Heavy Snoring Can Be A Danger Sign

Mount Kidd, Kananaskis Golf Course (Dr. Noorali Bharwani)
Mount Kidd, Kananaskis Golf Course (Dr. Noorali Bharwani)

Do you have sleep problem that leaves you chronically fatigued, sleepy and irritable?

If yes then you may have disorders like narcolepsy, snoring or sleep apnea.

Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day.

Snoring is rough rattling noise made on breathing in during sleep by vibration of the soft palate and the uvula.

Snoring is believed to occur in 30 per cent of women and over 40 per cent of men. It can be potentially serious health hazard. Many people may not think of snoring as a sign of something potentially serious, and not everyone who snores has obstructive sleep apnea.

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep.

Obstructive sleep apnea is more common form that occurs when throat muscles relax and block your airway during sleep and cause snoring. The other two are central sleep apnea and complex sleep apnea syndrome.

Obstructive sleep apnea can seriously affect your health. High blood pressure, heart attack, heart failure and stroke top the list. It can affect your heart rhythms. It can lower your blood pressure, lower your oxygen level and lead to heart attack and death.

If you are a chronic snorer and your partner observes that you make a snorting, choking or gasping sound then you have a problem.

It is time to discuss your symptoms with your doctor and get a referral to a sleep specialist. You will undergo tests to confirm the diagnosis. The tests involve overnight monitoring of your breathing and other body functions during sleep. The test is called nocturnal polysomnography.

If you have obstructive sleep apnea, your doctor may refer you to an ear, nose and throat specialist to rule out any blockage in your nose or throat. An evaluation by a cardiologist may be necessary.

How to manage obstructive sleep apnea?

Guidelines (2014) from the American College of Physicians (ACP) emphasize lifestyle modifications – especially weight loss. Though the guidelines do not offer any radical treatment updates, they do reinforce the effectiveness of tried and true therapies.

Breathing devices are still best for treating obstructive sleep apnea. Continuous positive airway pressure (CPAP) works well. It is the first line of treatment. It has to be used during sleep. It relieves symptoms but does not cure the problem.

Oral appliances are useful. They are worn only during sleep. Research shows that oral appliance therapy is an effective treatment option. But does not cure the problem.

Surgery is the last option to be used if all else fails. There are many different types of surgery for sleep apnea and snoring. Surgery will not fix everything. You may need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea.

Remember, surgery can have side effects and surgery alone will not fix all your problems. Discuss your options, long-term outcome and side effects of treatment with your specialist before going for surgery.

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A Dangerous Trio – Snoring, Sleep Apnoea and High Blood Pressure

Keep smiling, it makes people wonder what you are upto! (Dr. Noorali Bharwani)
Keep smiling, it makes people wonder what you are upto! (Dr. Noorali Bharwani)

Reports indicate nearly eight in 10 married couples say their partner has a sleep problem, like snoring, insomnia, or incessant tossing and turning. Sleep difficulties force their partners into separate sleeping quarters. More than 20 per cent say they are too sleepy for sex.

You can blame this on too much work, stress, caffeine, nicotine, alcohol, 24-hour cable TV, the Internet and email.

Lack of sleep has consequences like increased blood pressure that raises the risk of heart attacks and stroke. Diabetes and obesity have also been linked with chronic sleep loss. People who do not get enough sleep are more than twice as likely to die of heart disease.

To stay awake people tend to eat more and that means they put on weight. They smoke more and drink too much coffee and alcohol. That means they are prone to motor vehicle collisions. They hurt themselves and hurt others.

For optimal health it is important for adults to consistently sleep around seven hours each night. When we sleep, the body rests and restores its energy levels. A good night’s sleep will help us cope with stress, solve problems and help us recover from illness.

If you have sleep problem then seek help. There are many ways to help diagnose and treat sleep disorders including snoring. Your family doctor can refer you to a sleep clinic.

We know heart disease is the leading cause of death in advanced industrialized countries, and stroke is also a leading cause of death and disability.

American Heart Association wants you to know that the evidence is very strong for the relationship between sleep apnoea and hypertension and cardiovascular disease generally. If you are a snorer and have sleep apnoea then get proper treatment.

