Snoring - Sleep
Snoring - Sleep
Sleep Disordered Breathing
Sleep disordered breathing is a spectrum of respiratory events that may occur during sleep in varying degrees of severity. If it occurs due to blockage or obstruction to the breathing passages, it is termed Obstructive Sleep disordered breathing (OSDB).
The factors that determine severity of OSDB are the presence of absence of Hypopnoea (partial cessation of breathing movement) , Apnoea (complete cessation of breathing movement) or Arousals (waking up episodes). Depending on the severity, the various manifestations are
- Snoring: Increased upper airway resistance, not associated with apnoea , hypopnoea or arousals. Read about more Snoring.
- UARS: Increased upper airway resistance that leads to arousal, sleep fragmentation and excessive day time somnolence.
- OSA: Obstructive sleep apnea (OSA) is a common disorder of sleep disordered breathing which is characterized by repetitive episodes of complete (Apnoea) or partial (Hypopnoea) obstruction of upper airway during sleep resulting in lower blood oxygen saturation. It is commonly accompanied with snoring. Read more about OSA.
The terms obstructive sleep apnea syndrome or obstructive sleep apnea–hypopnea syndrome are used to refer to OSA when it is associated with symptoms during the daytime (e.g. excessive daytime sleepiness, decreased cognitive functions). Individuals who generally sleep alone are often unaware of the condition, without a regular bed-partner to notice and make them aware of the signs.
- Obesity hypoventilation syndrome:-Day time respiratory failure (the carbon dioxide level is very raised and the oxygen levels drop significantly) in obese patients (BMI >30 kg/m) in absence of upper airway obstruction.
How do you know if you suffer from OSDB ?
We use a simple scoring system as a screening tool to assess if you might have SDB. Take a look at this Epworth Sleepiness Score. This could give you an idea if you are suffering from SDB. If you have any doubt at all, please seek a consultation with us and our ENT specialist and sleep specialist will assist you.
How do we diagnose OSDB ?
Our team of doctors will take a thorough history to understand your problem and its severity. If possible, observations of the bed partner will also be helpful. We will carry out a thorough examination of head, neck, nose and throat.
As the obstruction may occur at one or more of the sites along the upper airway passages such as the nasal cavity, nasopharynx (behind the nose) , oropharynx (upper throat), hypopharynx (lower throat) , and larynx ( area of the voice box), it is likely we will advise a flexible endoscopic examination of the nose and throat. This is a simple and routine endoscopic examination performed in the clinic itself to allow a full examination of all these areas in one sitting and thus assess the patency of your airway.
The other very important diagnostic test is an overnight sleep study or polysomnogram (PSG). This test allows us to document the presence of and assess the severity of SDB. Read more about PSG here. We often take the opinion of our colleague Sleep Specialist Physician to help you decide on best possible options and solutions for your particular problem.
Treatment Options for OSDB
As the condition is multi-factorial and of varying severity, so are the treatment options, and these will need to be tailored to each individual. Our team of doctors will take in to consideration all the findings from your evaluation and of all the tests , to discuss the various options suitable for each person , and help you and your partner decide the way forward.
The options include:
Avoid Alcohol and sedation
CPAP / BiPAP
CPAP is considered the treatment of choice for certain patients with OSA, like those with moderate to severe OSA. This involves fitting the patient with a mask and titrate the correct air pressure needed to alleviate the respiratory events. The benefit assessment and titration is often done as part of the sleep study. Read more about here.
In some situations of snoring or mild OSA, we the doctor may discuss the option of wearing a Mandibular Advancement Device / Splint. Again , this will be decided based on the individual persons evaluation.
Surgery for SDB
For some patients, there are surgical options for snoring and sleep disordered breathing / obstructive sleep apnoea. Each person has to be assessed on his / her individual situation to help them decide if surgery is n appropriate option , what type of procedure or combination of procedures could be considered and what results to expect. Read more about it here.