साथ रक्तचाप और मधुमेह अनियंत्रित हो जाए तो यह ऑब्सट्रक्टिव स्लीप एपनिया का संकेत हो सकता है, ऐसी स्थिति में आपको एक नींद विशेषज्ञ या फेफड़े का डॉक्टर जो नींद की बीमारी में विशेषज्ञता रखता हो।

 If you have Snoring then first thing is to lose weight by maintain a healthy life style. You should avoid alcohol and do not deprive yourself of Sleep and sleep atleast 6 to 8 hours daily. In case you start having non refreshing sleep, excessive day time sleepiness and accidents due to sleep in day time while driving or uncontrollable blood pressure and diabetes associated with Snoring then it may be sign of obstructive sleep apnoea, in that case you should see a sleep specialist or a lung doctor who is specialised in Sleep Medicine.

यदि खर्राटे ऑब्सट्रक्टिव स्लीप एपनिया (ओएसए) से जुड़े हों तो खतरनाक है। यदि आपको वाहन या मशीन चलाते समय नींद का दौरा पड़ता है तो ओएसए दुर्घटना का कारण बनता है। इससे रक्तचाप अनियंत्रित हो जाता है, मधुमेह और हृदय गति संबंधी समस्याएं हो जाती हैं, जिससे दिल का दौरा, स्ट्रोक और नींद में अचानक मौत हो सकती है।

Snoring is dangerous if associated with obstructive sleep apnoea (OSA). OSA leads to accidents in case you get a sleep attack while driving a vehicle or a machine. It also leads to uncontrollable blood pressure and diabetes and heart rhythm problems and which can lead to heart attack and stroke and sudden death in Sleep.

खर्राटों को ओएसए में बदलने से बचने के लिए आपको स्वस्थ जीवनशैली अपनाकर आदर्श शारीरिक वजन बनाए रखना चाहिए। आपको शराब से बचना चाहिए और खुद को नींद से वंचित नहीं करना चाहिए और रोजाना कम से कम 6 से 8 घंटे सोना चाहिए। यदि आपको ऑब्सट्रक्टिव स्लीप एपनिया के लक्षण दिखाई देने लगें, तो आपको नींद विशेषज्ञ से परामर्श लेना चाहिए।

To avoid Snoring developing into OSA you should maintain ideal body weight by having a healthy lifestyle. You should avoid alcohol and donot deprive yourself of Sleep and sleep atleast 6 to 8 hours daily. In case you start having sign of obstructive sleep apnoea, you should consult a sleep specialist.

खर्राटे ऑब्सट्रक्टिव स्लीप एपनिया जैसी गंभीर समस्या में विकसित हो सकते हैं, खासकर जैसे-जैसे आपकी उम्र बढ़ती है और वजन बढ़ता है। यदि आपको ताजगी भरी नींद नहीं आती है, दिन में अत्यधिक नींद आती है या वाहन या मशीन चलाते समय दिन में नींद आने के कारण कोई दुर्घटना हुई है या खर्राटों के साथ अनियंत्रित रक्तचाप और मधुमेह है, तो यह ऑब्सट्रक्टिव स्लीप एपनिया का संकेत हो सकता है। उस स्थिति में आपको किसी नींद विशेषज्ञ से मिलना चाहिए जो आपकी नींद का परीक्षण करेगा और उसके अनुसार आपको सलाह देगा।

Snoring can develop into serious problem like obstructive sleep apnoea especially as you age and gain weight. In case you feel non refreshing sleep, excessive day time sleepiness or have had an accidents due to sleepiness in day time while driving a vehicle or machine or have uncontrollable blood pressure and diabetes associated with Snoring then it may be sign of obstructive sleep apnoea. In that case you should see a sleep specialist who will get your sleep test and advice you accordingly.

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