Snoring and Sleep Apnea

Don’t take snoring lightly! It can be the sign of an underlying serious disease!

Why do we snore?

  • Snoring is the loud sound produced by a person while sleeping.
  • It is caused when the air passage vibrates: this includes the palate, the uvula, the walls of the throat and the back of the tongue, as the tissues relax and become loose during sleep
  • One more reason is if there is turbulence in the nasal passages when air passes through them due to septal deviation, polyps, congestion of the nose from allergies, sinus disease, etc,
  • Enlarged Tonsils and adenoids are a major cause of snoring and mouth breathing in children
  • It can be loud enough to create a nuisance in public places and transport, disturb the sleep of the spouse and partner. It can be embarrassing for the snorer.
  • Snoring should be taken seriously. It is not healthy, neither is it funny. It could be the sign of a serious disease!
  • Sleep apnea increases the risk of high blood pressure, diabetes, weight gain
  • Silent heart attacks can occur early in the morning due to sleep apnea

Sleep Apnea

What do you mean by Sleep Apnea?

  • Apnea means a sudden stoppage of breathing
  • During sleep the airway collapses and shuts down completely as above. At this point the breathing stops. This is known as sleep apnea.
  • After a few seconds the brain realizes that the oxygen levels are falling and it sends signals to the chest and abdomen to start moving to force the airway open. This produces a sudden snorting sound and the patient is awakened. However the patient may not be aware of this.
  • If this happens more than 5 times in an hour at night it is not healthy.
  • It hampers normal sleep cycle and the patient does not get proper 3 levels of sleep or REM sleep

How do we diagnosis sleep Apnea?

Proper History taking

  • The symptoms of sleep apnea are not feeling fresh on waking up, dryness of mouth, headache
  • Sleepiness during the day. Some patients can fall asleep suddenly while driving, reading, sitting comfortably, watching television. This can be dangerous
  • Lack of alertness determined by special tests
  • Frequent visits to the toilet at night
  • Weight gain in spite of following weight loss measures. This is a vicious cycle. Sleep apnea makes losing weight difficult. Being overweight makes belly fat more and tissues in the mouth loose which worsens the condition.

Polysomnography or sleep study

This is a study of changes occuring in the body during sleep

  • It can be done at home. Various channels are attached to the body as above, and recording is done of changes in the body during sleep overnight
  • It is simple and does not restrict sleep position or regular bedtime habits

Drug induced sleep endoscopy or DISE:


It is a short stay procedure done with a shot of anesthesia to make the patient sleep like normal sleep. Once the snoring starts, the flexible endoscope is inserted through the nose and recording of the changes in the airway during sleep can be seen. Fluttering of the palate, narrowing of the airway and different changes are recorded during sleep

Treatment of Sleep Apnea

CPAP machine: The primary treatment is the Continuous positive airway pressure machine or the CPAP machine

  • It blows air in the airway keeping it open during sleep . This stops it from collapsing and stopping the breathing. This significantly reduces the apnea
  • It is not addictive or does not cause damage to the body as commonly believed
  • It requires some time to get used to. A variety of masks are available and humidifiers are there to help the patient be more comfortable

Surgery

Surgery helps in opening the airway and improving the breathing. It prevents collapse.

It is avoided in overweight people . Types of surgery are

  • Nasal surgery-septal , sinus and turbinate surgery to improve the airflow through the nose
  • palatoplasty
  • hyoid suspension and resection of the epiglottis
  • tongue base resection
  • tonsil and adenoid surgery in young children immediately relieves their problems. They can have weight gain, bed wetting and poor performance at school

Tongue holding devices and mandible repositoning devices also help. These are simple solutions.

Please consult your doctor for proper treatment and advice. The views on the website are for information only.

March 3: World Hearing Day: Take better care of your ears!

So a lot of patients come to me for ENT disorders, especially for ear problems,blocked ears, earache, wax removal, etc. I’ve seen a lot of patients try to treat themselves before they come to me. It makes things difficult.

What is ear wax?

Wax is a natural secretion of the body produced by special glands in the ear. It helps in removing any dirt, insects or foreign bodies in the ear. Wax naturally comes out on it’s own. However, for certain patients, if the wax is too hard or the ear canal is too twisted and narrow, the wax accumulates over a period of time. This can cause pain or blockage of the ear with difficulty in hearing. In that case it is advisable to visit your ENT specialist to get it cleaned.

Don’t use ear buds! They can push the wax inside. This makes it difficult to remove. You can damage your ear drum and hearing. If you get a nasty scratch in your ear canal it can get infected , or become a hair follicle infection which is extremely painful. In patients of diabetes it can even affect the surrounding structures and bones of the skull, a condition called skull base osteomyelitis, commonly called malignant otitis externa, which is a very serious condition difficult to treat. And sometimes the packed wax becomes so hard that it is painful to remove without giving general anaesthesia.

