Sleep Medicine is one of the emerging specialties in medicine. Humans spend upto 30% of their life in sleep but many are not aware that sufficient and restful sleep is a pre-requisite for health. Disorders of sleep can increase the risk of several cardiometabolic diseases including coronary artery disease, diabetes, cerebrovascular disease etc. Recent research shows that increasing one hour of sleep daily can reduce the calcification in the arteries supplying the heart by 33%.
The interview is with Dr Preeti Devnani, one of the very few qualified sleep specialists in India. She is American board certified in both neurology and sleep medicine. She is also the head of Sleep Disorders Clinic in Mumbai, a center that offers Level 1 attended sleep studies. She is also an executive council member in the Indian Sleep Research Society.
1) Studies show that longer hours of sleep per day is associated with better cardiac health. But with competition in all spheres of life increasing many individuals are forced to cut short their sleep. We tend to sleep late and wake up early. What is the recommended hours of sleep for a someone in 20-50 age group?
Between 6-8 hours of sleep are recommended. The accurate amount of hours is the amount that makes the person awaken refreshed.
2) Excessive daytime sleepiness/drowsiness seems to be a common complaint for many individuals. It makes us inefficient during our working hours. What are the most common causes of sleeplessness?
The common causes of excessive daytime sleepiness include;
-Insufficient Sleep Syndrome/ Lack of Sleep
-Obstructive Sleep Apnea/ Sleep related breathing disorders
-Circadian rhythm disorders/Shift-work syndrome
-Restless legs syndrome/Periodic Limb Movement
-Related to other medical causes such as Parkinson disease, stroke, trauma, infections etc.
3) Snoring seems to be a primary indicator of a possible underlying sleep disorder. But snoring can be due to other causes also. How does primary snoring differ from snoring that indicates Obstructive Sleep Apnea?
Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath). A polysomnogram (sleep study) can differentiate simple snoring from sleep apnea related snoring.
4) Some children do snore at night. Does sleep apnea occur in children?
It is estimated that between 3% and 12% of preschool age children snore. The majority of these children are healthy, without other symptoms, and have primary snoring. But some children that snore, about 1-3% by some estimates, have obstructive sleep apnea syndrome (OSAS), a condition that is increasingly recognized as leading to school and behavior problems in children.
5) Obstructive sleep apnea is predominantly a male disease but women are also affected. What are the risk factors for sleep apnea specifically in women?
OSA affect of 4% of males and 2% of females in the adult population. Risk of OSA for women is less than that of men until menopause when it then approximates that of men; 2.7% (menopausal women) as compared to 3.9% (men). Snoring increases during pregnancy; 14% of pregnant women snore, compared to 4% of non-pregnant women., 7% of this same pregnant group reported witnessed apneic spells. Snoring is more common in obese pregnant women than non-obese pregnant women.
6) The standard treatment suggested for sleep apnea is CPAP. But compliance seems to be a major issue. Is there any way to improve the compliance with CPAP?
To ensure CPAP compliance, CPAP education in regards to its application and the importance and benefits of CPAP must be addressed. Patient should undergo individual mask fittings, have frequent follow up in clinic to address difficulties in usage. CPAP Helpline and scheduled group meeting with other CPAP users also aid in improving compliance.
7) Studies done in the west show that individuals with untreated sleep apnea are involved in significant percentage of road traffic accidents. But in India, which has one of the highest traffic related accidents in the world, no screening for sleep apnea exists before a driving licence is issued. Will a targeted screening of high risk individuals for sleep apnea improve road safety?
Drowsiness= Red Alert
DRIVE ALERT, ARRIVE ALIVE
Drowsiness is the last step before you fall asleep! One third of drivers said that have fallen asleep while driving and almost half said that they have been drowsy while driving. Drivers in sleep and fatigue-related crashes were 4 to 5 times more likely than drivers in the control crash group to work night-shift jobs. Studies show that being awake for more than 20 hours results in an impairment equal to a blood alcohol concentration of 0.08%
8) Most sleep studies done in India are unattended home based studies and the reports are generated by the computer software. But some countries have mandated manual scoring since computerised scoring of apneas and hypopneas are fraught with errors. What is your opinion on this?
Level 1 –attended studies are still the gold standard recommendation. However there is a need for home based studies as access to sleep centers and costs are deterrent factors. These tests are still recommended to be carried out and reviewed by a sleep physician. Delegating this job to untrained personnel is discouraged.
9) Many patients with sleeplessness are obtaining sedatives over the counter without knowing that sedatives can worsen certain sleep disorders. Lack of sleep specialists and diagnostic centers seem to be a major problem. Absense of sleep related training in medical colleges and lack of post graduate degrees in sleep medicine in India are contributing to the problem. What are the options available for medical students in india to train in sleep medicine?
Sleep fellowships as post graduate training courses are being offered following which a diploma will be issued and students are eligible for certification examinations. This endeavour will help in the growth of sleep medicine in an organized and scientific manner and ensure appropriate patient care.
Sleep Disorders Clinic, Mumbai
Contact No: 022-26053370