OBSTRUCTIVE SLEEP APNEA (OSA): TREATMENT

OBSTRUCTIVE SLEEP APNEA (OSA): TREATMENT

OSA is the most common type of sleep apnea. Around 15-20% of adults experience OSA and it is associated with being overweight, older age groups, smokers, rhinitis, pharyngeal reflux and in males. During sleep, our muscle tone relaxes and the airway lumen diminishes which requires more respiratory effort. This increase in respiratory effort results in negative airway pressure causing the airway soft tissue to flop back and obstruct the airway.

Source: science based medicine.org

Symptoms of OSA

Most common symptoms include snoring and restless sleep with periods of silence (apnea) followed by sudden gasping and even arousal from sleep. This causes poor quality sleep which results in early morning headache, unexplained daytime sleepiness, trouble concentrating, mood changes such as irritability and poor work performance.

There are also heath implications as they are more likely to get hypertension, heart disease, stroke, diabetes and involved in accidents.

Investigations

Important to have a complete examination by an ENT doctor to check BMI, neck circumference, nose and oral cavity to look for any anatomical obstruction by any polyp, septum deviation, tongue or lymphoid tissue.

Sleep study (PolySomnoGram or PSG) is the ‘gold standard’ to diagnose OSA and can be done at home by sleep coordinators who will do a home visit.  Some other parameters which can be measured include heart rate, oxygen saturation, airflow and sleeping position. The Apnoea:Hyponoea Index (AHI) is used to grade the severity of the sleep apnea depending on the number of ‘events’ detected per hour of sleep.

An ‘apnea event’ is defined as complete cessation of airflow for at least 10 seconds while ‘hyponoea event’ is defined as 50% decrease in airflow for at least 10 seconds or 30% decrease in airflow with associated decrease in oxygen saturation or an arousal from sleep.

Treatment options

  • Lifestyle modification such as losing weight and gentle regular exercise (read “How much exercise should we need daily?”)
  • Avoid stimulants such as caffeine, alcohol or light emitting devices before sleep and observe good sleep habits (read “Sleep Disorders”)
  • Treat any nasal symptoms such as allergic rhinitis
  • Surgery such as Adenotonsillectomy or Cautery Assisted Palatal Stiffening Operation (CAPSO) or mandibular advancement procedure may be helpful
  • Continuous Positive Airway Pressure (CPAP) device

Download Teleme’s mobile app to find an ENT surgeon near you or ask a Sleep Coordinator about Sleep Apnea.

SLEEP APNEA: HOME EXERCISES

SLEEP APNEA: HOME EXERCISES

In addition to wearing a CPAP mask for sleep apnea, you can also strengthen the muscles around the airways by doing mouth exercises. When practiced for around 30 minutes a day, these simple myofunctional therapy exercises (which involve chewing and swallowing motions as well as specific movements of the tongue) have been found to improve symptoms by:

  • reducing the severity of sleep apnea
  • improving sleep
  • easing snoring

Myofunctional therapy is to re-train the movement of the tongue and orofacial muscles to establish adequate postures. These exercises will strengthen the tongue and muscles which may improve breathing problems, speech and facial growth.

Click below to watch a video on Myofunctional Therapy Exercise

Other recommended exercises which you can also do:

  • Push the tip of your tongue against the roof of your mouth and slide the tongue backward. Repeat 20 times
  • Suck your tongue upward so that the entire tongue lies against the roof of your mouth. Repeat 20 times
  • Force the back of your tongue downward against the floor of your mouth while keeping the tip of your tongue in contact with your bottom front teeth

Source: sleepfoundation.org

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SLEEP APNEA: TESTS & INVESTIGATIONS

SLEEP APNEA: TESTS & INVESTIGATIONS

If you have trouble sleeping, snore or suspect that you have sleep apnea, you can do the following 2 simple steps to:

i) Take a SLEEP APNEA QUIZ to see if you’re at risk.

ii) Talk to your doctor or sleep clinician about how to get a SLEEP APNEA TEST. This can be either an overnight sleep lab test (known as a polysomnography or PSG which needs to be done at a hospital) or a home sleep test (HST).

1) Sleep Lab Test (Polysomnography)

In a sleep lab or at a hospital, sensors will be placed on your body to monitor your sleep. With your permission, staff may also want to film your sleep study to gain more insight into your sleeping behaviour. This is to assess for unusual movements in your sleep (like sleep talking or walking) and for night-time seizures. You will need to stay overnight at the hospital for this test.

2) Home Sleep Test

A home sleep test (HST) is similar to a sleep lab test but with the convenience of being in your own home. Before a home sleep study night, a sleep clinician will show you how to apply the sensors & monitors and also how to use the recording device during the night. When you wake up in the morning, you can remove the sensors and return the recording device to the sleep clinician.

