Obstructive Sleep Apnoea. OSA

This article is not for my friends who have Obstructive Sleep Apnoea, who will never seek help, because they do not know they have OSA.

 

This article is for my friends who have a tough time sleeping next to someone who snores. Snoring is a symptom of a potentially dangerous medical condition called Obstructive Sleep Apnoea. It may be the first or only symptom , OSA.  You may be a spouse, a parent, a child , a neighbour, a room mate at a conference, anywhere, even a co-passenger on a plane, train or bus.  If you care about a person who snores, do read this . You may well be the only person who can save them from any of the following unfortunate and preventable events, as they are at risk.

1. Dying Quietly in their sleep

2. Suffering a stroke in their sleep

3. Having a heart attack in their sleep.

All 3 have 3 words in common ” in their SLEEP.”

I was due for a medical check up that I had skillfully dodged. I absolutely hate going to doctors because I am happy to bungle along and self medicate. Sometimes The Psalm, will drag his reluctant wife to a doctor. I dread going with him, because he will tell them about every wart and pimple I have ever had, my unhealthy lifestyle, my erratic sleep pattern and any other carefully guarded medical secret I may have tried to keep, numbered as long as a Big Basket grocery list.

We are like chalk and cheese.

The Psalm will read up the Differential Diagnosis about his condition, as if he is doing a University exam, before he goes to a doctor. He would have checked out the doctor extensively and he will tell his doctor everything. Coming from a research background, everything has to be evidence based. Given a diagnosis he will go back and read everything again in black and white and in colour. He will do all the tests suggested and he will go back to discuss them with his doctor. He will do everything the doctor tells him to do exactly the way the doctor tells him to do. If a doctor tells him to rub an ointment up and down, he will never ever rub the same ointment from left to right.

I do not do any one ,or all of the above. I go to a doctor only when I am dying or in unbearable pain. Or when drugged and dragged. I will listen to the doctor and I will do what I think I should do or can do.  There are parts of my body I will show anyone if I am conscious, or if I can help it.  Dr. Prabha Jairaj, the Obs/Gyn professor who trained us during my DGO days knows my views on that . I once told her to forget what she had just seen.  I have decided to go down with whatever I have, if I can and if I am allowed to.

We were going to Chennai for Xmas with the family. I thought I was safe . I was absolutely sure that he would never get an appointment at such short notice in the week between Christmas and the New Year.  He managed to get priority consults with Dr. Supraja the Pulmonologist and Dr. Ajith the Cardiologist at the MMM Hospital on the 31st of December. I could think of a zillion other things we could have done on New Year’s Eve.

Dr. Supraja is truly a delight to the eye in her crisp cotton saree, bright eyes and cheerful smile. We got on like a house on fire and we were laughing and joking like old friends. After she asked me some pertinent questions about my cough and allergies, she pushed her chair back to examine me.

“Doc, “ said this voice from the back , “Doc, she snores” said The Psalm in his attractive baritone.

I couldn’t believe my ears . The man was complaining about his wife’s snoring. I whipped around in horror at the blatant betrayal. The Psalm was studiously avoiding my pointed look. I turned back to laugh it off with my sweet  doctor and I was shocked to see the transformation. Gone was the friendly doctor . In her place sat a well trained thoughtful Pulmonologist with her diagnostic antennae up, looking as if she had just picked up a vital clue to a very serious condition.

“ She snores? “ she asked in a hushed voice.

“ Yes Doc , she snores “ said the Psalm nodding his head, woefully. “She snores, Doc . Loudly and Noisily. ”

“Does she have apnoeic spells when it appears as if she isn’t breathing ? “ enquired Dr. Supraja.

“Yes , Doc,” he whispered. ” She stops breathing for while. Then she startles herself and starts breathing and snoring again.”

“After I wake up with her snoring, I sit up all night looking at her to see if she is breathing. ” Implying that I never let him a good night’s sleep. The doctor looked at him sympathetically with a look that suggested “Oh you poor man “.

And here was I thinking that the man was gazing at me with adoringly after 47 years of marriage. He was watching to see if I was breathing! How unromantic is that ? How clinical ?

After that my husband and my Doctor continued to talk about me and my unladylike snoring as if I was not in the room.  Don’t mind me, I thought to myself.  Be my guest.  Keep going. Hello. I’m still in the room.