Don’t put warm oil in your ears, or ear drops without proper examination by your ENT specialist!

And don’t pour chemicals or hydrogen peroxide.

This can lead to painful difficult to treat fungal infections.

If you suddenly have symptoms of hearing loss, pain, ringing sounds in your ear, sudden dizziness with vomiting, please consult your ENT specialist urgently. Sudden hearing loss has a good chance of being reversed if detected early.

Children with hearing problems, colds should visit their specialists and be treated early.

For proper care, visit your ENT specialist

Sleep Disorders and Sleep Apnea

Image result for sleep stock image

Sleep is one thing which no one can deny. Everyone needs sleep. Minimum 7-9 hours sleep is required for Adults. However, in today’s fast paced life, people are losing out on adequate sleep. The corporate lifestyle, targets, deadlines, meeting, presentations, all have taken a toll on our sleep hours. Not to mention electronic devices, social media, mobile phones which provide an unlimited source of entertainment cut in our sleep hours too. Sleep is being neglected which is not healthy.

Sleep is a phase of our body for resting the body. It is an essential phase for the body clock or circadian rythm tp function normally. This body clock regulates secretion of certain hormones and certain physiological processes. Growth hormone is secreted maximum during sleep. It is a very important hormone since it helps in tissue repair, delaying the aging process and in injuries. So beauty sleep is a genuine thing.

The body clock is subject to light and dark changes throughout the day. This all is affected by artificial lighting, especially mobile screens, laptops and television. The exposure of light delays our sleep.

Image result for sleeping beauty stock
Image result for kumbhkaran sleeping stock

Ancient myths and fairy tales have recognized the importance of sleep. Sleeping beauty, who had to sleep for hundred years. And in Indian mythology, Kumbhakarna was cursed with six months of sleep, on the condition that if he was awakened that would lead to his early death.

In a way, this condition is true for everyone. Lack of sleep is hazardous to our life and we do not realize this.

If we do not get proper sleep we increase the risk of heart disease , blood pressure, weight gain, diabetes.

So we can see how important sleep is in our life.

Next: Sleep disorders

Take off Those Headphones!

Be careful.

Nowadays it,s common for everyone to be using headphones, even commuters, to listen to music, watch tiktok videos, but we don’t realise the hazards of them

Headphones, especially noise cancellation headphones make us unaware of our surroundings. They’re appropriate for sitting comfortably and safe in flights and on buses, trains,etc, but if you’re walking on the road you’re totally cut off. You don’t realize what is happening around you, especially while crossing the road. In the past few years, the incidence of road traffic accidents has tripled due to the use of headphones.

Headphones can cause sensorineural hearing loss. Don’t listen to loud volumes for long periods of time. Heed the permitted levels set by mobile phones

Take care of your ears!

Our ears are very important to us. We Listen with them. They help us in communicating with others, various sounds in the surroundings around us. Ears help us to hear when danger is approaching , so we can get to safety quickly, especially while crossing a busy road.

Nowadays ears are important to us with the onset of smartphones and music. We use our ears for relaxation and entertainment.

However, As much as people take care of their eyes, we do not bother about our ears. We listen to loud sounds in public or with headphones, we attempt to clean our ears on our own, put oil and various substances in the ears.

Common problems of the ears:

Image result for earwax stock images

Wax: Wax is formed naturally in the ear by glands similar to oil glands in the skin. It is a mechanism of protection from dirt, foreign bodies and pollutants.

Wax naturally comes out. It is not required to clean it on your own.

Sometimes wax accumulates in the ear canal and causes deafness, pain and sometimes dizziness. This is normal for some people who have a narrow or twisted ear canal. Sometimes the wax itself is hard. It’s just a tendency for wax to collect for some people. They should not attempt to clean it on their own as this could lead to complications but to consult their local ENT doctor

Fungus: In case of damp weather, or moisture or instillation of oil or ear drops or self medication, fungus grows in the ear. This fungus is similar to the mold found on stale bread and food.

It can cause pain, blocking of ear and discharge.

Fungus can be removed by your doctor by syringing or under the microscope. Sometimes you may need 2 or more visits to the doctor to clean up your ear as fungus tends to grow again.

Image result for insects in ear stock images

Insects: The ear canal is small. Sometimes small insects like ants, cockroaches, spiders, flies, etc can make their way into your ear . The humming of their wings and wriggling can be quite distressing

Cockroach and beetle legs have sharp spines which can scratch.