ResMed’s ApneaLink™ Air home sleep testing device includes a chest belt, nasal cannula, oximeter and recording device, which can detect apneas, hypopneas, flow limitation, snoring, blood oxygen saturation and breathing patterns during your sleep.

Results

The following aspects of sleep evaluation may be measured during your test:

  • Sleep efficiency: These results quantify the total number of minutes a person sleeps during a sleep study divided by the total amount of time they were recorded sleeping. The higher the sleep efficiency, the higher the percentage of sleep time versus awake time
  • Apnea Hypopnea Index (AHI): This looks at how often a person experiences sleep apnea and hypopnea (partial obstruction). More than five episodes of either is considered an abnormal AHI in adults
  • Oxygen Desaturation Index (ODI): This refers to the number of times a person’s oxygen level drops while they’re asleep. Oxygen levels above 90% are considered normal
  • Heart rate: In general, a normal heart rate is between 60 and 100 beats per minute (BPM)

After your sleep study, you can discuss the treatment options with your doctor or sleep clinician.  Treatment of sleep apnea can lead to an improved well-being and help alleviate these symptoms:

  • Loud snoring
  • Lack of energy during the day
  • Daytime sleepiness
  • Morning headaches

Download Teleme’s mobile app to find an ENT surgeon near you or ask a Sleep Coordinator about a Home Sleep Test.

SLEEP: HOW TO GET A GOOD NIGHT’S SLEEP

SLEEP: HOW TO GET A GOOD NIGHT’S SLEEP

Getting a good night’s sleep requires more than just going to bed on time. Try the following sleep tips to give yourself the best chance of getting consistent, quality sleep each night.

  • Allocate enough time for sleep. Sleep is just as important as diet and exercise so it is important to allocate the right amount of time in your day for sleep and plan the rest of your schedule accordingly. Getting a good night’s sleep means 7–8 hours each night for adults (including older adults), 9–10 hours for teenagers, at least 10 hours for school-aged children and 11–12 hours for preschool-aged children.
  • Create a consistent sleep routine. As creatures of habit, we are usually more successful when following a routine. Sleep is no different. From your pre-sleep ritual to going to bed and waking up at the same time, you will find that consistency makes it easier for you to fall asleep.
  • Create a comfortable sleep environment. Make sure your bedroom is quiet and comfortable – especially your bed. It may take some experimenting on your part but finding a comfortable bed and pillow is invaluable. We spend one-third of our lives in bed so don’t compromise on comfort.
  • Turn off all light emitting gadgets at least 30 minutes before bedtime. Whether it’s television, reading, email or texting, give yourself a nice window of time to unwind and relax before sleep. Television and bright lights also suppress melatonin production thereby making it more difficult to fall asleep.

If you feel like you’re doing everything you can to get a good night’s sleep but no longer have the energy to do the things you love, you may have sleep apnea which affects three in 10 men and nearly two in 10 women. Talk to your ENT surgeon or Sleep Coordinator about your sleep issues.

Download Teleme’s mobile app and ask a Sleep Home Medical Appliance Coordinator about Sleep Apnea                        

NASOPHARYNGEAL CANCER

NASOPHARYNGEAL CANCER

Nasopharyngeal cancer (also known as NPC) is when a tumour develops in the lining of the nasopharynx which is the area of the upper part of the throat behind the nose. NPC is quite common accounting for around 5% of all cancers in Malaysia. It can start at the age of 35 years with a peak incidence of around 50-60 years.

Main Causes of Oral Cancers are:

  • Genetic (common in Southern Chinese)
  • Family history
  • Smoking
  • Salted fish or preserved vegetables
  • Wood dust or industrial fumes (formaldehyde)
  • Epstein-Barr Virus

Symptoms & Signs of NPC

  • Tinnitus which is a buzzing sound in one ear (early sign)
  • Decreased hearing in one ear
  • Blocked or recurrent infection in one ear
  • Blocked or congested nose
  • Swollen gland in the neck
  • Recurrent nose bleeds
  • Headache or double vision (late sign)

CT, MRI & PET Scans helps to localise the NPC to help doctors plan treatment.

Treatment of NPC

Nasopharyngeal cancer is treated by a team of doctors and health professionals which include the ENT surgeon, Dietician and Oncologist. Treatment requires:

  • Intensive Modulated Radiotherapy (IMRT)
  • Concurrent Chemo-Radiotherapy
  • Neck dissection or Naso-pharyngectomy surgery (required if chemo-radiotherapy fails)
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