In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnoea, characterized by five to 15 episodes per hour; moderate sleep apnoea, defined by 15 to 30 per hour; or severe sleep apnoea, meaning more than 30 each hour.

A sleep clinic can get you started with investigations and treatment known as continuous positive airway pressure (CPAP). The CPAP device involves wearing a mask while sleeping. It keeps the breathing passages open and oxygen flowing. It can yield fast results. Blood pressure comes down quickly. This improves your prognosis.

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Restless Legs can Disturb Your Sleep

A beautiful place in Kananaskis to dream, relax, listen to music, dance and sleep. (Dr. Noorali Bharwani)
A beautiful place in Kananaskis to dream, relax, listen to music, dance and sleep. (Dr. Noorali Bharwani)

Before we talk about your legs and how they are connected to your sleep, let me tell you what others have to say about sleep. If you are a person who believes in meditation then you would agree with Dalai Lama, who said, “Sleep is the best meditation.” I believe in that.

If you are a George Bernard Shaw fan then you will agree with him, “Marriage is an alliance entered into by a man who cannot sleep with the window shut, and a woman who cannot sleep with the window open.” I won’t tell you where I stand on that.

If you tell your doctor you are constantly tired, have day time sleepiness, have difficulty falling asleep at night, have to move your legs at bedtime to find comfort then you probably have restless legs syndrome.

A syndrome is a group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.

According to an article in the Canadian Medical Association Journal (CMAJ November 19, 2013), restless legs syndrome is a neurologic movement disorder that may adversely affect sleep, and thereby result in daytime fatigue, somnolence and a reduced quality of life.

The article goes on to say, “This condition has also been associated with hypertension and cardiovascular disease. The pathophysiology of restless legs syndrome is incompletely understood.”

Restless legs syndrome is common, affecting five to 15 per cent of the population. Making a diagnosis is not easy. The National Institutes of Health state that four criteria are essential for diagnosis:

  • An urge to move the legs usually accompanied by, or caused by, uncomfortable and unpleasant sensations in the legs;
  • Unpleasant sensations that begin or worsen during periods of rest or inactivity;
  • Unpleasant sensations that are partially or totally relieved by movement;
  • And unpleasant sensations that are worse in the evening or at night compared with during the day or that only occur in the evening or at night.

There is no specific laboratory test or treatment to conclusively confirm the diagnosis or treat it. Management by a sleep specialist is required. Avoiding alcohol, caffeine and cigarette smoke may help.

According to the article, the American Academy of Sleep Medicine has recently published detailed management guidelines – available online.

If I remember correctly, Marilyn Monroe was said to have trouble sleeping. I wonder why. She said, “The nicest thing for me is sleep, then at least I can dream.”

That’s it for today. Think big, laugh a lot, sleep well and have sweet dreams.

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Restless Leg Syndrome Leads to Restless Sleep

After a night of restless sleep. (iStockphoto)
After a night of restless sleep. (iStockphoto)

Recently, one of my friends was diagnosed with restless leg syndrome (RLS). It is also known as Ekbom’s syndrome. It is a movement disorder. Important thing to remember is that it is not a psychological or emotional condition. It is thought to be a neurological disorder and it is believed that a brain chemical known as dopamine is involved.

About three to 15 per cent of the population is affected by RLS. It is more common in women than men. The prevalence increases with age. There may be a family history of the condition. Some medications can trigger RLS.

Individuals suffering from this disorder have a distressing need or urge to move the legs, usually accompanied by an uncomfortable, deep-seated sensation in the legs that is brought on by rest (sitting or lying down), relieved with moving or walking, or worse at night or in the evening.

RLS can be associated with involuntary limb movements while patient is awake and/or periodic limb movements (PLM) while patient is asleep. Studies show that more than 80 per cent of people with RLS also have PLMs. But the majority of people with PLMs do not have RLS.

The diagnosis of RLS is based on the clinical history. RLS may be a symptom of iron deficiency therefore the iron status should be assessed. Overnight sleep study may be helpful. There is no good medication to control the symptoms.

If you have unexplained leg pain then discuss your symptoms with your doctor and get proper investigations done at a sleep clinic.

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