Losing sleep over OSA

We all probably know someone who snores loudly. But it is important to understand the mechanism of snoring. When you snore, you actually stop breathing for a few seconds and resume on your own.
In severe cases, where this stoppage of breathing extends for much longer (even up to a minute), it is described as Obstructive Sleep Apnea (OSA). In India, about 2.4-3.4 per cent of men and 1-25 of women show a medically significant level of OSA.
OSA almost always disturbs sleep through most of the night, causing the individual to feel tired and listless just after waking up. Reflexes tend to slow down, thus having an adverse impact on your ability to drive a car or work on electrical appliances.
But a more serious impact of sleep deprivation is the development and worsening of chronic diseases, including Diabetes Mellitus, high blood pressure and heart disease.
The connection between OSA and Diabetes Mellitus is somewhat indirect. Sleep disorders of any kind have a similar impact in terms of Diabetes Mellitus. Further, OSA is just one of the causes of Sleep Disorders; there are several others.
The estimated number of Indian people believed to be suffering from OSA is about 34 million, not all of whom are diabetic. On the other hand, WHO South Asia Regional Office (SEARO) has estimated that about 70 million (8.7 per ecnt) Indian people have already developed diabetes.
While these numbers are alarming enough, the scientific explanation for this phenomenon is equally intriguing. What happens is as follows: when you are awake, your body generates certain hormones. These hormones are needed to tackle the myriad physical and psychological challenges that you encounter from morning till night.
These hormones enable our body to remain alert and energetic with extra glucose and oxygen being pumped into the blood. But sleep is the time when your body winds down and recuperates itself.
When you keep awakening from sleep in the middle of the night, cortisol secretion increases and your body has to suddenly return some glucose to the bloodstream. And when you go back to sleep, this mechanism gradually winds down.
However, when this swing happens several times each night, a part of the glucose tends to stay in the blood, instead of being stored in the liver. This is also the reason why medicines for diabetes are less effective in those who sleep badly.
This risk of chronic disease is an important reason why OSA must be treated aggressively through surgery, CPAP (Continuous Positive Air Pressure) or by other means. The form of treatment varies, depending on the cause of OSA.But the therapy of first choice in most cases is CPAP.
CPAP is a technology in which air is pushed into the breathing passages, thus clearing the “obstructive” element in OSA. This ensures that ensures oxygen enters the lungs during breathing, which is then transferred to the blood stream.

(Contributed by
Dr Mithun Bhartia,
Endocrinologist)

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