Excessive Daytime Sleepiness
Getting too little sleep is bad for your health. But getting too much—as wonderful as it may sound to some—can be problematic too. It can affect a person’s health, performance and safety.
Extreme daytime sleepiness is an overpowering urge to sleep during the day, even when you’ve had adequate sleep during the night, this may be due to the duration of the sleep which is just not enough or due to decreased quality in sleep, meaning the person is in bed but the brain didn’t receive the rest that it ought to.!!
When does one suspect excessive day time sleepiness—when it is observed that a person is falling asleep at an in appropriate time and situations like in meetings, while in conversation, worse while driving!! And for the person himself doesn’t feel fresh after a good night sleep.
Consequences are way too many: ranging from Decreased Performance and Alertness, loss of short term memory and cognitive impairment, stress in personal relationships, occupational injury and automobile accidents, all leading to decreased quality of life .and in longterm it can lead to increased blood-pressure, stroke, mood disorders and growth retardation in children.
Remarkably sleep loss can be contributing to obesity based on research! Any person making a resolution to lose weight should probably consider a parallel commitment for getting more sleep.
Commonest causes could be, working in unusual shifts, conditions like obstructive sleep apnea, narcolepsy (delt by neurologists), hypothyroidism, (deficiency of thyroid harmone produced) vitamin D deficiency, hypoglysemia (decrease in blood sugar), sometimes also mislabelled and treated for chronic fatigue syndrome.
Among all the said etiologies, sleep related breathing disorders ranging from simple snoring to obstructive sleep apnea represent the commonest and the most undiagnosed and untreated conditions. Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. This means the brain — and the rest of the body — may not get enough oxygen.
There are two types of sleep apnea, obstructive it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep preventing air entry into the lungs and subsequently starving the brain of oxygen. This is characterized by loud snoring.
Central sleep apnea: here the airway is not blocked but the brain fails to signal the muscles to breath.
It is mandatory to diagnose sleep apnea once suspected by the symptoms of the condition, one of the most important being excessive day time sleepiness. The gold slandered means to diagnose the condition is by a sleep study or polysomnography, which can be even done at home!
Once diagnosed it can be treated by either wearing a positive airway pressure mask during sleep or a device in the mouth while sleeping or surgery can be a simple outpatient procedure to trans oral robotic surgery. The problems associated with wearing mask all night long every day of the year are numerous; hence multicentre trials have put the compliance of the treatment with positive airway pressure very low at the end of one year. Hence more and more people are now turning to other means of treatment like intra oral devices and surgery.
Living with and managing Excessive day time sleepiness: starting from, limit alcohol and drug use, improving sleep hygine by –avoiding late night dinners, sleeping on time every day, not watching tv till late night, reading a book before going to sleep, diming the lights, ambient lighting, take care of allergies and frequent colds, consult a Top ENT Specialist in Hyderabad and take advice on management of the problem.
Sleep Disorders among Children
When you have had a “Good Night” you usually awake saying a chirpy “Good Morning”! Insufficient sleep makes you irritable and restrains your concentration. Adequate sleep on the other hand will boost your energy, concentration and memory. The same rules are applicable for children.
Generally, a child between the ages of 1 to 3 years need about 10-13 hours of sleep with a nap during the day. Preschoolers need 10-12hours of sleep. Children 6 to 9 years need about 8-10 hours of sleep. Preteens need 9 hours sleep.
20% of children snore at night. Common causes could be nose block, allergic rhinitis, enlarged adenoids and tonsils. These can be easily treated. Children who struggle to breathe while sleeping may suffer from obstructive sleep, as they snore; their chest appears to be sucked in. OSA (obstructive sleep apnea) is described as difficulty to breathe while asleep, due to the airway being partially or completely blocked resulting in lack of oxygen in the body which can in turn lead to stress on the brain and lungs. This can be treated with adenotonsillectomy. OSA is common among obese children having a crowded upper airway, and can be treated by CPAP. Tongue reduction is considered on failure of conventional treatment. Sometimes OSA can be misdiagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Bed Wetting is not a disease but a common symptom found in approximately 15 % of children especially boys above the age of three. It could be hereditary and usually stops at puberty.
Bed Wetting is also related to sleep disorders, poor bladder control, kidney problems, or tensions and emotions that require attention. In case of OSA an ENT Surgeon should be consulted. Besides this family support, encouragement and taking a paediatrician’s opinion is also recommended
There is no enemy for a better sleep than snoring. It is perceived as a silent killer that also troubles people sleeping nearby. Snoring mainly occurs due to partial airway obstruction i.e. obstruction for inhaling of air whereas in severe forms it leads to a condition called obstructive sleep apnea.
Sleep apnea is seen during severe obstruction in throat when lung tries to take up air for the purpose of breathing. It is in turn characterised by the severity of the condition during a normal seven-hour period of sleep. If sleep gets disturbed/choked for five times in an hour it is rated as moderate apnea while sleep disturbances for more than thirty times in an hour represents severe condition of apnea. Due to sleep fragmentation; mood swings and irritability can be seen in individuals suffering from this condition followed by excess day time sleepiness that hampers both personal and professional responsibilities of the affected person. It may also lead to short term memory loss. It has been found that a majority of individuals suffering from apnea are prone to sudden heart ache, untreatable hypertension, increased insulin resistance etc. Right diagnosis involves observing the spell of apnea. Individuals also wake up from sleep often to pass urine while profuse sweating is observed in some of them.
