If you think about it, each of us spends roughly 1/3 of our lives asleep. Imagine that instead of having blissful, restful sleep, we were struggling to breathe during those hours during the night, with our body struggling to even supply itself with enough oxygen! A scary thought indeed.

Sleep apnea is a common, yet very serious condition where a person goes through periods of being unable to breathe for more than 10 seconds, for multiple sessions per night. Did you know that around 15% of Singaporeans suffer from obstructive sleep apnea? This causes their sleep to become extremely fragmented and leads to poor quality of sleep, resulting in lower levels of energy and daytime sleepiness. Beyond that, obstructive sleep apnea is related to a host of physiological problems like metabolic dysfunction and an increased chance of developing cardiovascular issues.

On top of that, the sad truth is that patients suffering from OSA are not the only ones who suffer from a drop in overall quality of life; their partners are severely affected as well. Snoring is often thought to be an individualistic trait and not a medical one. Many partners of those suffering from OSA will often feel disturbed during their sleeping hours and unable to fall asleep due to their partners choking or snoring intermittently during bedtime, which can lead to resentment and ultimately a fractured relationship. Hence, a condition like OSA should not be underestimated – it can have profoundly negative effects on a person’s life, safety and personal relationships.

As an ENT specialist, how do I approach management of OSA?

Being an experienced ENT doctor in Singapore, I usually start with patient education as the most important first step towards helping my patients understand and manage their condition. Once the diagnosis is confirmed, I will refer to what doctors call a disease severity guide to determine whether or not the patient is at a great risk for an adverse outcome. This also helps me create a starting point or baseline where I can measure the effectiveness of all the treatments I prescribe.

I will also ask about my patients sleep & snoring patterns. This is often a tricky subject as some of my patients sleep alone and it will be quite difficult schedule-wise for some of my patients who may not have a partner to track their habits. Questions I will ask them will include ⁽¹⁾:

1. How sleepy they feel (on the Epworth Sleepiness Scale)
2. Total number of hours of sleep per night
3. Presence or severity of headaches
4. Gasping or choking during sleep
5. Prevalence of snoring or intermittent snoring

Once I complete my testing & diagnostic questionnaire, I will share the results of my testing with my patient. Of course, as my patients are largely laymen when it comes to medical facts and figures, I won’t be focusing on that when I conduct my session with them. Instead, I will focus on:

1. Risk factors 
2. Natural history of the disease
3. Consequences they face from having OSA

They will also be counselled on what lifestyle changes they will need to make in order to manage this disease. For patients with OSA, it is imperative that they are warned against driving or operating any dangerous equipment while they might be suffering from daytime sleepiness. They should also be sure to notify any of their other doctors they are seeing that they have OSA, so that their prescriptions or treatments can be altered accordingly to account for the disease.

What are most effective actions I can take as an OSA patient to manage my condition?

Some things I recommend to my patients include simple things like changing their sleeping position from lying flat on their back to sleeping on their sides, in order to open up their airways as much as possible during sleep. Certain medications (e.g. sleeping pills) and alcohol should also be avoided so as to not worsen the existing symptoms of OSA.

However, the most impactful action that many of my OSA patients should take would be to adopt a daily exercise routine and lose weight. Amongst adults who are obese in the United States, up to 45% of them suffer from some degree of OSA. The lifestyle changes I recommend can include a general reduction of calorie intake as well as an exercise regime geared towards cardiovascular health and burning calories. Patients who stuck to this regime for more than 3 months generally reported a significant loss in body fat percentage, a reduction in their apnea-hypopnea index (AHI) and an increase in quality of life. ⁽²⁾

While CPAP machines are the gold standard mechanical treatment geared towards improving airflow, there are many lifestyle changes that my patients can make that will greatly improve their overall prognosis for this disease. It is important that patients do not overly rely on medication and technology as a one-stop method to managing OSA; adopting a healthy lifestyle is often equally or even more important at managing this underreported and dangerous disease.

References

1. http://www.smj.org.sg/article/recognising-sleep-apnoea
   Choon How How, MMed, FCFP, Pon Poh Hsu, MBBS, MD, Kah Leong Alvin Tan, MBChB, MRCS Singapore. Recognising sleep apnoea. Med J 2015; 56(3): 129-132.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/
   Abel Romero-Corral, MD, MSc, Sean M. Caples, DO, Francisco Lopez-Jimenez, MD, MSc, and Virend K. Somers, MD, PhD, FCCP. Interactions Between Obesity and Obstructive Sleep Apnea and Implications for Treatment. Chest. 2010 Mar; 137(3): 711–719.