In that case don’t panic. Don’t pour oil or water or anything in your ear or attempt to pull them out. That can worsen the problem or cause injury.

If they are alive shine a torch light in the ear. Most insects are attracted by light and will come out easily

Maggots: In people with poor hygiene, terminally ill patients, sometimes flies enter the ear and lay eggs.

The maggots which hatch can cause pain and irritation. They can be removed by proper treatment

Consult your doctor immediately

Pus from the ear: This happens for people with colds, when the cold reaches the space behind the ears. With proper medicines it should clear up. Always consult your doctor, especially for small children

Image result for foreign bodies in ear stock images

Foreign bodies; This is common in small children, mentally retarded people, etc Common things are:

  • Seeds of fruits, like dry peas, peanut, tamarind seeds, wheat, riceetc
  • rubbers, pen, pencil, stones
  • small toys, thermacol, etc
  • Beads and decorative jewellery
  • The deadliest are small button cells of battery operated toys. The alkali in them can eat away tissue and bone and create a nasty situation.
  • Adults commonly have cotton, sticks, etc in their ears.

Sometimes inert non living foreign bodies can sit in the ear for years together without harm and are discovered incidentally

Image result for deafness stock images

Deafness: There are a lot of reasons for deafness. wax, colds, etc

Consult your doctor immediately if you have sudden loss of hearing. Medication helps in cases of nerve deafness.

Dizziness and Tinnitus: There are various reasons for this which your doctor will help you.

Image result for vertigo stock images

Here are some Do’s and don’ts about the ears:

Don’t

  • Pour oil inside your ears. It’s a common traditional custom to put oil in your ears, one of grandma’s remedies. However, the oil will sit in a nook or corner in the ear canal and get infected with fungus, which takes a long time to treat.
  • Insert ear buds inside your ears. People use keys, matchsticks, hairpins which are equally bad. You can damage your ear drum, hearing mechanism and go deaf. You can get a nasty boil in the ear canal which is extremely painful. In diabetic patients with uncontrolled sugar this can spread to the skull bones and can be fatal. This condition is known as Skull Base Osteomyelitis, formerly Malignant Otitis Externa
  • Listen to loud noises for prolonged periods of time. Sounds around 120 decibels are known to damage the delicate structures in the inner ear and the nerves for hearing.
  • Be aware of your surroundings. While walking in public, on the road don’t keep your headphones on
Illustration of hearing, journey of the sound wave in the ear. The sound wave is captured by the auricle, penetrates in the auditory canal, vibrates the eardrum membrane, which in turn vibrates the ossicles, malleus, incus, stapes). The vibration of the stapes make the fenestra vestibuli membrane vibrate which causes hydraulic waves in the cochlea perilympha, blue), applying pressure on the endolymph inside the cochlea channel, moving the basilar membrane, pink), causing the hair cells to move against the tectorial membrane, producing a nerve impulse in the cochlea nerve fibers, yellow). This nerve impulse moves to the auditory nerve and carries the message to the auditory area of the brain, which analyses the data. (Photo by: BSIP/UIG via Getty Images)

Do

  • Consult your doctor for earache, pus coming from the ear, hearing loss, foreign bodies, giddiness etc.
  • protect your ear from water especially in the rains
  • follow the instructions on use of medicines and follow up regularly

Monsoon woes! Allergies and respiratory illnesses

colds in monsoon
Cough. Closeup Of Beautiful Young Woman Caught Cold Or Flu Illness, Having Sore Throat And Coughing With Hand Near Mouth. Portrait Of Unhealthy Girl In Scarf Feeling Pain In Throat. High Resolution

Monsoon has been very harsh this year. Lot of flooding, Natural disasters, waterlogging, etc. And monsoon leads to diseases, especially vector borne diseases. Monsoon too contributes to the following:

  • Humidity and moisture encourages growth of fungus and dust mites in the house
  • Pollen allergies increase due to flowering of seasonal plants
  • pests like cockroaches and other insects thrive during this season

Diseases like allergies, viral fever, colds, stomach upsets are on the rise in this season.

To prevent progress of these diseases following precautions should be taken:

  • Avoid collection of water in old vessels, tyres, etc
  • Holes and potholes should be filled to prevent breeding of mosquitoes
  • Wear long sleeved clothes and cover yourself to prevent insect bites
  • Sleeping in a mosquito net is the best option
  • Don’t wear wet clothes. Keep a dry pair at your workplace if possible
  • In case of fever immediately contact your doctor
  • Dont eat street food. Avoid eating out as much as possible
  • Don’t travel in case of floods and waterlogging. Waters harbour leptospirosis

The views of the website are solely of the author. Please contact your doctor for further advice.