Sixty-two years old and weighing 92kg, Chennai-based Sheik Abdul Kader craved a good night’s sleep for 10 long years. Heavy snoring and frequent urination were constant irritants. Worse, while he was recovering from open-heart surgery, he found his lungs so worn out that he could hardly walk—for no apparent clinical reason. It was then that his cardiologist consulted a sleep specialist who diagnosed obstructive sleep apnoea, or OSA, which is characterized by pauses in breathing, often accompanied by snoring.
Three months into treatment for OSA, Kader, who has lost 6kg, now wears a continuous positive airways pressure, or Cpap (a breathing device) at night and sleeps peacefully. He says, “I am now back on my feet as well as to my small business.” However, he will have to use the Cpap device for the rest of his life, says his physician, Suresh Kumar, a consultant in neurology and sleep medicine, Vijaya Health Centre and Fortis Malar Hospital, Chennai.
Illustration by Jayachandran / MINT
A widespread problem
Kader suffers from what is the most common—and rapidly spreading—sleep disorder in the country. “Sleep apnoea is the single largest cause of hypertension, congestive heart failure, angina, stroke and several other conditions,” says Sanjay Manchanda, a sleep consultant at Sir Ganga Ram Hospital, Delhi. On an average, 33% of the world’s population has one of several sleep disorders—there are more than 90 types. Says Dr Manchanda, “As a society, we are sleeping at least 2 hours less, and fast following what the West is doing.” Our health care infrastructure isn’t geared to diagnose, let alone treat, sleep disorders.
A case study
Arun (who only wants his first name to be used) is a 21-year-old finance executive from Chennai who scouted the Internet, while his family turned to religious rituals, to understand his sudden compulsive bouts of sleepiness. “From age 15, I used to get this uncontrollable urge to sleep during the day, but at night I’d get up at 2am or 3 am,” he says.
For years, he struggled to understand what was wrong. Then, while surfing the Web, he found Vijaya Health Centre, where a simple sleep study called polysomnography showed that he was suffering from a sleep disorder called narcolepsy—or excessive daytime sleeping.
Experts such as Dr Kumar and Dr Manchanda are quick to point out that though narcolepsy may not be known to laymen, it’s not so rare—it’s more a matter of under-reporting and poor diagnosis. They fear more people in India could be suffering from this genetic disorder.
Arun has now been prescribed antidepressants and some lifestyle changes. “I take a short nap in the morning before starting work, and one in the afternoon and this has enhanced my productivity,” he says, adding that he feels more in control of his life, though he is not allowed to drive.
Still a mystery
A physiological process that occupies a third of our lifespan, sleep is still little understood. Scientists haven’t quite found a biological function for it. Yet, a lack of it has been linked to everything from psychiatric disorders to weight gain and immune system disruption.
However, a host of recent studies are providing new insight. In July, the journal Science reported that researchers had identified a sleep-promoting factor in the fruit fly. A similar molecule in humans, they say, could help find therapies for sleeplessness, a disorder that is prevalent worldwide.
In the same month, a group of researchers reported in the Proceedings of the National Academy of Sciences, US, that they had identified neurons which are active in the cerebral cortex (also referred to as “grey matter”, responsible for functions such as information processing, memory and consciousness) during slow-wave sleep (deep sleep).
The findings could have implications for the treatment of sleep disorders such as insomnia and “sleep-dependent activities like mood and memory”.
In June, for the first time, researchers from the University of California in Los Angeles reported in Neuroscience Letters that people with sleep apnoea have a tissue loss in certain brain regions which can disrupt memory and thinking.
Sleep is both quantitatively and qualitatively essential for mental and physical health, as the body does a lot of repair work during slumber, says Dr Kumar. So, experts believe that if adults are not sleeping well or not waking up rested, feel fatigue or breathlessness, or have high blood pressure at an early age, they should undergo a sleep study. It can be done either at home (under professional supervision) or at a hospital.
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