“She doesn’t sleep at night , Doc” he continued. ” I’m terrified Doc. I am terrified that she will stop  breathing altogether”

To cut a long and embarrassing story short , they came to the conclusion that I had symptoms of OSA. Obstructive Sleep Apnoea because of the following reasons.

1. I snore loudly and noisily with intermittent spells of deadly quiet.

2. During these quiet spells that alternate with my noisy snores,  I don’t appear to be breathing.

3, I do not feel refreshed when I wake up in the morning. I am not bright eyed and bushy tailed.

4. I wake up with a headache.

5. I am tired before I even start the day.

6. My throat and mouth are dry and horrible when I wake up,  because I sleep and snore with my mouth open.

7. I fall asleep when I watch TV, when I sit in a car or when bored. Basically whenever I am stationary and this could be in the middle of a scintillating conversation.

8. Horror of horrors, I fall asleep in church and I snore through the sermon. I have to be nudged awake before the congregation identifies the pew that snores.

Dr Supraja then explained to me that when people sleep, their muscles relax intermittently and block their airway during sleep. “When this happens in chubby people with thick necks this is worse” she said looking looking at my nonexistent neck. “When air passes through a narrowed passage way, it causes turbulence and snoring. Sometimes the relaxed tongue can fall back and obstruct the airway completely, causing death.”

In someone with Obstructive Sleep Apnoea, the quantum of air that reaches the lung is decreased.  The exchange of gases in the lungs is compromised. The blood to all the organs of the body including the brain and heart contains reduced oxygen. Long spells of repetitive hypoxia or low levels of oxygen, damages the organ. If it the drop critical and reaches dangerous levels, it can cause a stroke, a heart attack or death during sleep.

I brightened up.  “Dying in sleep is an answer to  prayer, Doc”,  I chirped up. With my luck, I would be waiting at the airport when my ship came in and I would be waiting at the harbour when my plane flew in. I  knew in my case, given my luck, it may not be death in sleep.  It could be a stroke or a heart attack , when I lingered, anchored to a hospital bed and dependent on another human being for every body function, including change of diapers. That would kill me.

” We’ll do the sleep study” I said, sitting upright. ‘We can now do sleep studies at home” Dr. Supraja said. “No need for admission to a hospital or a Sleep Lab.” That was good, I thought to myself.  The Psalm could have them with me. He snored too. The only difference was that I did not go around telling strangers that he did.

The test was arranged and we were strapped to machines that recorded a battery of tests, including the length of time we snored, stopped breathing, our heart rate and the oxygen saturation in our blood throughout the sleep studies that lasted 8 hours.  The whole examination was graded on a scale to be scanned by Dr. Supraja the next day.

We sat opposite her poised at the edge of our chairs, like a couple of medical students awaiting our exam results. My score was worse than The Psalm’s.

The Psalm was advised to sleep on his side and prop his head up with 2 pillows. I was assigned to be the reluctant owner of a CPAP machine . When I heard the price of the portable machine machine that I could carry around the world with me in my hand luggage, I nearly stopped breathing. The Psalm looked relieved that we were not swiping the card for identical machines with identical prices on the same identical night.

I now go to be bed with air plumbing . A machine with a memory lives by my bedside. When switched on, it blows air into a long plastic tube connected to 2 nose cushions, pushing a gentle breeze into my nostrils.   This ensures  that my air passages are kept patent allowing air to  pass through noiselessly with no turbulence or snoring.  The oxygen saturation is never allowed to drop to dangerous and critical levels. My organs after years of oxygen deprivation now float buoyantly within me. The Psalm, lying on his side, propped up on 2 pillows and  looking down at me, says that I sleep like a baby.  He is delighted that he too gets a good night’s sleep.

I have taken you to our nuptial bed and laid bare our sleeping habits because I have taken up a crusade to spread awareness of a potentially medical condition , Obstructive Sleep Apnoea.  If reading this reminds you of someone’s loud and noisy swelling, tie them up and take them to a Pulmonologist, even if they fight and bite and scratch all the way. If you get someone as good as Dr. Supraja , you are blessed.

You may well be The Psalm in their life. The Good Samaritan who prevented the progression of  OSA and the dreaded sequelae of its neglect in mine.

The person who has OSA will never seek help for snoring.

 

 

 

 

 

 

 

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