Diagnosis is effectively done using Polysomnography which involves identifying the root cause of the problem like sleep posture, the amount of oxygen being taken inside, loudness of snore in decibels etc. Once diagnose is done accurately, multiple treatment options are available at Mediciti Hospitals, a hub of ideal health care in Hyderabad. Treatment sometimes involves rectifying the incorrect posture leading to apnea. PAP (Positive Airway Pressure) therapy is a scientific and proven way of addressing apnea that pumps air into collapsed airways thereby relieving the condition and offering relief to patients. Treatment also depends on the organ/part involved which can be treated using nasal strips, jaw forwarding devices and a host of other advanced medical devices and also different types of surgery that corrects the discomfort in the body like for example, tonsillitis. Mediciti also employs specialized robotics surgeries to cure the condition effectively. Sleep apnea is a condition which may persist for a long time and needs periodic check up and improvised treatment.
Sleep apnea is a sleep related breathing disorder that affects many of us today especially in the urban setting. For those who are affected by this disorder the upper airway which allows air to freely pass in the lungs collapses, partially or completely resulting in the person to stop breathing for a few minutes at a time, this can be very fatal to themselves and very frightening to the sleeping partner!! While there are currently a variety of different ways to treat sleep apnea, some are more successful than others depending upon the condition or stage of disease.
The CPAP mask is generally considered one of the most effective treatments, but compliance is an issue because some patients are not able or willing to tolerate the mask – they find it uncomfortable, hard to get used to, or have other issues with it.
Now we have a safe an effective permanent treatment for sleep apnea in the form of trans oral robotic surgery.
This novel surgery was first developed in the states for the management of head and neck tumors, now being used in the treatment of sleep apnea.
ADVANTAGES OF TORS
The beauty of TORS is that it provides surgeons with much improved dexterity and precision to access the base of the tongue for surgical procedures, The surgeon controls the system which translates the doctor’s hand movements into smaller, more precise movements of tiny instruments inside the mouth allowing the surgeon to access the tight space at the base of the tongue. Tongue base surgery has been challenging due to the difficulty of manipulating surgical instruments in a limited operative field where lighting and visualization is restricted.
However, with a high definition, 3-D camera and advanced imaging technology, TORS allows surgeons to visualize areas of the mouth and throat at level of detail that could only be seen in the past through open incisions. As a result, TORS is only minimally invasive compared to traditional methods.
We use the TORS procedure to remove any excess tissue at the tongue’s base that falls or flaps in the way of the breathing passages during sleep, which is often the culprit in the airway blockage that leads to sleep apnea
What to expect for a patient?
Patients are first examined to see if they have the candidacy for a tors, meaning one has to go through a series of tests including sleep study and sleep endoscopy and in some cases ct scan of the head and neck. Once considered for surgery, which will take a couple of hours to perform. The post operative stay is for 2 to 3 days normally; however it’s really dependent upon the patient’s recovery with respect to pain tolerance and reduction of soft tissue swelling. A post surgical sleep study is usually recommended three months after surgery.
As an alternative to CPAP which has poor compliance of upto 50 % over long-term, the TORS with a 72 hour hospital stay on an average, is a sophisticated treatment option for a lifelong disease, especially for patients that have failed other treatment options.
Patients that underwent Trans Oral Robotic Surgery say that they noticed an improvement in their breathing pattern and level of comfort when they go to bed the very next day. They have improved quality of life and can sleep better, have more energy and will potentially live longer thanks to the TORS procedure.
All living creatures follow a certain kind of sleep or resting pattern. Nature has designed our body in such a manner that you may call regular sleeping your beauty sleep or bedtime, for a normal healthy life you have to enter slumber land!
Concerned parents seeing their teenage children having odd and irregular sleeping habits are confused about this new generation disposition. The average teenager requires about nine hours of sleep, but unfortunately there are only 20% who have reported getting that amount of sleep.
“Teenage” is a stressful period, as at that time the body is subjected to many physical and emotional changes. During late puberty the body secrets sleep related hormone melatonin at a different time than it normally does, which means the peak levels of this hormone may be later than midnight. This changes the sleep – wake cycle. An adult may feel tired by 8.30 p.m. but a teenager could be awake, waiting to fall asleep till 2.00 a.m.
Research done in 2006 in the U.K. found that one of the main culprits for inadequate sleep habitude among teenagers was electrical and electronic gadgets! Televisions with round the clock cable, Computers, IPods, Video games etc. have made a mockery of the saying “Early to bed and early to rise will make you healthy, wealthy and wise”! Nine out of ten parents believed that their teenagers got sufficient sleep which was not true. It is no wonder you see today’s teens struggle to cope with stress and emotions. Sleep deprivation can make one irritable and irrational, lack of self confidence, poor performance in school or college and mood swings are also common symptoms of this syndrome. Serious and complicated health problems can arise because of low immune system that can make one more susceptible to serious illness.
Make sure to sleep on time for nine hours, have normal activities, regular and healthy meals at the appropriate time, as this ensures a “Good Night” sleep, which is paramount for a healthy life style. Complex complaints of this malady should be treated by a qualified medical professional.